USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 12
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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 refnsal or negleet, ten dollars. (See section 11.)
... IT- interment.nl - Luggage 1
7
17 1 .
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Rec
FORM C.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
Name,
Graciela Michel
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex.
Hemale Color While
Date of Death,
Het. *
1901
. 189 ; Age,Years,
Months,.
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Jungle
Occupation,
*Residence, { If out of town, )
falso state fully )
Forth Chelmofor& Max
Place of Birth,
Lawrence Maxx
* Place of Death,
# North Chelmsford Mars
Name of Father,
Hector Michel
Birthplace of Father,
Canada
Maiden Name of Mother,
anna Provencher
Birthplace of Mother,
canada
Place of Interment, (Give name of Cemetery),
It Joseph Cemetery
Dated at ...
Low all Mass
Joseph Albert
Signature and place of business of Undertaker.'
#54 Cheever
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Place and Date of Death,
Disease or Cause of Death, #
Whooping Cough
Duration of sickness,
Beventes
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
J.E Jamey
M. D.
of
Forth Cherchent Thors
Date of Certificate
1901
* 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 Sallor in the War of the Rebellion, give both Primary and Secondary Cause.
₹
Fraciella Michel
Age,
Y ..
4 M ...
.
D.
died at
North Chilisford Man City 41901
on
1901
207
Commonwealth of Massachusetts.
Certifying Physician.
1
No.
RETURN OF THE DEATH.
OF
at
Date,
I
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 1 .11
1
208
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,
Whatha A Blood
Sex Female Color,
₹
white
Date of Death,
February 12
190 1; Age, 65 Years,
3
Months, 10 Days.
Maiden Name,
§ If married, widowed ?
or divorced.
Martha
of Crosby
Husband's Name,
John N. Blood
Single, Married, Widowed or Divorced, Married Occupation,
*Residence, { If out of town, )
¿ also state fully. }
Carlisle
mark
Place of Birth,
Octeville Mase
*Place of Death,
Chelmsford Mars
Name and Birthplace of Father,
Daniel Crosby
Maiden Name and Birthplace of Mother,.
ettigial Bodfish.
Place of Interment, (Give name of Cemetery),
Carlisle mask
Dated at Chelmsford More
Thomas . V.
on
February
13 th.
190 (
Signature and
place of business.
of Undertaker.
Carlisle Man.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Martha a. Blood
.Age,
6.5 x 3 M. 10D.
Place and Date of Death,
died at
Chelmsford Mass.
Feb. 120.
190 ) .
-
Primary,
Myocarditis
Bronchitis
Duration,
I certify that the above is true to the best of my knowledge and belief.
Unnen Howard.
M. D.
Signature and Residence of Certifying Physician.
Chelmsford
Date of Certificate,
+06.13
190/ .
* 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.
›
1
Duration,
Several months
Disease or Cause
of Death, }
Secondary,
4
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 funcreal 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 arc delivered to the Board of Health the hand ...
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,
Date of Death,
tel 14
20 1, Age 25
Years,
6
Months,
Days
Maiden Name, { If married, widowed } or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,.
Occupation,.
Highland dir Arth Philusford
* Residence,
{ If out of town, {
faiso state fully §
advocacia
Maryland.
Place of Birth,
* Place of Death, Highland an
Worth Thelucaford
Name of Father,
James Tale
Birthplace of Father,
Ireland
Maiden Name of Mother,
m. Vagy
Birthplace of Mother,
I Vertland
Place of Interment, (Give name of Cemetery),
Dated Jah12th201
Signature and place of business of Undertaker.
324 maiset St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Place and Date of Death,
Disease or Cause of Death, #
Consumption
Duration of sickness,
Fourteen mounth
I certify that the above is true to the best of my knowledge and belief.
FE Vanily
M. D.
Signature and Residence
of
Certifying Physician.
North Chebefund 200
Date of Certificate
July 17h
1901
* 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.
Reda tal, 18-1901
on
William Tole
Age, 25 Y
6
M D.
died at
North Chelmsford Muro Jely 16 9.07.
209
Sex,
Color,
No.
RETURN OF THE DEATH.
OF
at
Date,
I
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 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 narenn how - 1
ec
FORM C.
Commonwealth of Atlassachusetts.
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,
Clarence Flanders Wright
Sex,
Color,
Date of Death,
Stab 17
1900; Age, 13
... Years, 1 Months 27 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, .Occupation,
*Residence, {If out of town, )
? also state fully. § Chelmsford
Place of Birth,
*Place of Death,
Name and Birthplace of Father, George B. B. Wright, Chelmsford
Maiden Name and Birthplace of Mother, .. Fadelaine Henshaw New Brunswick
Place of Interment, (Glve name of Cemetery),
Chelmsford Center Cemetery
5
Walter Perhan
Dated
Tab 17
190€
Signature and
place of business
of Undertaker.
Chelwaging
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
letavance thandero Wright Age 3 x. / M 27 D.
Place and Date of Death,
died at ....
Chelmsford Feb. 17th
190/.
Disease or Cause
-
Primary,
of Death, ţ Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
Amara Howard ~M. D.
Certifying Physician.
Date of Certificate,
426.
190/ .
* 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.
Scarlet Junker
Duration,
6 days,
1
on
110
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 scctions 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 funercal 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 forthwith counter_n . nd transmit the same to the clerk of the city or town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
21/
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,
Charles Sweetser
Sex,
Color,
W.
Date of Death, March 4
190/; Age, 80
.Years, ..
11 Months,
9 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, ..
Widowed
Occupation,
Farmer
*Residence, also state fully.
{ If out of town, }
Chelmsford. Mars
Place of Birth,
Westrand
Mass
*Place of Death,
Chequesfond, Mass
Name and Birthplace of Father,
Elias Sweeties, Westford Mass (Probably)
Maiden Name and Birthplace of Mother, Mary ledams Chelmsford, Mass.
Place of Interment, (Give name of Cemetery),
Cheliusfind Center Cemetery
Hatten Perhar
on Mich. 4
190/
Dated at.
Chelmsford Mar.
· Signature and
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death,
Primary,
Duration
14 days
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
6.78. Chambulici
M. D.
of Certifying Physician.
Chelmsford Wass
Date of Certificate,
March 14.
190 1.
* 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.
....
Raid Manch 4-1901
Agent of Board of Health.
died at
Chelmsford, Mais, Ma. 4 190).
Disease or Cause
of Death,#
Secondary,
Charles Sweeten
Age, 80 Y. 11 M. 9 D.
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 auch atatament .-
Rev
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,
Julia Sophia Rechley
Sex,
Color,
Date of Death,
April 7 1961 189 ; Age,
45
Years,
Months,
Days.
Maiden Name, { If married, widowed }
or divorced.
Husband's Name,
Single, Martied, Widowed or Divorced,
Occupation,
At home
* Residence,
( If out of town, }
( also state fully )
Chelmsford
Place of Birth,
Worcester Mass
* Place of Death, Chelmsford
Name of Father,
Joseph B Display
Birthplace of Father,
Bennington OF
Maiden Name of Mother,
Sarah P graph
Birthplace of Mother, .
Place of Interment, (Give name of Cemetery),
Dated at
Lowell
on Apr 9 1901 :
Signature and
place of business
of Undertaker.
Lowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Age,.
Y.
M.
D
1
Place and Date of Death,
died at
Mass. april 7th .9.01
Disease or Cause of Death, #
J
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief. ..
Signature and Residence
Saward It. Chamberlain:
1.
M. D.
of Certifying Physician.
the Chelmsford Mart
Date of Certificate
apel 8th,
.1901-
* 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.
212
Charlestown muss
Cambridge Mass
No ... RETURN OF THE DEATH.
OF
at
Date,
I
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 I, to the board of health or to the clerk of the city or town in which the death occurred:
Rcc
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,
may
Cook
Sex.
Color,
Date of Death, ..
Apr 6
190% ; Age, ~ Years,.
-
.. Months,
1
.. Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, --- Occupation,
* Residence, § If out of town, { also state fully. §
Of Chelmsford masa
Place of Birth, Chelmsford mass
*Place of Death,
Chelmsford base.
England
Name and Birthplace of Father, Laeth E. Cook Bettham Yorkshire.
Maiden Name and Birthplace of Mother, Ellen Lee Huddersfield, England
Place of Interment, (Give name of Cemetery), A. Chelunsford Mas
Dated at N. Chelmsford
Signature and
-
Votre brasinel pr
place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
May Cook
Age, - Y. ~ M. / D.
Place and Date of Death,
died at
7. chehurford
april 7 th
190/.
Disease or Cause of Death, ± Secondary,
Infantile Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
JE Varney
M. D.
Signature and Residence
S
of
Certifying Physician.
H. Chilenaferal
Date of Certificate,
april 7-
190/.
* 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.
Name and Age of Deceased, t
- Primary,
190(
213
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 Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
P
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,
Magn
Sex,
male
Color,
Date of Death,
1901; Age, 30 Years,
Months,
21 Days.
1
{ If married, widowed į
Maiden Name,
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,,
Married Oco
Laborer
{ If out of town, 7
*Residence, ¡also state fully. §
Chelmsford Mass
Place of Birth,
Canada
* Place of Death,
Chelmsford Mass
Name of Father,
Quésime Jagnon
Birthplace of Father,
Lavado
Maiden Name of Mother, Corey Daily
Birthplace of Mother,
Elpanada
Place of Interment, (Give name of Cemetery),
St. Joseph Cemetine
Dated at
Lowell Mass
011.
April 2
907
Signature and place of business of Undertaker. '
Joseph Albert
#54 Echever
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Ion. Age, 35
.M.
D.
Place and Date of Death,
Disease or Cause of Death, #
Disk
Duration of Sickness,
I certify that the above is true to the best of ily knowledge and belief.
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