USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 4
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SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until lie 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 elerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the casc 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 thercof 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 healthi 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 delivered to the board of health orto its agent, the board or agent shall forth- with countersign and transinit 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 deatlı, 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.
Rec
Commonwealth of Massachusetts. -
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
the fardette)
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
Years,. ~ Months, 5 Days.
hemorrhage of iowaly
Three days
6. {Duration of Sickness, . By whom certified,
M. Richards, MD, Lowell
7. Residence,
8. Occupation, .
-K- Obcewar Ford
9. Place of Death, .
10. Place of Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name),
.
Sarah (Coce)
13. Birthplace of Father, . Canada
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Tadlance Gandede
DATED at ....
Screens ford, o
way 10 189
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. September, 1892 .- 5,000.
......
7. 1
.
Disease or Cause of Death, (Primary and Secondary),
A Cheers ford dectance
Ganada
/ 0
May 9-1548
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, 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. If a physician neglects or refuses to make a certificate, as aforesaid, 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 ean 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 eity or town or remove therefrom the body of a deceased person 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 eity or town clerk. No sueh permit shall be issued until there has been delivered to such board, or agent or clerk, as the ease 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 such certificate as is required of the attending physician ; and in ease of death by violence the medieal 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 forthwith 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 exceeding fifty dollars.
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must, make this return before the burial or removal of the deceased.
Date of Death
Mary 10 th
1898
Name,
Gladhad Johan
Maiden Name.
Sex,
Amale; Color,
Single, Married or Widowed,
Name of Attending Physician,
DI lefais
Age,
/
years,
1
months,
days.
Residence of Deceased-No.
Chelmsford
Street (or-Corporation), Ward-
Occupation,
Husband's Name,
Place of Death-No.
Chelmsford
Street (or Corporation), Ward
Samell Mich
Birthplace of Deceased, Edward & Sahan
Father's Birthplace, Ali Signatur
Mother's Nam
Isabella
4.1 ..
F !
Mother's Birthplace,
Mother's Maiden Name, On 01
Place of Interment,
Cemetery, Range
,
Lot
Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this.
10 Th
day of
May
. 189
Physician's Certificate of the Cause of Death. (SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death
may
10
1898
Name and Sex of Deceased,
Gladys
Jahan
Female.
Place of Death-No.
Street (or Corporation).
Disease or Cause of Death,
Burn
(When the child is still-born, so specify.)
duration of*
3 days
Complications,
Convulsions
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
Chelmsford
Street,
Dated at Lowell, this
day of
may X 1
189 8
While
10
Father's Name, .
OF
189
12
Lee
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN Cscof how Il.
To the Board of Health and the Clerk of the
Chelmsford
Undertakers must must make this return before the burial or removal of the deceased.
Date of Death, May 12
1898
. Name, ..
Frank A Lamphere
Maiden Name,
Sex,
male ; - Color,
de
Single, Married or Widowed,
EH ..
22
Age,
.years,
5
months,
.days.
Name of Attending Physician,
Residence of Deceased - No. Chelmshace
Occupation,
Husband's Name,
Place of Death - No.
Chelmsford
Birthplace of Deceased,
Street, for Corporation), Ward
Chelmsford
Father's Name,
Albion & Lamphere
Father's Birthplace,
Lebanon NH
Mother's Name, .
Mary &
Mother's Birthplace,
Bradford
Mother's Maiden Name,
Place of Interment,
Chelmsford
Signature of Undertaker or Informer,
Dated at Lowell, this
14 th
day & la
189.8
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,"
Frank a. Lamphere
Age, 22
Date and Place of Death, t
-.
died at.
Chelmsford, Mass May 2th,
1898
Disease or Cause of Death, -
of
Consumption
Duration of Sickness,
(Primary and Secondary.) }
alors Que monchã
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
EH. Chamberlin Chelmsford Mass
May 13th
Date of Certificate,
1898.
* Or Sex of Infant (not named). Jf stillborn so state.
t If child died immediately after birth so state. Just December 1806 -5.000.
# If a soldier or sailor who served in the War of the Rebellion.
, Lot ...
, Grave,
Cemetery, Range
Meunier
Street, (or Corporation), Ward .
MAWIA WYHIV Hus allenuea a person during his last illness shall, when requested, forthwith furnish tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the discase of died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a c immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a stating to the best of his knowledge and belief the fact that such a child dicd after birth or was born dead. If a phys lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses ( to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resic
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human bod 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 or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be reti recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of heal physician employed by a city or town for the purpose shall, upon request of sald board, agent or clerk, make such certif required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent sl with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is shall thercafter furnish for registration any other information as to the deceased or to the manner and cause of the deat clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine nc ing fifty dollars.
Commonwealth of Massachusetts. 13
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
May 22nel 1898
2. Name,
allen 7. Davis
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
70 „Years, 4 Months, 50 Days. Valvular disease d Pearl -
tuo months
6. Duration of Sickness, . By whom certified,
E. H. Chambulani
Chelmsford
7. Residence,
8. Occupation, .
9. Place of Death, .
Chiclana lead
Phillipstore
10. Place of Birth,
11. Name of Father,
Lavinda Worderch
12. Name of Mother, (Maiden Name),
13. Birthplace of Father,
14. Birthplace of Mother, .
11
15. Place of Interment,
11
Signature of Undertaker or other person making the Return, .
a. P. Buchan
DATED at Chelangford , on May 23 18 8.8 1
* 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. Jan. 1895 .- 5,000.
Disease or Cause of Death, (Primary and Secondary), ;
Labour
Salonton L
Rec
[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 sickuess, 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 rebelliou, 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 physiciau, 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 tlie 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 perinit is so given shall thereafter furnishi 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.
Lec
14
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or 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, j
5. Age, .Years, 10 Months, 25 Days. Pneumonia Disease or Cause of Death, (Primary and Secondary), ; two weeks
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
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, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur of Sheldon
DATED at.
A Chelmsford
, On
May 24
1898
* 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.
May 23rd 1898 Bessie M. Warles
Female - Single
White
GA. Harlow M.D. North Chelmsford
North Chelmsford North Chelmsford
John & Warla Almeno(Dijon) Works Guernsey, England. Elliot- maine. North Chelmsford
[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 belicf, the name of the deceased, his age, the disease of which he tlied, 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 birthli 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 thic 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 lie 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 cnough 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 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 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.
1
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Away, 24 -1898
2. Name, Lancia a adams Laura a Johnson
(Maiden Name),*
(Name of Husband),*
J -m
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, 3.7 Years, 11 Months, 24 Days. Disease or Cause of Death, (Primary and Secondary), ; Heart Disease) 6 mot 1
6. Duration of Siekness, . By whom certified,
O.P. (Porter 11.2). Cheleus Gard
7. Residenee,
8. Oeeupation, .
9. Place of Death, .
6 helues ford
10. Place of Birth,
Bridouvater WH
11. Name of Father, Andrew & Johnson.
12. Name of Mother, (Maiden Name),
Bridgewater LA
14. Birthplace of Mother, .
Samborutan NH 6 heleus food
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
albertQ@nhau
DATED at
Chilies for
, on
may 25
1898
* 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.] l'late. Ed. Jan. 1995 .- 5,000.
mary S'Cawley
13. Birthplace of Father, .
[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 lie 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 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 physiciau ; aud 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 trausmit 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 deatlı, 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. iug fifty dollars.
Rec No.
Commonwealth of Massachusetts.
16
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
May 27 1898
2. Name,
Horace Holl-
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, 77 Years, 8 Months, 4 Days. Disease or Cause of Death, (Primary and Secondary), ; Cerebral Hemorrhage Ino weeks
G. ‹ Duration of Sickness, . By whom certified,
E. H. Chamberlain M. D. Chelmsford
7. Residence,
8. Occupation, .
9. Place of Death, .
Pembroke ddr 2
Daniel Roll-
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
11
11
15. Place of Interment,
Laconia
Signature of Undertaker or other person making the Return, .
albert-P Perhenne
DATED at
Chelansford
, on
May 28
5
1888
18 9
* 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. September, 1892 .- 5,000.
10. Place of Birth, .
Chelong ford
11. Name of Father,
Sarah Holt-
Percebiche N.H.
[Public Statutes, Chapter 32, as amended by Acts of ISS8, Chapter 305 ; Acts of 1889, Chapter 224.]
SECTION 3. A physician who has attended a person during his last illness shail, when requested, forthwith furnish for registration, 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 siekness, and the date of his deeease. If a physician neglects or refuses to make a certificate, as aforesaid, 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 negleets 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.
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