USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 5
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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 city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the ease nay 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 eannot 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 eity or town for the purpose shall, upon request of stid 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 forthwith eountersign and transmit the same to the elerk 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 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.
PUndertakers must must make this return before the burial or removal of the deceased.
Date of Death,
June 4th
1898
...
Name,
Lucy A Huntoon
Sex, Le male; Color, La
Maiden Name,
SinNe, Married or Widowed, .
Name of Attending Physician,
Se Chadbourne
Street, ( Comeas fera)
Residence of Deceased - No.
1397
Forham
Occupation.
At home
Husband's Name,
Place of Death - No. ...
Chelmsford
Birthplace of Deceased,
Father's Naute,
george Winslow
. . .
...
Father's Birthplace,
westboro (Mass
Mother's Name,
mary
Mother's Birthplace,
Ilanton
Place of Interment,
Lowell
Cemetery, Range
Lot
, Grave,
Signature of Undertaker or Informer,
day of.
June
1895
Dated at Lowell, this
10th
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
June 9
189.8 ....
Name and Sex of Deceased, Lucy A Huntoon
Le male.
Place of Death - No. 1397 gorkum Street Chelmsford
(When the child is still-born, so specify.)
Disease or Cause of Death,
Cancer
duration of *
Complications,
I certify that the above is a true return to the best of my recollection and letist.
Name and Professional Title, F. W. Chumboun
Residence, No.
Cunhal Bek
Dated at Lowell, this
Street,
.. day of
189
8
Age,
61 years, 10
months,
~ days.
george & Huntoon
Street, (or Corporation), Ward
Lowell
Mother's Maiden Name,
Street, (or Corporation).
RETURN OF DEATH
OF
:
... ... 189 ..
18
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
?Undertakers must must make this return before the burial or removal of the deceased.
Date of Death.
May 30 th,
22
1898
.. Name, .
Melvin It Dam
Maiden Name,
Sex,
male ;
Color,
Single, Married or Widowed, .
Age,
5.4 years, 8
months, 4 days.
Name of Attending Physician, Howard
Residence of Deceased - No. 1
thehand
Street, (or Corporation), Ward
Occupation,
Carpenter
Husband's Name,
Place of Death - No. Chelmsford
Birthplace of Deceased,
Great Falls, U. N.
Father's Names, Calin Dam
Father's Birthplace,
Mother's Name,
Elizabeth
Mother's Birthplace.
Mother's Maiden Name,
So well mars
Cometery, Range
Lot
, Grave,
Signature of Undertaker or Informer, Dehuit Wennbecke
Dated at Lowell, this
30 th
day of
189 8.
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
May 30 Ht
30 8
189
DA Dam
·
Name and Sex of Deceased,
male.
Place of Death - No.
Chelmsford
Street, (or Corporation).
Disease or Cause of Death, Chronic nephritis (When the child is still-born, so specify.)
duration of * Several years.
Complications.
Valvular disease of heart
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Amara toward. M. D.
Residence,
Chelmsford Mass. Street,
Dated at Lowell, this 3 ) u
day of
May
189.8 .. ..
Street, (or Corporation), Ward.
Place of Interment,
Echem.
Rec
DEATH
OF
Melvin Engine Dam May 31 et 1898
19
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
June 18 - 1848
2. Name,
Elmira Wham
Berry
(Maiden Name),*
Clement- Uphame
3. Sex, and whether single, Married, or Widowed,
m &W .
1. Color, t
5. Age,
78
.Years,
1
Months,
24 Days.
Paralysis
6 months
Dr Howard
7. Residence,
at- home.
Chelmsford ....
Holderness Y -
newell Barry
11. Name of Father,
Hannah, H
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
13. Place of Interment,
Signature of Undertaker or other person making the Return, .
? albus@Pichau
DATED at
Chilis ford
, on
June 19
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. September, 1892 .- 5,000.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified,
Chelunsford
8. Occupation, .
9. Place of Deatlı, .
10. Place of Birth,
Chelmsford
(Name of Husband),*
[Public Statutes, Chapter 32, as amended by Acts of 1883, Chapter 305 ; 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 aforcsaid, 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 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 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 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 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 lollars.
Re
20
Commontucatth 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, t
5. Age, Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Deatlı, .
10. Place of Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name), Canada
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
June 29th 1898
Anna
buben
Sheila
James F. Truber
Married
Female White
58 Years, 3 Months, Days. Organic disease of heart
Fred E. Varney M.D.
North Chelmsford. House Keeper North Chelmsford
Canada
Canada
North Chelmsford
A.H. Sheldon
DATED at N. Chelmsford, on. June 30th 18 28
* If a Married Woman or Widow. t 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.
[ 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 discase of which he died, the duration of his last siekness, and the date of his deccase; 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 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 inanner 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.
21
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowett.
Town of
Chelmsford
Undertakers must make this return before the burial or removal of the deceased.
Date of Death
189 & ...
Name,
Hiram & Brown
Maiden Name.
Sex,
male ; Color, La
Single, Married or WNlowed,
Age,
62
years,
9
months,
22
days.
Name of Attending Physician,
Dr Scabora
Residence of Deceased-No. Chelmsford
Street (or Corporation), Ward
Occupation,
. Husband's Name,
Place of Death-No.
Chelmsford
Birthplace of Deceased,
Street (or Corporation), Ward
Lowell
Father's Name,
ponas Brown
Father's Birthplace,
Mother's Name,
mary (M. "
Mother's Birthplace,
.. !
Hildethe
Place of Interment,
Chelmsford
Cemetery, Range
, Lot
Grave,
Signature of Undertaker or Informer,
&Blusier
Dated at Lowell, this
11th
day of.
189 5
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Hiram Josiah Brown
Age, 63 yrs. 10 mths.
Date and Place of Death, t -
died at.
Chehuston, mass, July 10th, 1808,
Chronic Nephritis, Caudine Delalation +Ordem a of Lungs.
D'sease or Cause of Death, -
of
(Primary and Secondary.)}
tration of Sickness,
about Inian.
I certify that the above is true, to the best of my knowledge and belief.
Arthur I. Scolonia
Chelmsford, mare;
180 8.
L.R. L.R. L.R. A.R
THUTEA
Date of Certificate, Only.
lied immediately after birth so state. ate. Ed. December, 1996. - 5,000.
# If a soldier or sailor who served in the War of the Rebellion.
I.R
nature and Residence of Certifying Physician,
...
Mother's Maiden Name,
OF
, vouper 221; Acts of 1893, Chapter 20
uus avenuea a person during his last illness shall, when requested, forthwith furnish for re 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 siekness, and the date of his deecase; and a physician who has attended at a birth of a child dy immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certhlc: 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 n leets or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not execed fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give b the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refnses or negle to make such certifieate 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 a human body until 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 e or town, from the city or town clerk. No such permit shall be issued until there has been delivered to sueh board, or agent clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned a recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in li thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physici cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or a physician employed by a eity or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as required of the attending physician; and in ease of death by violence the medical examiner shall, if requested, make the saul When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall fort with countersign and transmit the same to the clerk or registrar for registration. The person to whom the perinit is so giv shall thereafter furnish for registration any other information as to the deceased or to the manner and eause of the death, as t clerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not excee ing fifty dollars.
Tee
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,
Left 2
1898 Name ...
Asenath & SLewis
Sex, Lemale; Color, La
Age, 82 years, 10 months,.
... days.
Maiden Name,
Single, Married or Widowed,
Dr Thomas
Name of attending Physician,
Residence of Deceased-No.
Chelmsford (mass
Street, (or Corporation), Ward
Occupation,
At home
Husband's Name ..
Nathan Lewis
Place of Death-No.
Chelmsford
Street, (or Corporation), Ward.
Birthplace of Deceased,
Raumney Att
Father's Name,
leńknown's
Father's Birthplace,.
unknown
Mother's Name,
Mother's Birthplace,
Brainard
Mother's Maiden Name,
Place of Interment,
Album RH
Cemetery Rang ........ ..... Lot.
., Grave,
Signature of Undertaker or Informer,
Able unier
day of.
Seft
IS9 8
Dated at Lowell, this
Physician's Certificate of the Cause of Death. (SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Left 2
1898
Name and Sex of Deceased, Asenath & Lewis
Place of Death -- No.
Chelmsford
Street, (or Corporation).
When the Child is still-boris, so specify.
Disease or Cause of Death, ..
·Valuela Disease of Her
duration of *
Complications,
Shock
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, ...
920 + Thomas M 2
Residence, No.
304 Werktand
Street,
Dated at Lowell, this
3
day of
Sept
IS9 8
*Reckoned to the time of death.
[Be very particular to fill the blanks, and strike ont words that are not correct, such as street or corporation, single, married or widowed, and insert " fe " before male when the deceased is a female, and when the deceased is colored please insert. ]
Approved,
BOARD OF HEALTH.
-
22
CR male.
NOIUAN UN DEATH
OF
189
23
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name, Ada MEads
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex, +1 Color,
Date of Death,
189 8; Age, 17 Years, - Months, 2 Days.
Maiden Name, ' { If married, widowed } or divorced.
Husband's Namc,.
Single, Married, Widowed or Divorced, IC Occupation,
* Residence, also state fully. ) { If out of town, { South Boston
Place of Birth, 11
*Place of Death,
Name of Father,
Loring Heads
Birthplace of Father,
Nestori Et.
Maiden name of Mother, Gachcara
Birthplace of Mother, Bostori
Place of Interment, (Give name of Cemetery),
Dated at Setzen, 1898 on
Signature and
faluner
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
CEda Meade,
Ages 17
Date and Place of Death, 1
died at.
Chlunsford Mark, Det. 4.1808.
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, -
of
4 days.
I certify that the above is true, to the left off my knowledge and belief.
Mallecker Mr. Redford Mars
Signature and Residence of Certifying Physician,
Date of Certificate,
Drift, 4/- 1898.
* Or Sex of Infant (not named). If stillborn so state. [ If child died immediately after birth so state.
# If a soldier or sanfor who served in the War of the Rebellion.
Plate. Ed. May, 1893 .- 5,000.
Apendicitis _
place of business of Undertaker.
Rel
ing fifty dollars.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until Ifc 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 perinit 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 lien 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 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 conntersign 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-
staring to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician 1 lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceed fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give b the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negle
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.
No.
1
RETURN OF THE DEATH
OF
at
Date,
189
...
Filed,
189
SI Agisuation a Certinc.
ir 444 of the Acts of 1897 require that every householder in whose house a death occurs, the int at the time of the death of any of his kindred, or the person in charge of an institution in thin five days after the date of such a death, give notice thereof to the board of health or to a which the death occurred. (See section 6.)
of a vessel shall give notice of the death of any person under his charge to the board of health pwn within the Commonwealth at which his vessel first arrives after such death. (See section 7.) imply with the requirements of seetions 6 and 7, five dollars. (See section 8.)
fended a person during his last illness shall forthwith after the death of said person, upon a certificate setting forth the required facts. (See section 10.)
gleet, ten dollars. (See section 11.)
of the funereal rites preliminary to the interment of a human body shall obtain the physician's
Rel
Ed. Jan. 23, 1994. 5,000.
[ACTS OF 1889, CHAP. 208.] AN ACT
24
Plate.
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each eity and town shall on the first day of each month make a certified copy of the record of all deaths and births recorded in the books of said city or town during the previous month, whenever the deceased person or the parents of the ehild born, were resident in any other city or town in this Commonwealth at the time of said death or birth; and shall transmit said certified copies to the clerk or registrar of the city or town in which such deceased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where sueh deceased person or parents so resided, whenever the same ean be ascertained ; and the elerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This aet shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the City of Lowell
(City or ToyR. )
during the month of. August 1898.
1. Date of Death,
Arquil 21, 1898
2. Name,
I May J'ai
(Maiden Name), .
Mary Duffy
(Name of Husband),
Edward Gal
3. Sex, and whether single, Married, or Widowed,
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