USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 14
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Place of Interment, (Give name of Cemetery),
idet.
Dated at So. Chickenford
Signature and
Walter Perham
on Oct 19
189 9
place of business
of Undertaker.
Chelmsford Mars
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
6 3 mps. 5 mths, 15 ds.
Age, ................ Y.
M.
.D.
Place and Date of Death, #
died at
So. Checkno food, mans, Oct. 19
189.9.
Disease or Cause of Death, §
Chronic Nephritis
Duration of sickness,
About three years.
I certify that the above is true to the best of my knowledge and belief.
Arthur C. Sectora.
M. D.
Signature and Residence S of
Certifying Physician. Chelmsford masa.
Date of Certificate,
Oct. 20
1899.
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. t If child dled immediately after birth, so state.
§ If a Soldler or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
102
1
No.
RETURN OF THE DEATH
OF
at
Date,
189
Filed,.
189
The provisions of chapter 444 of the Acts of 1897 require that 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 elerk of the city or town in which the death occurred. (See 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. (Sec 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 faets. (See section 10.)
Penalty for refusal or negleet, ten dollars. (See section 11.)
-
unaman harring slingeren of the funeral rites preliminary to the interment of a human body shall obtain the physician's
cer L'et:
wirruce with st
10,
corn it, together with
to the board of
health or to we clerk of the city or tov in which death occurred.
103
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,
Mary A. Shouldring
Sex male Color
White.
Date of Death,
1 Oct. 24.
1899; Age, 74
Years,
Months,
Days.
Maiden Name,
or divorced.
Mary & Richardson
Husband's Name,
Oraich & Spa Eding.
Single, Married, Widowed or Divorced,
Sidoned Occupation,
*Residence, {If out of town, )
¿ also state fully. §
Si. Chelmsford Hace.
Place of Birth, Besten 1 Mars.
*Place of Death,
So. Selvford, Mark:
Name of Father,
Zackias Richardson
Birthplace of Father,
Jörnsend Mass.
Maiden name of Mother,
Elige Ficher
Birthplace of Mother,
Batter Mass
Place of Interment, (Give name of Cemetery),
Mark Cond So. Men : ford.
Dated at
Signature and
Daniel P. Bham
on 1. 24
1897.
place of business
of Undertaker.
Ji 6 helmefare Mas
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Mary A. Spaulding
Age, 74 Y.
Place and Date of Death,#
died at
So. Chelmsford Mitun.
Oct. 24, 1899
Disease or Cause of Death, §
Paralysie
Duration of sickness,
About this year.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
J. Lobona
M. D.
Certifying Physician. Leheliafor mar.
Date of Certificate,
(Cet:
189 9 .
Give also street and number, if any.
t Or 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.
No.
RETURN OF THE DEATH
OF
.
at
Date,
189
Filed,
189
The provisions of chapter 444 of the Acts of 1897 require that 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 oceurs, shall, within five days after the date of such a deatlı, give notice thereof to the board of health or to the clerk of the eity or town in which the death occurred. (See 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. (Sec section 7.) Penalty for neglect to comply with the requirements of seetions 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 faets. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
Any person having showen of the funeral rites preliminary to the interment of a human body shall obtain the physician's certificate mado i,
the board of liealth or to u
Ree
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
1 (FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Date of Death,
h, Che8 29th
189 %; Age, 5 Years,
Months,
Days.
Maiden Name,
or divorced.
married, widowed į
Husband's Name,
Single, Married, Widowed or Diyorced,
Occupation,
*Residence, { If out of town, )
Middlesex County Finant Jehove
Place of Birth,
* Place of Death
Alidellescu County quant School
Name of Father,
, Chilile Magnive
Birthplace of Father,
England
Maiden name of Mother,
Birthplace of Mother,
Gottenown
Place of Interment, (Give name of Cemetery),
enelela
Dated at
Lowwell
Signature and
30 th icot
1899
place of business.
of Undertaker.
188athiddleceus8
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Sinon Magnus
Age, /SY. M. D.
Place and Date of Death,
died at
North Chelmsford Oct 29
189.9
Disease or Cause of Death,
Emywifelas
Duration of sickness,
one week
I certify that the above is true to the best of my knowledge and belief.
J. E. Varney
M. D.
Signature and Residence of
North Chelmsford
Certifying Physician.
Date of Certificate,
nor.
20
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.
LOL!
Sex Male Color: White
¿ also state fully. 3.
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 deathi oeeurs, 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 elerk of the eity or town in which the death oceurred.
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 eity or town within the Commonwealthi at whiel his vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of seetions 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 deecased 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 haviny ch?
the physician's certificate made
the board of liealth or +
...... hody shall obtain
Rec
105
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, Veitie
Cartoon
Sex, Female Color,
Date of Death, ...
30Km
1897; Age, /
.Years, .5 Months,
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
*Residence, { If out of town, )
Freut Chelmsford
¿ aiso state fully. §
Place of Birth,
Treat Chelmsford
"Place of Death,
Feel- Cheloneford
Name of Father,
Studions Cartoon
Birthplace of Father,
Javucken-
Maiden name of Mother,
Sofia Cardsin
Birthplace of Mother,
Studen
Place of Interment, (Give name of Cemetery),
Dated at His1 Chelonefrid Signature and
on the 315 5, Oct- 1899
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t nellie Carlson
Age, .. / M. 3 D.
Place and Date of Death, #
died at
West Chilis find Out 30℃
189.9
Disease or Cause of Death, §
Convulsions
Duration of sickness,
two hours
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
F & Varney
M. D.
Certifying Physician.
north Chehurford
Date of Certificate,
Oct. 300
1899.
Give also street and number, if any.
t Or sex of infant not named. If stlli-born, so state. + If child died immediately after birth, so state.
§ If a Soldler or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
No.
RETURN OF THE DEATH
OF
at
Date,
189
.
Filed,
189
.
The provisions of chapter 444 of the Acts of 1897 require that 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 eity or town in which the death occurred. (See 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. (Sec section 7.) Penalty for neglect to comply with the requirements of scetions 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 faets. (See section 10.)
Penalty for refusal or negleet, ten dollars. (See seetion 11.)
. In the interment of a human body shall obtain the physician's in the board of
city
Ree
FORM C.
Commonlocalth 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,
Frank 1. Morny
Sex,
.Color,
Date of Death,
Oct. 30
189 9, Age,
21 Years,
3
Months,
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or DixBreed,
5
Occupation,
(Belinoford Mais
*Residenee, { If out of town, ) ¿ also state fully. ) Lowvale, Mass.
Place of Birth,
*Place of Death,
Palmstora, Mass.
Name of Father,
hromad
Porland
Birthplace of Father,
Maiden name of Mother, Mary Hart
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Irland
St. Patricks Conretory dowell Mass.
Dated at
30 Oct
1899
Signature and
place of business
of Undertaker.
169 Worthen LA Luce Man.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age, 21 Y. 3 M.
D.
Place and Date of Deatlı,
died at
Bul. 20"
1899
Disease or Canse of Death,#
Communication
Duration of sickness,
about me yas
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifylug Physician.
M. D.
Date of Certificate,
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.
Leter of. Savage
on
106
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 thic 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 eity 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 deatlı.
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 can 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 i
the board of health or to th . ( .A {"
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,
Still Born-
Harrington
Sex,
Make Color,
Date of Death,
-Nov 16th
189 9 ; AgeYear ......... Months,
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divoreed, Occupation,
*Residence, { If out of town, ) ¿ also state fully. §
Place of Birth,
West Chelmsford
*Place of Death,
1.
Name of Father,
William Im Harrington
Birthplace of Father,
New Brunswick
Maiden name of Mother,
Khoda Grant-
Birthplace of Mother,
NewBruns wick
Place of Interment, (Give name of Cemetery),
Wat Chelmoland
Dated
Signature and
AL Parkhurst
on Non 16h
189 9
place of business
of Undertaker.
Trust Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death,#
died at
Wed-Chelcasting nor 16h
189.9.
Disease or Cause of Death, §
stillborn
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
J & Varney
M. D.
Signature and Residence S of
Certifying Physician.
Date of Certificate,
For 17
189 9.
Give also street and number, if any.
+ Or 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.
/07
Harringleri
Age,Y. M. D.
No.
RETURN OF THE DEATH
OF
at
Date,
189
...
Filed,
189
. .
The provisions of chapter 444 of the Acts of 1897 require that 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 sueli a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred. (See 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. (Sec 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 faets. (Sec section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's :... ] hu section 1, to the board of
Lec
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Fan Name, Bridget (FILL OUT WITH INK ALL NAMES TO BE IN FULL.)
Sex, .Color,
Date of Death, November2, 189 ; Age, 73 Years,
Months, Days.
Maiden Name, { If married, widowed ) or divoreed. Járchiar
Husband's Name,
Single, Married, Widowed or Divoreed, Oeeupation,
*Residenee, ¿ also state fully. ) ( If out of town, { Standford
Place of Birth, roland
*Place of Death,
Name of Father,
Dielane Lasciar
Birthplace of Father, roland
Maiden name of Mother,
Birthplace of Mother, roland
Place of Interment, (Give name of Cemetery), Lowall
Dated at ...
fremfor
Signature and
William
on
cron, 300
1899
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Bridget Faye
Chelmsford
Age,
13 years.
Date and Place of Death,t - , died at.
Disease or Cause of Death, -
of
Gastritis
(Primary and Secondary.)}
Duration of Sickness,
I certify that the above if true, to the best of my knowledge and belief.
Date of Certificate,
nov. 30
1899
* Or Sex of Infant (not named). If stillborn so state.
t If child died immediately after birth so state. Plate, Ed. December, IS96. - 5,000.
# If a soldier or sailor who served in the War of the Rebellion.
nov. 29.
.899
Signature and Residence of Certifying Physician, ... Umasat Toward
108
-
..
189
189.
OF
No
RETURN OF THE DEATH
at
Date,
Filed,
:4 of the Acts of 1897 require that every householder in whose house a death occurs, the t the time of the death of any of his kindred, or the person in charge of an institution in five days after the date of such a death, give notice thereof to the board of health or to ich the death occurred. (Sec section 6.)
vessel shall give notice of the death of any person under his charge to the board of health within the Commonwealth at which his vessel first arrives after such death. (Sec section 7.) y with the requirements of sections 6 and 7, five dollars. (Sec section 8.) 'd a person during his last illness shall forthwith after the death of said person, upon certificate setting forth the required facts.
(See section 10.)
+ t, ten dollars. (See section 11.) the funereal rites preliminary to the interment of a human body shall obtain the physician's section 10. and return it torather with the facts required by section 1. to the board of
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 belicf, the name of the deecased, his age, the disease of which li died, the duration of his last siekness, 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 physiciau 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 sueh certificate he shall forfeit to the treasurer the sum of teu 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 towu 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 sueli 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 employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make snch 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 certifieatc are delivered to the board of health or to its agent, the board or agent shall fortli- with countersign and transmit the samc 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.
Rec
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town In which the death occurred.
Name,
Sarah hima.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death,
Dec y
1899; Age,
65
Years
Months,
18
Days.
Maiden Name, { If married, widowed )
or divorced.
married, boramen skill.
Husband's Name,
John Thomas.
Single, Married, Widowed or Divorced, ...
imarried
Occupation,
*Residence,
{ if out of town, }
( also state fully )
Place of Birth,
England
* Place of Death,
fritto Chelmsford.
Name of Father,
Birthplace of Father,
England.
Maiden Name of Mother,
Caram.
Birthplace of Mother,
England
Place of Interment, (Give name of Cemetery),
Edson.
Dated at
Lowall
Signature and
&M. Jeg & Co
011 Decy
place of business
of Undertaker.
33 Prescott Sr
PHYSICIAN'S CERTIFICATE.
Sarah Thomas
Age,
6.5.8. 4 × 18
D.
Place and Date of Death,
died at
1 ponto Chelmsford Dec7. 899.
Disease or Cause of Death, #
Typhoid Fever
Duration of sickness,
three week
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
S
JE Varney
M. D.
of
north Chelmsford
Certifying Physician.
Date of Certificate
Dec 8h
1899
* Give also street and number, if any.
t Give sex of infant not named. If stlii-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.
100
Name and Age of Deceasedt
1899
Sex,
Vemall Color,
storto Chelms ford.
No.
RETURN OF THE DEATH.
OF
at
Date,
I
Filed,
I
Acts of 1897, Chapter 4444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, II 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. f
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 IO. A physician who has attended a person during his last illness shall forthiwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION II. 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 can state the same. ; Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rite's preliminary to the interment of a h shall oh+iin the physician's certificate made in accordance with section Io, and return it, together with the facts : mired by section r, to the board of health or to the clerk of the city lor town in which the death occurred.
Rec
110
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,
Charles Lealvin Ward
Sex,
M.
..... Color,
Mr.
Date of Death,
December 9
1897 ; Age,
64 Years,
/ ____ Months,
0
Days.
Maiden Name, { If married, widowed } or divoreed.
Husband's Name,
Single, Married, Widowed or Divorced,
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