USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 15
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- Primary,
acuteHepatitis
Duration,
5 days
Disease or Cause
of Death, ¿
Secondary,
apoplexy
Duration,
8 years
I certify that the above is true to the best of my knowledge and belief.
G. a. Harlow
M. D.
signature and Residence S of Certifying Physician.
Tangoboro
Date of Certificate,
may 30th
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.
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF
WilliamHenry Reed
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 1
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.
.
Ree
Commonwealth of Massachusetts.
:
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
è divinalbridge Dutton Sex, Male Color, white
Date of Death,
June 4
Years, 120 /; Age,3.9 10 Months, 2 Days.
Maiden Name,
or divorced.
Husband's Name,.
Single, Married, Widowed or Divorced,
Jarred Occupation
Farmer
*Residence, { If out of town, )
Chelmsford, Mass.
Place of Birth,
*Place of Death,
Chelmsford, Mass
Name of Father,
Elbridge Duttono
Birthplace of Father,
Chelmsford, Mass
Maiden name of Mother,.
Laura Maria Wright,
Birthplace of Mother,
Westford Mass.
Place of Interment, (Give name of Cemetery),
Chelmsford Centro
Dated at
Chelmsford
Daniel P Brom
on. June 4
1861
Signature and
place of business
of Undertaker.
South Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Edwin E. Dutton
Age, 59 Y. 10 M. 2D.
Place and Date of Death, #
Disease or Cause of Death, §
died at
Chelmsford, mars.
789/90%.
Heart Dicion- Mitral Reqagitation -
Duration of sickness,
aIndefinite
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
Arthur J. Scolonia,
M. D.
Date of Certificate,
8/ 190/189
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If ehild dicd immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
201
§ If married, widowed }
¿ also state fully. Chelmsford, Mais
No.
RETURN OF THE DEATH
1
OF
at
Date,
ʻ 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 thercof to the board of health or to the clerk of the city or town in which the death occurred. (Sce 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. (Sce 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 interi.hier 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.
Rod
Commonwealth of Classachusetts.
[ACTS OF 1897, CHAP. 444.]
SECTION 13. The clerk of each city and town shall forthwith make certified copies of the records of all births and deaths recorded in the books of said city or town during the previous month, whenever the deceased person or the parents of the child born were resident in any other city or town in this Commonwealth or any other state at the time of said birth or death; and shall transmit said certified copies to the clerk of the city or town in which such deceased person or parents were resident at the time of said birth or death, stating in addition the name of the street and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained; and the clerk of every city or town in this Commonwealth so receiving such certified copies, or certified copies of births, deaths or marriages, from the clerk of a city or town without the Commonwealth, shall record the same in the books kept for recording births, deaths or marriages.
Blank to be used in compliance with the foregoing. (FILL OUT WITH INK, ALL NAMES TO BE IN FULL.)
Copy of the Record of a DEATH
recorded in the books of the City of Lavell
during the month of
(City or Town. ) June 1899.1901
1. Date of Death,
June 12 1901
2. Name,
James to M' Enally
(Maiden Name), . (Name of Husband),
3. Sex and Color,
male W-
married
4. Single, Married, Wid- owed or Divorced,
5. Age, 38 Years, Months, Days.
Disease or Cause of Death,
appendicitis
6. {Duration of Sickness, By whom certified,. .
I. V. meigs m. D
7. Residence,
Highland avenue North Chelmsford
8. Occupation,
Sexton in Church
9. Place of Death, .
St. John's Hospital Lowwill mars
10. Place of Birth, north Chelmsford.
11. Name of Father, James
12. Name of Mother, (Maiden Name.)
Juland
13. Birthplace of Father, .
Ireland
14. Birthplace of Mother, .
St Patrick Cem, Lowell mais,
15. Place of Interment, (Name of Cemetery.)
I certify that the foregoing is a true copy.
Attest : Gerard Sadman mais
1899.
City . Clerk.
(City or Town.)
1
232
Mary ( Ready
No.
COPY OF A RECORD
OF THE DEATH OF
which occurred in the. (City or town.) of
1899.
Filed
1899.
233
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.)
/ Namc, Fredrick 2. Blodgett. Sex, Color,
2
Date of Death, Jamie 29 th
190/; Age, 86 Years, 8 Months, 2 Days.
3
Maiden Name, { If married, widowed ) or divorced.
x Husband's Name,
X Single, Married, Widowed or Divorced, Occupation, Farmer
6
*Residence, { If out of town, )
¿ also state fully.
North Chelmsford
7 Place of Birth, Tyngsboro bass
8 *Place of Death, A. Chelunsford Mask
Name and Birthplace of Father, Fredrick Blodgett (Binet place Unknown
; X Hannah Parkhurst Dunstable
10
Maiden Name and Birthplace of Mother,
/1 Place of Interment, (Give name of Cemetery), North Chelow fod River Side Centery
Dated at ..
A. Chelmsford
Signature and
John marinel 20
on June 24th
190/
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Frederick Wr Blodgett Age. 86y. 8 M. 2 D.
Place and Date of Death,
died at
North Chekanferd Same 29 90%.
Methatis
Duration,
2 years
Duration,
I certify that the above is true to the best of my knowledge and belief.
FE Tamney
M. D.
Signature and Residence
of
Certifying Physician.
North Chekustens
Date of Certificate,
1
190 /.
forly
* 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.
1
Agent of Board of Health.
- Primary, Disease or Cause of Death, # Secondary,
place of business of Undertaker.
Rec
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 oceurs, 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 eity or town in which the death oeeurred.
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 eity or town within the Commonwealth at which his vessel first arrives after sueli 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 faets.
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 negleet, 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 certifieate made in accordance witli section 10, and return it, together with the facts required by seetion 1, to the board of health or to the elerk of the eity or town in which the death oeeurred.
[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 sueh 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 , rod to the 4 Board of Health, the board or agent shall forthwith countersign and trans"
un c . c. town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars. -
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,
Ward
Sex,
1
. Color,
Date of Death,
1800/; Age,.
73
Years,
9
Months.
2.5
Days.
Maiden Name,{
{ If married, widowed }
or divorced.
Husband's Name, David KENuke
Single, Married, Widowed or Divorced, . Married
Occupation, ... Fanquer
* Residence,
{ If out of town, }
also state fully
Place of Birth,
Parish of St. Uune P. 2. Canada:
* Place of Death,
Name of Father,
Birthplace of Father, Trine Hh Que S. S. Canada.
Maiden Name of Mother, Teen Margaret Perrin
Birthplace of Mother, Perion IShemma I. 2. Canada.
Place of Interment, (Give name of Cemetery), West Shelunsford
Dated at
Powell
on Jules 3, 1901
Signature and
place of business
of Undertaker.
Lawwell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
David NEJake Age, 73 %. 9 M 28 D.
Place and Date of Death, died at
Disease or Cause of Death, #
Wass Placas jord, July 1, 1201
Chronic Cystitis
Duration of sickness,
Several months.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
S
Amasa Atoward.
M. D.
of Certifying Physician.
Chelmsford
Date of Certificate
Jah 2
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.
Recce James 3.
لايجد
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 'n having charge of t ... Ta 'inind. o the interment a huma
shall obtain the physics rtificate made in accordance with Lection to and return it, togethe, with the fac re- quired by section I, to the i . .. do health or to the clerk of the city ; town in which the death occurred.
235
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,
Date of Death,
.190 / ; Age, ....::
.Years, -Months, ................. Days.
Maiden Name, {
( If married, widowed į
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
*Residence, ¿also state fully. §
{ If out of town, {
Prelunford
Gender
Place of Birth,
* Place of Death,
Name of Father,
adelaide Gerais
Birthplace of Father,
Ginada
Maiden Name of Mother,
adeline
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Dated at
Signature and place of business of Undertaker. 1
Of chambault
2738 menmach
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt Place and Date of Deathı, died at Still form
1
Age,
Y
M
D.
T
Disease or Cause of Deathı, #
Duration of Sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence 5 - of City Physician.
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
TRADES HAMN COUNCIL
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 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 foi i term. La human body · shall obtain the physician's certific. made in accordance with section Io, and ? w. it, togen . vith the facts required by section I, to the board of health or to the clerk of the city or town in wh . 1 1. leath occurred.
Rec FORM C.
236
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,
Seth 0 Sampson
Sex,
Color,
Date of Death, July 1st
190/; Age, 18 Years, 10 Months,
... Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divoreed, Occupation, mason
*Residence, ¿ also state fully.
{ If out of town, }
North Chelmsford
Place of Birth,
Fitchburg
base
*Place of Death,
cs. Chelmsford
Name and Birthplace of Father, Blaney Sampean Fitchburg
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Riverside
Cemetery
Dated at
A. Chelmsford Masz
Signature and
-
Jolie marinel gr.
on July 125
190 (
place of business
of Undertaker.
1ch. Chelmsford masa,
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Seth Q Sampson
Age, 78 x 10 M. / D.
Place and Date of Death,
died at ...
no chelmsford
July 1"
.190/.
Disease or Cause | Primary,
of Death, #
Secondary,
Cancer
Duration, several years.
old als
Duration,
I certify that the above is true to the best of my knowledge and belief.
masa Steward.
Signature and Residence S
of
Certifying Physician.
Chelmsford . Mars.
Date of Certificate,
July 32%
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.
M. 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 suchi 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.
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,
Premiative chile
Jean
Sex,
Female Color,
Date of Death, July of
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,
Chiliand make
*Place of Death,
Name and Birthplace of Father,
William It. Bean, Manchristian, W, LA.
Maiden Name and Birthplace of Mother, ..
Sala B. Porter, Suwork,
"
-
Place of Interment, (Give name of Cemetery).
Price Range Century
Dated at
Chelmsford, Mark
Malta Perhaus
July 12
on
190 /
Signature and
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Final cheek ME B. Beau
Age, ~ Y. ~ M. ~ D.
July 1%
190/.
Disease or Cause
of Death, ±
Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
-
Signature and Residence S
of
Certifying Physician.
Chulmustard, Taxe
Date of Certificate, July
S
190 / .
* Give also street and number, if any. t Give sex of imant 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.
Place and Date of Death,
Primary,
died at
Premativa bitte
Duration,
1
.M. D.
237
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 notiec 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 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 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 aud 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.
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