USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 13
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M ....... .. , D.7
Sept. 7'
Place and Date of Death,
died at
Disease or Cause of Death,}
Pulmonary Tuth Culosis
Duration of sickness,
the year
I certify that the above is true to the best of my knowledge and belief. edge and
Thomas h. Fuiich
... M. D.
Signature and Residence S of Certifying Physicland Wymario Exch, howard, Zucch
Date of Certificate, .
Sept. 8
1899.
* Give also street and number, if any.
t Give sex of infant not named. If still- born, so state. If child died immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
95
Name and Age of Deceased, f
No ...
RETURN OF THE DEATH
OF
at
Date,
189
Filed,
189
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 AND 12.]
SECTION 6. Every householder in whosc house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death oceurs, shall, within five days after tlic date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the elerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he ean state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
1
Rec
FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Milliam It Hout
Sex,
Color,
schite
Date of Death,
September 8 1899; Age, 78 Years, 11
Months, ~. Days.
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, ~~
Occupation,
Retired
*Residence, { If out of town, )
¿ also state fully.
South et Chelmsford Center
Place of Birth,
Barnstead N.H.
*Place of Death,
South Str Chalmisport Center
Name of Father,
James
Hank
Birthplace of Father,
Unknown
Maiden name of Mother,
abbie Stevens
Birthplace of Mother,
Unknown
Place of Interment, (Give name of Cemetery),
Dated at
Lawell mass
Im Manalle.
on
Lepte 8
.189 9
Signature and
place of business
of Undertaker.
33 Prescott it
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and. Date of Death,
Disease or Cause of Death,#
died at
Chelmsford Cent Teplo 9
Tuberculosis.
Duration of sickness,
Between try and three gens
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
George W. Acelor M. D.
Lowell. mant.
Date of Certificate,
Septi Que
1899.
* Give also street and number, if any.
t Give sex of infant not named. If still- born, so state. If child died immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
William It 1 day& Age, 785. 11 10.
No.
RETURN OF THE DEATH
OF
at
Date,
189
.
Filed,
189
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 AND 12.]
SECTION 6. Every householder in whose house a death oecurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death oceurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after sueli death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forthi the required faets.
SECTION 11. In ease the deceased was a soldier who served in the war of the- rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge o:
the physician's certifieatc made in accordance wit
the board of health or to the clerk of the city
Img hade shall obtain
Rec
Commonwealth of glassachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Geneva Florence Dumm Sex,
C
Color,
Date of Death,
Seit 19
1899; Age, 4 Years, 8 Months, 9 Days.
Maiden Name,
or divoreed.
§ If married, widowed }
Husband's Name, ...
Single, Married, Widowed or Divoreed,
Oeeupation,
*Residence, { If out of town, )
¿ also state fully.
Place of Birth,
Sinnene the.
*Place of Death,
Chelmsford
Name of Father,
Leroy Dumm
Birthplace of Father,
Breakford the
Maiden name of Mother,
Gertrude Makenzie
Birthplace of Mother,
Simmens The.
Place of Interment, (Give name of Cemetery),
ChelmoAnd Center
Dated at
Chelmsford
Walter Perhay
on
Salk 19
1899
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Severa Florence Dam Age, 48. 8 M. 9 D.
Place and Date of Death, ¿
died at
Chilisford, September 19the
189.9.
Disease or Cause of Death, §
Ciente Lamprigitíz
Duration of sickness, almar 2%, days
I certify that the above is true to the best of my knowledge and belief.
Odwane It Chambulance
Signature and Residence S
of
Certifying Physician.
Chelmsford:
.M. D.
Date of Certificate,
September 2, 241899.
T
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If ehild died immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Signature and
place of business
of Undertaker.
97
No.
RETURN OF THE DEATH
OF
at
Date,
189.
..
L
Filed,
189
The provisions of chapter 444 of the Acts of 1897 require that every householder in whosc house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred. (Sec section 6.)
The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. (See section 7.) Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
Any person having charge of thic funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
Commonwealth of Massachusetts.
98
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed, 4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
Date
6. Duration of Sickness, . By whom certified, .
7. Residenee,
8. Oeeupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
1. Birthplace of Mother, .
15. Place of Interment, .
North Chelmsford Mars.
Arthur H. Sheldon
DATED at N. Chelmsford. ....... , on Sept. 22nd 1899
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. { If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Jan. 1995. - 5,000.
-
White
Years, ...
4 Months,
4
.Days.
Marasmus
F. E. Varney M.D. North Chelmsford Mars.
North Chelmsford Mais North Chelmsford Mars. Joseph E book
Ellen (Lice) look England England
· Signature of Undertaker or other person making the Return, .
Sept. 22nd
William
look
1899
Male - Single
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician cinployed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and eause of the death, as the elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
gg
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Danno Vieren
Sex, 221 uh Color,
Date of Death,
Sept. 2 3
1899; Age, 30 Years,
.Months,
.Days.
Maiden Name, { If'married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Garmin
*Residence, { If out of town, )
¿ also state fully. §
Just bruins ford-
Place of Birth,
4
*Place of Deatlı,
Name of Father,
Thomasao
Birthplace of Father,
Prefand
Maiden name of Mother,
inlaw of the
Birthplace of Mother,
Place of Interment, (Give name of Cemetery).
SV Jateros Lowell hlaso
Dated at
on
23 of Sept
1899
Signature and
place of business
of Undertaker.
324 Planer St-Joined Was
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age, 33 Y.
M.
D.
Place and Date of Death,
died a fost Christand Self
23
189
Disease or Cause of Death,#
uberculosis
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
Un duro Leau
.M. D.
Date of Certificate,
1899.
Il mas
1
* Give also street and number, if any.
t Give sex of infant not named. If still-born, so state. If child died immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
1
No.
RETURN OF THE DEATH
OF
at
Date,
189
Filed,
189
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 AND 12.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required faets.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he ean state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificato modo in . . 11. frade ansied los centinn 1. to
100
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Color,
Date of Death, Jefl- 24
.. 1899; Age, 14 Years, - Months, - Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,. - Occupation, Ao. Cheersford
* Residence, { If out of town, ) ? also state fully. §
Place of Birth,
*Place of Death,
Name of Father,
Birthplace of Father, England
Maiden name of Mother, Mary J. Facol
Birthplace of Mother, 5 Ireland
Place of Interment, (Give name of Cemetery), Lowell-
Dated at No. Seemsfor
on Sept 21189
Signature and phce of business of Undertaker.
John Larkinf
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,* Unsie Larkin
Age, 14
Date and Place of Death, + - died at
north Chelmsford Sept. 24- 189 9:
Disease or Cause of Death, - ' of (Primary and Secondary.)} Oneumana
Duration of Sickness, -1
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
Date of Certificate, Sell-24=
1899.
* Or Sex of Infant (not named). Jf stillborn so state.
{ If child died immediately after birth so state. Plate. Ed. December, 1896 .- 5,000.
{ If a soldier or sailor who served in the War of the Rebellion.
Sex. Y
No.
RETURN OF THE DEATH
.... .
189.
189
OF
at
Date,
Filed,
Ser 444 of the Acts of 1897 require that every householder in whose house a death occurs, the cent at the time of the death of any of his kindred, or the person in charge of an institution in within five days after the date of such a death, give notice thereof to the board of health or to en which the death occurred. (Sec section 6.) of a vessel shall give notice of the death of any person under his charge to the board of health s town within the Commonwealth at which his vessel first arrives after such death. (Sec section 7.) ocomply with the requirements of seetions 6 and 7, five dollars. (See section 8.) attended a person during his last illness shall forthwith after the death of said person, upon on a certificate setting forth the required faets. (See section 10.)
1. IL. informent, of a human body shall obtain the physician's
Aha linard of
(Sec section 11.)
Eneglect, ten dollars.
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthiwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or; if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hercinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are dellvered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
Commonwealth of Massachusetts.
10/
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, Oct. 15th 1899
2. Name,
(Maiden Name),* (Name of Husband) ,*
Male
3. Sex, and whether single, Married, or Widowed, White
4. Color, ¡
5. Age,
- Years, Months, ... Days. Stillborn
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Siekness, . By whom certified,
F. E Varney M. D.
North Chelmsford Mars.
7. Residence,
8. Oeeupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, . Ireland
15. Place of Interment, Lowell Mass
Signature of Undertaker or other person making the Return, .
Arthur H. Sheldon
DATED atu
A. Chelousford, on October 15th
1899
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Dec., 1896 .- 5,000.
North Chelmsford Mas. North Chelmsford Mars. James N. MCCoy Catherine (Fas) Mc Cor
North Chelmsford Mars,
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, wheu requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a finc not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give botli the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall i ury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in sueh eity or town, from the city or town elerk. No such permit shall be issued until there has been delivered to sueh board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by seetion three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in ease of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the perinit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not execod- ing fifty dollars.
Rec
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
1.
Sex, Which Color.
Date of Death, / 01/12/5
189,9 ; A. ............ Years, . ... .... Months, 3 Days. 13
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
*Residence, If out of town, ) ¿ also state fully. § r
Place of Birth,
*Place of Death,
Name of Father,
Birthplace of Father,
Maiden name of Mother,
Birthplace of Mother,
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