USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 10
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SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
+
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he 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 in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the . Board of Health, the board or agent shall forthwid
registration.
SECTION 5. Penalty for violation not exceer
-
Rec
FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
. (FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Peter
Hogan
Sex,
.... Color,
Date of Death,
Nov 20
1900 ; Age, / 0 Years, ~ Months.
- Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Laborer
*Residence, ¿ also state fully.
West Chalmford
§ If out of town, {
Place of Birth,
Ireland
*Place of Death,
West Chalanford
Name and Birthplace of Father,
Unknown Ireland
Maiden Name and Birthplace of Mother,{{
11
1
Place of Interment, (Give name of Cemetery),
St Patrick Lowell Mans
Dated at
Lowell
James /mixDermott
on
20 Nov
190 0
Signature and
place of business
of Undertaker.
270 Borham St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Peter Hogan
Age, JOY. M. D.
Place and Date of Death,
died at
Week Chilenofond Nor 20 1900.
Disease or Cause - Primary,
of Death, } Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
J.E. Janney
Signature and Residence S of
Certifying Physician.
north Chelucfeny
M. D.
Date of Certificate,
Nor 20
190 0.
* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
191)
Encephalitis
Duration,
L
No.
RETURN OF THE DEATH
OF
at
Date,
190
Filed,
190
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and . 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he 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 in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such 'statement and certificate are delivered to the Round of TT-11
192
Rec FORM C.
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,
Veruska ance
Sex, Color, W.
Date of Death, nov 23
190 0; Age, 73 Years, 10 Months, 21 .Days.
Maiden Name, { If married, widowed ) or divorced. Perucha ano lactMust
Husband's Name, Johan Bisher
Single, Married, Widowed or Divorced,
WidowerOccupation,
Housewife
*Residence, { If out of town, )
¿ also state fully.
Chelmsford
plaies.
Place of Birth,
*Place of Death,
Name and Birthplace of Father, John Parkhunt Chelucefino.
Maiden Name and Birthplace of Mother Signal Manning, Billerica
Place of Interment, (Give name of Cemetery),
Dated at chelmsford
Walter Perham
on
nov. 24
190 0
Signature and
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ț
Jesusha Jase Shed
Age, 13 x 10 M 2/ D.
Place and Date of Death,
died at
Chelmsford Mars.
Mar 23 " 1900.
-
Primary,
Paralysis of theart.
Duration,
X
Old age
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
Chelmsford, class,
Date of Certificate, Mor. 250 1900.
+ Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
--
....
Umar Howard. D.
Disease or Cause of Death, Secondary,
No.
RETURN OF THE DEATH
F
OF
at
Date,
190_
Filed,
190.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for negleet to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he 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 in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed thercfrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the
Ree
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Sur FI Noble
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex,
Megle Color,
White
Date of Death,
Nov. 25
190 0; Age,
1
.. Years,
0
Months,
0
.Days.
Maiden Name, { If married, widowed )
or divorced.
×
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
×
*Residence, {If out of town, )
To Chelmsford, mass
Place of Birth,
Amherst, N.OH
*Place of Death,
Youth Chelmsford, Mass
Name and Birthplace of Father,
Hiram Fil Noble Pittsfield Me
Maiden Name and Birthplace of Mother,
Hattie A Heald Trestlord Mass.
Place of Interment, (Give name of Cemetery),
Green Cemetery, Carlisle Mass.
Dated at
Checivisford
Signature and
-
Thomas A, Green.
on
Nov. 26
.190 0
place of business
of Undertaker.
Carlisle, Mass.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age, . /. Y.
....... M.
Place and Date of Death,
died at
1. 25, 190 0.
Primary,
Duration,
2 Weeks.
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
Certifying Physician.
M. D.
Date of Certificate,
2000-26;
190 8.
* Give also street and number, if any. | Give sex of infant not named. If still-born, so state.
{ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
123
Disease or Cause
of Death, ¿
Secondary,
¿ also state fully.
-- -
No.
RETURN OF THE DEATH
OF
at
Date,
190
Filed,
190
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he 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 in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the . . . & the city or town for
Ric
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which th
eath occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Sarah Warley
Sex,.
.Color,
Date of Death,
December 14 th 1900; Age, 59 Years, ~ Months,
.. Days. -
Maiden Name,
{ If married, widowed }
or divorced.
Sarah Warley
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
housework
*Residence, also state fully.
{ If out of town, }
ch Chelmsford
mask
Place of Birth,
Plymouth
England
*Place of Death,
N Chelmsford masks
Name of Father,
Thomas Warley
Birthplace of Father,
Plymouth,
England
Maiden name of Mother,
mary
Lake
Birthplace of Mother,
Plymouth
England
Place of Interment, (Give name of Cemetery),
Chelmsford mass
John marinel fr.
on
Dec 15 th
1
1800
Signature and place of business of Undertaker.
A. Chelmsford masks
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Place and Date of Death, #
Sarah Warley
Age, 69%.
.D.
Disease or Cause of Death, §
died at
North Chelmsford Que 14th 1891400
Cancer
Duration of sickness,
one year
I certify that the above is true to the best of my knowledge and belief.
& a Harlow
M. D.
Signature and Residence of Certifying Physician.
Tyngsboro mass
Date of Certificate,
1fee, 18 th
18:00
Give also strect and number, if any.
+ Or sex of infant not named. If still-born, so state. If child dicd immediately after birth, so state.
§ If a Soldier or Sailor in thic War of the Rebellion, give both Primary and Secondary Cause.
194
1
Dated at
N. Chelmsford
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. (See section 7.) Penalty for neglect to comply with the requirements of scctions 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts. (See section 10.)
Penalty for refusal or negleet, ten dollars. (See section 11.) Any person having shaun of it .. .
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,
Jaffry
Levegner
Scx,.
Color, W.
Date of Death,
Dec 16
1900; Age, - Years, 10 Months,
-Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,. .
Single, Married, Widowed or Divorced, Occupation,
*Residence, { If out of town, )
West Chelmsford Masa
? also state fully. §
Place of Birth,
West Chelmsford mais.
*Place of Death,
West Chelmsford Mark
Name of Father,
Desire Levegney
-
Birthplace of Father,
·Ganada
Maiden name of Mother Alise Robechau
Birthplace of Mother,
Canada
Place of Interment, (Give name of Cemetery).
If Jasehh Cemetery Lawell Mann
Dated at.
A Chelmsford
Signature and place of business of Undertaker.
Jaseph Albert , choverst
on
Dec 16
1800
Lowell mask
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f Jaffry Sevegney Age, Y - M. 10 D.
"Place and Date of Death,
died a
Zarab- Chefmatiné mars Dec 16
188900
Disease or Cause of Death, §
Convulsions
Duration of sickness,
one
day
I certify that the above is true to the best of my knowledge and belief.
JE Janney
M. D.
Signature and Residence S of Certifying Physician.
north Cherusfund
Date of Certificate,
Dec 20 h
1899.00.
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If child dicd immediately after birtli, 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 houscholder 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 thercof 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. (See section 7.) Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
Any person having charge of the funereal rites preliminare to the increment of a human hade shall obtain the shedision's
Ree
FORM C.
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
Emma & Safford
Sex female Color white
Date of Death,
Dec 17th 190480; Age, 47 Years,
3
.. Months,
2
Days.
Maiden Name, { If married, widowed )
or divorced.
Emma
& Patt
Husband's Name,
Harry
Safford
Single, Married, Widowed or Divorced,
Widow Occupation,
at home
*Residence, { If out of town, }
East Chelmsford
{ also state fully )
Place of Birth,
Central Giallo R. l.
*Place of Death,
East Chelmsford
Name of Father,
Ornam Patt
Birthplace of Father,
Pawtucket R. I.
Maiden Name of Mother, martha Simes
Birthplace of Mother,
Pawtucket R. I.
Place of Interment, (Give name of Cemetery),
Edson Cemetery
Dated at.
Lowell
6. M. young Vlo
on
Dec 18th
I
900
Signature and
place of business
of Undertaker.
33 Prescott It
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt Emmal Safford Age, 47 x 3 M 2 D.
Place and Date of Death,
died at
East Chelmsford Dec 17.1900
Disease or Cause of Death, #
anthrax
Duration of sickness, .
About two Oriko
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
5
Jh Waller
M. D.
86 Branch S/~
Date of Certificate
.0
Dc 18
1900
* Glve 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 Rebelllon, give both Primary and Secondary Cause.
116
No.
RETURN OF THE DEATH.
6
J. Safford
at
Deu ; eu17
1900
Date,
Dec, 19
Filed,
900
Acts of 1897, Chapter 444. [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, withan five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required 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 rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section Io, and return it, together with the facts re- quired by section r, to the board of health or to the clerk of the city or town in which the death occurred.
Y
Ret
FORM C.
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,
Die M 190; Age, 17
Sex,
Color,
Date of Death,
Years,.
.Months,
Days.
Maiden Name, { If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation, North Chelmsford
*Residence,
[ If out of town, Į
{also state fully §
Wieland.
Place of Birth,
IF lahin Hospital
* Place of Death,
Name of Father, Michael Dowd
Birthplace of Father, not known Maiden Name of Mother,
Birthplace of Mother,
Place of Interment, (Glye name of Cemetery),
Apatricks Remitir
Dated at ... aktuell Maso
Dec 119
900
Signature and place of business of Undertaker.
224 Manat US
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
alguns Dound
Age, 17 %.
... M.
D.
1900
Place and Date of Death, died 'at St. John's Hospital Road Nic 191 mastoiditis Disease or Cause of Death, #
Duration of sickness, two months.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Freduide 4 teachers.
M. D.
of
Certifying Physician.
3 Resident Surgeon St. John's Hacht
Date of Certificate I
howell
* Give also street and number, If any.
t Give sex of Infant not named. If still-born, so state. If child died immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
1
Wieland
Yuland
011
4
No.
RETURN OF THE DEATH.
OF
at
I
Date,
Filed,
I
Acts of 1897, Chapter 444. [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.
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 forthwith 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 rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section Io, and return it, together with the facts re- quired by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
FORM C.
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,
Oh YV yard
Sex, .. Color,
Date of Death,
Dec 28
18900 Age,.
60 Years,.
Months,
Days.
Maiden Name, { If married, widowed } or divorced.
Husband's Name,
Single, Married, Widowed or Divoreed,
Occupation,
Farmer
So, Shems ford
*Residence,
( If out of town, }
(also state fully }
Place of Birth,
80, chelmsford
* Place of Death,
50. Obecnie ford
Name of Father,
Jonathan Fr
Birthplace of Father,
Maiden Name of Mother,
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