USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 14
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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 funcrcal 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.] 1
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 , ysician's certificate of the cause of death. When such statement and certificate arc 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.
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,
Hannah () Kimball
Sex. 71 Color, 7.V.
Date of Death,
Mary 3
190/; Age, 67
Years,
6
.Months,
11 Days.
Maiden Name,
or divorced.
Hannah Hill.
Ellioth,
Husband's Name,
Wilson Kimball
Single, Married, Widowed or Divorced, Marked Occupation, Housewife
Chelmsford, Mass.
*Residence, { If out of town, )
¿ also state fully. 3 -
Thorntonf n. H.
Place of Birth,
*Place of Death,
Chehurford, Mass
Name and Birthplace of Father,.
Ephesians Elliott Campton, MEN
Maiden Name and Birthplace of Mother,
Lovey Elkins
Place of Interment, (Give name of Cemetery),
Edson Cemetery Lowell, Mas.
Walter Perhary
on
May 4
190/
Signature and
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Hannah E. Kimball
Age, 67 Y. 6 M. 11 D.
2
Place and Date of Death,
Primary,
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Edward H. Chambertin
M. D.
Certifying Physician.
3
Chilinsport, Mark,
Date of Certificate,
May
4th
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.
died at
Clubuneford Mass.
May
3.
190 /.
Disease or Cause
of Death, #
Secondary,
Comme
Signature and Residence
of
223
Dated at
Chelmsford, Mais
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 oecurs, 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 offieer 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 faets.
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 elerk 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 eity or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No sueli 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 certifieatc 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.
-------
22€/
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,
Dames # Ayer
Sex,
Color,
Date of Death,
1 May 6 1901 +50; Age, 57
Years,
Months,
Days.
Maiden Name, { or divoreed.
Husband's Name,
Of estaurant
Single, Married, Widowed or Divorced,
Occupation,
*Residence, ¿ also state fully. §
{ If out of town, {
10, Oficiosford
Place of Birth,
* Place of Death,
Name of Father, Albert Ayer
Birthplace of Father,
Maiden Name of Mother, Cynthia Cale
Birthplace of Mother,
Whitefula RH,
Place of Interment, (Give name of Cemetery),
Dated at Lowell
Signature and
place of business
011 ...
PHYSICIAN'S CERTIFICATE.
1
Name and Age of Deceasedt
James H Ngày
Age,
Y.
M
Place and Date of Death,
died at Thirty de helpsford May & 1906
Disease or Cause of Death,#
Disease of Heart (Mitral Regurgitation)
Duration of Sickness,
Tivo Malo
I certify that the above is true to the best of my knowle hos and Belief.
Signature and Residence of
40 Decoad St Louch M: D.
City Physician Date of Certificate May, 4th
1981.
* 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.
5
TRADES ANEN COUNER
May 6 1901
of Undertaker. 1
Lowell
1
. .
If married, widowed į
No.
RETURN OF THE DEATH
OF
at
I
Date,
I
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 ch .. the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section ro, 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.
Ree
Commontvealth 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, for Mane. ( Bielson
.Color,
Date of Death,
; Age, ~ Years, ~ Months, ~ 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. §
Place of Birth, -
*Place of Death,
Name of Father,
Birthplace of Father, .
Maiden name of Mother, 1
Birthplace of Mother,
Place of Interment, (Give name of Cemetery)
Dated at
on
of Undertaker. Hest Chelmsford mood
PHYSICIAN'S CERTIFICATE.
lived but feer
minutes
Billen
Age, ~ Y. - M. ~ D.
died at
wat Chehun dert May 9 1699
Disease or Cause of Death, §
Premature binh
Duration of. sickness,
I certify that the above is true to the best of my knowledge and belief.
JE Varney
M. D.
Signature and Residence § of
Certifying Physician.
Hank Chilisfire
Date of Certificate, May 9 €
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.
Name and Age of Deceased, f Place and Date of Death, ¿
Signature and A . S. Parkhurst
189 1
place of business
225
1
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. (Sec 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 funeral with~ ~~~ 1:
-
Rec FORM C.
226
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,
Benj Minich Fiske
Sex,
W.
Date of Death,
May 9
190/ ; Age, ...
75 Years,
3
Months,
10 Days.
Maiden Name,
{ If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Married
Occupation,
Retired
*Residence, { If out of town, )
Chelmsford, mase.
¿ also state fully.
Place of Birth,
Boston, Mass. Charlestown
*Place of Death,
Chelmsford, Mass.
Name and Birthplace of Father,
John Munich Fiske Lexington Mass.
Maiden Name and Birthplace of Mother,
Eliza Wenn Salem Mass.
Place of Interment, (Give name of Cemetery),
Chelmsford Centre
Dated at
Cheliefert, Mace.
Signature and
Walter Parton
on
May 10
190 /
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Benj. M. Fiske
Age,
75 x 3 M. 10 D.
Place and Date of Death,
- Primary,
Endocarditis
Duration,
6 months
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
Certifying Physician.
Chelmsford
Date of Certificate,
May 10"
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.
Recul May 11.
Agent of Board of Health.
died at
Chelmsford
May 9 0
190 /.
Disease or Cause
of Death, #
Secondary,
masa Howard
M. D.
Color,
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 thercfor 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.
nee
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,
Olipa Fiske Winn
Sex,
7
Color,
W
Date of Death, ..
Way 9.
190 / ; Age,.
65.
Years
Months,
.Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, ( ) Lingle Occupation,
§ If out of town, { Chelmsford Wasd.
Place of Birth,
Sabem Mass.
*Place of Death,
Chelmsford Mass.
Name and Birthplace of Father,.
Ohw Wina Salem THard.
Maiden Name and Birthplace of Mother,
Sarah Webber Salen Mass.
Salem Mais.
Place of Interment, (Give name of Cemetery),
Dated at ... 1
Walter Parhay
on
May 10,
190 /
Signature and
place of business
2
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Eliza Fiske Wir
Age, 65 Y
M.
.D.
Place and Date of Death,
died at.
Chilisfood Hass
May 99
190 /.
Primary,
Strangulatie Itania
Duration, 5days
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Edward It Chantal
M. D.
of Certifying Physician.
Chilmate, Ware
Date of Certificate, may 11 ta
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.
Read May 11
Agent of Board of Health.
too
Disease or Cause of Death, # Secondary,
227
*Residence, 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 whosc 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 elerk 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 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 deathi 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 authoritics. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cat of death. When such statement and certificate arc delive" te the Board of Health, the board or agent shall forthwith co ersign and transmit the same to the clerk of the ...... for registration.
SECTION 5. Penalty for violation not exceeding y dollars.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
Name,
Marie More
Sex, HevaleColor
Date of Death,
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, Į
Place of Birth,
* Place of Death,
Name of Father,
Birthplace of Father,
Maiden Name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery).
Dated at
I
?
o11
21 11
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Marie Rose Lambert
.Age,
1 x 1
M.
7. D.
Place and Date of Death,
died at
Chelmsford Mars, May 10th
1901
Disease or Cause of Death,¿
Broncho- Pneumonia
Duration of Sickness,
about four (41 days)
I certify that the above is true to the best of my knowledge and belief.
Edward H. Chamberlin
1
M. D.
Signature and Residence of
City Physician. Chelmsford Mass
Date of Certificate
May 11th
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. .
# Il a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
5
IMAGES CAN COUNTL
Reed May 11
228
(FILL OUT WITH INK. "ALL NAMES TO BE IN FULL.)
Signature and
place of business
of Undertaker. '
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 10, 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.
229
YFORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Thomas J
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Teilen
Sex,. .
Color,
Date of Death,
May 2 6 1001; Age,
70
Years,
Months,
Days.
If married, widowed Į
Maiden Name,
or divorced.
Husband's Name,
Single, Married, Widowed or-Divorced, ......
Occupation,
East Chelmsford
*Residence, ¿ also state fully. )
Place of Birth,
Ireland
* Place of Death,
East Chelmsford
Name of Father,
Birthplace of Father,
Maiden Name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery)
Dated at May 26th
St. O' Donnell
0 11
I 900
Signature and place of business of Undertaker. 1
32.4 Maiet St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Age, 10 Y.
.M.
D.
Place and Date of Death,
died at
I
Disease or Cause of Death, #
Dican of divor
Duration of Sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of City Physician.
M. D.
Date of Certificate.
May 28
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
0
Lowell
Queland
[ If out of town, {
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. „ving charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's cate made in accordance with section ro, and return it, together with the facts required by section I, to the board of healthi or to the clerk of the city or town in which the death occurred.
230
FORM C.
Rev 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,
William A.
Reed
Sex,
male Color, white
Date of Death,
may 29 190/; Age, 62 Years,
11 Months, 12 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced. Widowed Occupation, Salesman
*Residence, also state fully.
§ If out of town, }
West Chelmsford
Place of Birth, Lowell Maso
*Place of Death,
West Chelmsford
Name and Birthplace of Father, William Reed, unknown
Maiden Name and Birthplace of Mother, Regia Shattuck Pepperell
Place of Interment, (Give name of Cemetery), Lowell Cemetery
Dated at
Lowell
C. m. Young &les
on
30th May
190 /
Signature and
place of business
of Undertaker.
33 Prescott St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t WilliamH Reed
Age, 62 Y /1 M/ 2D.
Place and Date of Death,
died at.
West Chelmsford
May 29th
.190 /.
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