USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 13
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Signature and Residenee
of
City PhysicianA
Date of Certificate
* Give also street and number, if any.
+ 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.
5
died at Chelmsford. Mars. april 2, 90%.
Quand Lua M. D.
o state
214
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 clerlt 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 IS. Any persor. shall obtain the physician's corte made zu accorlan .. with - ton
ient rtoge )
require : by sectir the boar ' fhealth of to the clerk of the city of town lis death occurit
a cary.
Name, Electra M. Carlton 215
Place of Death,
Atkinson 14
No .Street.
Ward,
Village,
How long a resident, About 26 year
Previous residence,
If death occurred at an institution give name of same,
How long an inmate,
Where from,
Date of Death : Year,
1981 Month Anil Day 3
Age : Years
71
Months.
18
Days
Place of Birth,
Chempoford Mass
Date of Birth: Year, 1836 Month, Dec Day, 16
Married, Single, )
Female Color, While
Widowed, or
Divorced,
inale
Occupation,
Cause of Death,
1. Chronic Heart Disease
Duration,
5 or 6 years about
Contributing Cause,
Duration,
Name of Father,
David Carlton
Maiden Name of Mother,
Sarah Pollard
Birthplace of Father,
Lowell Mass
Birthplace of Mother,
Hudson 1 4
Occupation of Father,
OFarmer
[Record continued over.]
Deceased was wife of
Widow of
Name of Physician (or other person) reporting said Chas & Durant P. O. Address, Haverhill
Place of Interment,
Date of Interment,
April 6 190
Name of Cemetery,
Undertaker,
P. O. Address,
18 Sound st da
THE STATE OF NEW HAMP
I hereby certify that the above death record is knowledge and belief.
Clerk of
.
Date amil 8, 190
6 / رح
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,
William H. Rickard
Sex,
ihale Color,
White
- Date of Death,
March 23ch 190182
; Age,.
79 Years,
2 Months,
23 Days.
Maiden Name, { If married, widowed )
or divoreed.
Husband's Name,
Single, Married, Widowed or Divorced,
Widower Occupation,
Farmer
* Residence,
{ If out of town, }
? also state fully,
Houth Chelmsford - Formerly North Reading
Place of Birth,
Canterbury N.H
*Place of Death,
So. Chelmsford
Name of Father,
Daniel Pickard
Birthplace of Father,
Rowley mare.
Maiden name of Mother,
Susan Harvey
Birthplace of Mother,
Houden N.A.
Place of Interment, (Give name of Cemetery),
North Reading
Dated at
Signature and
Daniel &Beam
on
march 23
19901
place of business
of Undertaker.
3
So Chemaporel Mar
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death, ±
died at
So. Chelmsford Mck. 23# 1901
Senile degeneration.
Disease or Cause of Death, §
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
Certifying Physician.
S
amas Now and
M. D.
Date of Certificate,
Mch, 23
190
1
Give also street and number, if any.
t Or 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 Causc.
M Hi Pickard
Age,.
79 8. 2. M. 23D.
3. 4.
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. (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 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.
FORM C.
Commonwealth of Classachusetts.
217
1
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,
John B Huilds
Sex,
Color,
Date of Death, March 15
190g; Age, 17
Years, ~ Months, Days.
Maiden Name,
{ If married, widowed }
or divorced.
-
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
operative
*Residence, { If out of town, )
¿ also state fully.
North Chelmsford
Place of Birth,
North chelmsford mass
*Place of Death,
North chelmsford v.
Name and Birthplace of Father,
John Shields Ireland
Maiden Name and Birthplace of Mother,
the Carlin Ireland
Place of Interment, (Give name of Cemetery),
At fabriek Sowell
Dated at ......
Attale Desvolt
on
quasek 15
190₺
Signature and
place of business
of Undertaker.
To Gochorus At
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Disease or Cause
-
Primary,
of Death, ¿ Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
F. E Varney
M. D.
Signature and Residence S
of
Certifying Physician.
north Chilens for
Date of Certificate,
March 169
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.
John B Sheilds
Age, /7Y. M. D.
died at
North Chelmsford Mars Mich 15.
.190/.
Pneumonia
Duration,
18 days
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.
7
SECTION 11. In ease 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 - phan. 1 " 'he cause of death. When such statement and certificate ar so the Board of Math, wie b .orthwith countersign and transmit the same to the clerk of th v. town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
1
FORM C.
Commonwealth of Massachusetts.
No ...
....
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
· Name,
Charlotte S. moore
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex female Color, white
Date of Death,
April 10
190/; Age, 5.8 Years,.
Months,
7
Days.
Maiden Name,
{ If married, widowed {
Charlotte S. Parker
or divorced.
Husband's Name,
James W Moore
Single, Married, Widowed or Divorced, marriedOccupation, at home
*Residence, { also state fully. §
{ If out of town, }
north Chelmsford
Place of Birth, new Burnswick
* Place of Death,
north Chelmsford
William Parker
England
Birthplace of Father, ....... Catherine Smith
Maiden Name of Mother,
novisotia.
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Littleton
mass
Dated at Lowell
b. m. young the
O11. April 11.1901
Signature and place of business of Undertaker. ' 33 Prescott It
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt Charlotte S. moore Age, 58 x. / M. 7 D.
Place and Date of Death,
died at
north Chelmsfordapril 10.1901
Disease or Cause of Death, #
Duration of Sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S GER A Thomas
M. D.
of City Physician.
304 Welfare S
Date of Certificate
April, 2º 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 Canse.
5
RAUES LAMPU COUNCIL
218
Name of Father,
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 deatlı.
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 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.
ST. And person having charge of the fu eat Liter prelu mary to the interne a human body shall obtai . the physician's certificate made in accordal. . with section ro, and rij 't together with the facts required by section I, to the board of health or to the clerk of the city or town in which the death o wurred.
-
Per
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,
ofTher & macdougall Sex Female Color, 22 Let
Date of Death, April 10 /90/182; Age,. , 31 Years, m Months, 20 Days.
Maiden Name, { If married, widowed } Nellie Rosella Suptill
or divorced.
Husband's Name, ArThu, 2 Raymond maddon face
Single, Married, Widowed or Divorced, Married Occupation, Pouzecrvene
South 6 here ford hice20
*Residence, { If out of town, ) ? also state fully. Chemppielle maine
Place of Birth,
"Place of Death,
so Chelmsford ner
Name of Father,
marshall Supplies
Birthplace of Father,
Maiden name of Mother, Martha M. Willis
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Dated
on
1690
place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ; nellie Pasilla TheDrug all Age, 31 Y. 3 M. 20 D. :
Place and Date of Death, #
Disease or Cause of Death, §
died at So. Chelmsford, Imas, april 10th, 789-1901. acute Indigestion and Cardiac Getheria.
Duration of sickness,
38 hours.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
Authun & Sestoria M. D.
Certifying Physician. 2
Chelmsford, man.
Date of Certificate, april 11, 19°/89 -189 -.
Give also street and number, if any.
t Or 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.
219
Signature and Klani 18 Bram
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 faets. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
Anv nerson having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's
220
Rel 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,
John Shields
Sex,
Color, .
Date of Death,
april 16
1911
190
; Age,
5 Years, -Months,Days.
Maiden Name,
{ If married, widowed į
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,.
Occupation,.
Labores
*Residence, ¿also state fully. )
( If out of town, }
North check stord
Place of Birth,
Ireland
* Place of Death,
North chelmsford
Name of Father,
Bernard
Birthplace of Father,
Dieland
Maiden Name of Mother,
Harinaldie de achance
Birthplace of Mother,
Place of Interment, (Give name of Cemetery).
It Patrick
Dated at
Signature and
place of business
of Undertaker. !
70 bockann st
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
John Shields
Age,
57%.
M .. .
.D.
Place and Date of Death,
died at
Harto Chelmsford apail 16h
1901
Pulmonary Tuberculosis
Disease or Cause of Death,#
Duration of Sickness,
Eighteenths.
I certify that the above is true to the best of my knowledge and belief.
JE Varney
M. D.
Date of Certificate
april 17-
1901
* Give also street and number, if any.
+ 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.
5
signature and Residence S of City Physician. north Chelunfund
5
IHMle Dewott
O11. Juil 14
1901
- -
No.
RETURN OF THE DEATH
OF
at
I
Date,
Filed,
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 required by section I, to the board of health or to the clerk of the city or town in which the death occurred.
221
FORM O.
1
No.
Commonwealth of Massachusetts.
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, .
-
m& Enancy
Sex, Color, 12-
Date of Death, Apr 21 st
190/ ; Age,.
.Years,
Months,
.. Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
*Residence, ¿ also state fully.
{ If out of town, }
Place of Birth,
*Place of Death,
1. thetis goed bruss
N. Chetransfert
Name and Birthplace of Father, John H6. fr Enannen
Mark.
Maiden Name and Birthplace of Mother, Albree In: Grath A. Chelinford. mare.
Place of Interment, (Give name of Cemetery), Catholic Cemetery Laut mars
Dated at
A. Chelmsford
on Afn 21 190 /
Signature and place of business of Undertaker.
J.J. Chelnford Praxe
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Mª Enaney
Age, ...
... Y.
M .D.
Place and Date of Death,
died at
n. chelinfine
april 21
190/
Disease or Cause of Death, ¿
- Primary, Secondary,
still bom Duration,
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,
190 /".
* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
t 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.
Read the 23
Agent of Board of Health.
mass
muze.
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 oceurs, 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 iu 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.
Free 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,
marre
Brown
Se female Color, white
Date of Death,
April 30
190/ ; Age, 33 Years,
6 Months, 20 Days.
Maiden Name, { If married, widowed ) or divorced.
mary
Plunkett
Husband's Name,
James Brown
Single, Married, Widowed or Divorced,
married Occupation,
at home
*Residence, { If out of town, )
West Chelmsford Mass
¿ also state fully.
Place of Birth,
Scotland
*Place of Death,
West Chelmsford
Name and Birthplace of Father, James Plunkett Scotland
Maiden Name and Birthplace of Mother, Jennette Mckenzie
Place of Interment, (Give name of Cemetery),
next [freceux for)
Dated at
Lowell
C. m. young & b
on
May 1 st
190 .
place of business
of Undertaker.
33 Prescott St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Mary Brown
Age, 55 x. 6 M 20 D.
Place and Date of Death,
- Primary,
Dieence of Liver
Duration,
4 months
Duration,
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.
3
Date of Certificate,
May 14
1901.
* 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.
died at
Weet Chelmsford
april 30
.190/.
Disease or Cause
of Death, }
Secondary,
Signature and
.
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.
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