USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 8
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Name and Professional Title
Imeig Pr D. associate Medical Examiner
Residence, No.
Street,
Thernmack
Dated at Lowell, this ..
101 ch
day of
DEC.
. 189 8.
*Reckoned to the time of death. [ Be very particular to fill the blanks, and strike out 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.]
Rec
Widowed
Age, 10 years
months.
2 days.
TÍT TÍM G
4
OF
189
٠٫٠
- جميــ
Commonwealth of Massachusetts.
46
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Dec 2' Reardoil
(Maiden Name),*
(Name of Husband),*
3. Scx, and whether single, Married, or Widowed, 5
4. Color,t
5. Age, -Years, ~ Months ~ Days. Difficult Palom
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
8. Bhereford
11 L
10. Place of Birth, 1 1 11. Name of Father, Daniel A Many OfGarvin
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, .
DATED at.
Chacunfond, On Free, 24 1889
* 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.
[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 died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a ehild 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 elerk. 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 samc. When snch satisfactory statement and certifieate 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 seetion shall be punished by a fine not exceed- ing fifty dollars.
47
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,
le 27 th
189 8Name, -
Serige E Mettere
Maiden Name,
Sex,
male ; Color,
Single, Married or Widowed,
Age, 70 years,
7
months,
days.
Name of Attending Physician,
anndeve
Residence of Deceased - No. Chileind
Street, (or Corporation), Ward
Occupation,
Farmer
Husband's Name,
Place of Death -- No. thelmafruf
Street, (or Corporation), Ward
Birthplace of Deceased, Redbord Una&L.
Father's Birthplace,
Redtrial Oraz
81
Mother's Name,
Mother's Birthplace,
Mother's Maiden Name, Denvett 02022
Place of Interment,
Signature of Undertaker or Informer, AMich Weinbach
Dated at Lowell, this
27 th
day of
189 8
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW,)
Date of Death,
LEE 27 th
189 8-
Name and Sex of Deceased, & Buttere
male.
Place of Death - No.
Disease or Cause of Death,
bernie bir+ stuart disease duration of * probably about Two years
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
475 Stestforse
.Street,
Dated at Lowell, this
Trority Sevratiti
day of
180 8
*Reckoned to the time of death. [ Be very particular to fill the blanks, and strike out 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. ]
...
Father's Name,
Cemetery, Range
Lot
Grave,
Street, (or Corporation).
(When the child is still-born, so specify.)
Ree
OF
189
Res
Commonbocalth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
maly 9. Hori
(Name of Husband),*
John Wheeler
3. Sex, and whether single, Married, or Widowed,
married
4. Color,
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified, .
2 years Dr. Hecher
7. Residence,
8. Occupation, .
9. Place of Deatlı, .
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, .
DATED at. Chelmsford
, on
3/9/2011898
* 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. Nov. 1890-5,000.
63
Years,
Months, 21
Days.
Wer Chelmsford
Tverr Chelmsford Waterford Marie
West Chelmsford
A. G. Pankhur
10.201898 Mary 8 Wheeler
[ACTS OF 1888, CHAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows :- 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 pun- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the buriator removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - Section 5. No uudertaker, sexton or other person shall bury in a city or town or remove thercfrom the body of a dceeased 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 therc has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment 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 licu thereof a certificate as hercinafter 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 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 dc- livered 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 mann( nav require. Any person [ 1, rovel May 1, ISSS. violating any of the provisions of this section shi
Ed. Sept., 1559. 5 M.
[ACTS OF 1889, CHAP. 208.] AN ACT
Plate.
1
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each city and town shall on the first day of cach 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 (leceased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time of said death or birth; and shall transmit said certificd copics 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 honse, if any, where such deceased person or parents so resided, whenever the same can be ascertained ; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certified copics shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act 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 Town. )
during the month of January 18 9 9. .
1. Date of Death,
Jan. 1. 1899
2. Name,
(Maiden Name), .
(Name of Husband),
Edwin F.
3. Sex, and whether single, Married, or Widowed,
Married
4. Color,
42 Years, Months, Days.
Disease or Cause of Death,
at Hospital 24 hours.
6. Duration of Siekness, By whom certified,.
E R. Macintosh M. D
7. Residence,
at Home
8. Oeeupation, .
St. John's Hospital Lawell
9. Place of Death, .
Prince Edward Island ·
10. Place of Birth,
11. Name of Father,
12. Name of Mother,
11
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
I certify that the foregoing is a true copy.
Attest :
Jan. 10
1899
Clerk.
(City or Town.)
5. Age,
Cerebral Hemorrhage
Youth Chelmsford
Unknown
11
North Chelmsford
Cordelia Carkin
٠
50
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City of Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name, ...
Matthew Morning
Sex: Male
Color,
White
Date of Death,
Jan.
2nd
1899 ; Age, 42 Years,.
11
. Months,
Days.
Maiden Name, (If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Married Occupation,
Engineer
* Residence, { If out of town, )
? also state fully. §
North Chelmsford
... ..
Place of Birth,
Scotland
* Place of Death,
North Chelmsford
Name of Father,
John
Morning
Birthplace of Father, ..
Scotland
Maiden name of Mother,
Elizabeth Nichols
Birthplace of Mother,
Protland
Place of Interment, (Give name of Cemetery),
North Grafton Mass.
Dated at ...
North Chelmsford
Signature and
Arthur N. Sheldon
on Jan 3rd 1899
place of business
of Undertaker.
North Chelmsford.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Matthew Morning Age, 4Lx 11 V.
Place and Date of Death,}
Disease or Cause of Death, §
.D.
died at North Chelmsford Jan, 2nd 189
Consumption
Duration of sickness,
two years.
I certify that the above is true to the best of my knowledge and belief.
Fred & Varney M. D.
Signature and Residence S of Certifying Physician. north Cucluster thues
Date of Certificate, Jan. 329
1899.
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.
1
Re
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 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. (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 facts. (See 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 certificate made in accordance with section in and unturn it forother with the facts required by section 1, to the board of health or to . Inity
Reu
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,
Jan 6
1899 Name
Albert P Derhan
Maiden Name,
Sex,.
male; Color, dla
Single, Married or Widowed,
Age, 48 years,
6
months, 3 days.
Name of attending Physician,.
Da Porter
Residence of Deceased-No.
Chelmsford
Street, (or Corporation), Ward
Occupation,
Harmer
Husband's Name
Place of Death-No.
Chelmsford
Street, (or Corporation), Ward,
Chelmsford
Birthplace of Deceased,
Father's Name,
Jarmul P.
Father's Birthplace, ichten
1
Mother's Name,
Isenett
Mother's Birthplace, unknown
Lewis
Mother's Maiden Name,
Place of Interment,
Chelmsford Cemetery, Range.
, Lot
, Grave,
ABC unier
Signature of Undertaker or Informer,
Dated at Lowell, this
9 th
day of Zaman
1899
-
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
pan 6
1899
Date of Death,
Name and Sex of Deceased, Albert Proctor Perham
Place of Death -- No.
Chelmsford (Mark
Street, (or Corporation).
Disease or Cause of Death,
duration of
*
8 days
Complications,
Typhoid Fever
I certify that the above is true return to the best of any recollection and belief.
Name and Professional Title,
lu.w.
Residence, No.
253
Street,
Central
Dated at Lowell, this
Eighth
day of.
Jaw .:
189.9
*Reckoned to the time of death.
[ Be very particular to fill the blanks, and strike out 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,
male.
When the Child is still-born, so specify.
DEATH
OF
189
Ree
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,
Colimena W. Lambert
Sex, Female Color,
white
Date of Deatlı,
Jun 7th
1899 ; Age, 63 Years, 0 Months,
4 Days.
Maiden Name, { If married, widowed )
or divorced.
Withers
Husband's Name,
Peter
humbert
Single, Married, Widowed or Divorced,
Married Occupation,
*Residence, { If out of town, )
North Chelmsford
Mais
¿ also state fully. §
Place of Birth,
Dead River Me
*Place of Death,
North Chelmsford
Name of Father,
Isaac Withey
Birthplace of Father,
Maiden name of Mother,
Rebecca Proctor
Birthplace of Mother,
Dead River Me
Place of Interment, (Give name of Cemetery),
North Chelmsford Cemetery
Dated at North Chelmsford
Signature and
Arthur A Sheldon
on
Jan.
9th
1899
place of business
of Undertaker.
North Chelmsford
3
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death, #
died at
North Chelune fert Mars. Jan 75- 1899
Disease or Cause of Death, §
Catanhal Pressens
Duration of sickness,
One week
I certify that the above is true to the best of my knowledge and belief.
F. E Varney
M. D.
Signature and Residence of Certifying Physician.
Novos Chelmsford
Date of Certificate,
189 %
Give also street and number, if any. + Or sex of infant not named. If stili-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.
52
blissene W. Lumberl.
Age,
63 5 10 MI. 4 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 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 sueh a deatlı, 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 deatlı. (See 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. (Sce section 10.)
Penalty for refusal or neglect, ten dollars. (Sec seetion 11.)
Any person having charge of the funeral witha preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section
health or to the clerk of the city of town
53
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,
Sarah N. Cook
Inde Color, White
Date of Death, North Jan. 7
1899; Age, 74 Years,
7
Months, 2. .... Days.
Maiden Name, { If married, widowed }
or divorced.
Cressey
Husband's Name,
Jonathan B. book
Single, Married, Widowed or Divorced, Married Occupation,
*Residence, { If out of town, )
¿ also state fully. )
N. Chelmsford
Mass
Place of Birth,
Rowley Mass.
*Place of Death,
North Chelmsford
Name of Father,
Nathaniel Gresser
Birthplace of Father,
Rowley Mais
Maiden name of Mother,
Surah N. Hale
Birthplace of Mother,
Rowley Mass.
Place of Interment, (Give name of Cemetery),.
North Chelmsford Mass.
Dated at.y
A.Chelmsford
Signature and
ir H Sheldon
on
Jan. 9th
1899
place of business
of Undertaker.
N. Chelmsford Mass,
If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and secondary cause of death. See Chap. 224, Acts of 1889.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Age, 74
Date and Place of Death, -
died at và Quelque Mivel
au ste
1819
Disease or Cause of Death, -
Duration of Sickness de
I certify that the above is true, to the best of my knowledge and belief.
1
Name and Residence of Certifying Physician, ...
1
Date of Certificate, 221;
18/7
*Or Sex of Infant (not named).
[May, 1888.]
section shall be punished by a fine not exceeding fifty dollars. SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is amended so as to read as follows : - 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 thereo a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not 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 of 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 register for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de. ceased 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 [Approved May 4, 1888.
facts relating to deceased persons, is amended so as to read as follows : - 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 neg.
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
No.
RETURN OF THE DEATH
OF
at
Date,
189
Filed,
189
er 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 n 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 own within the Commonwealth at which his vessel first arrives after such death. (See section 7.) Comply with the requirements of sections 6 and 7, five dollars. (See section 8.)
» tended a person during his last illness shall forthwith after the death of said person, upon a certificate setting forth the required faets. (See section 10.) Fagleet, ten dollars. (See section 11.)
re of the funereal rites preliminary to the interment of a human body shall obtain the physician's with section 10, and return it, together with the facts required by section 1, to the board of kawa in which the month accured.
54
Re
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, Jan 11
1899 Name Louisa de Man Scor
Maiden Name,
Sex, Lemale; Color,
Single, Married or Widowed,
Age, 70 years, 5 months, days.
Name of attending Physician, Da Howard
Residence of Deceased-No. Chilensfund Meet, (or Corporation), Ward
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