USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 16
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SECTION 5. Penalty for violation not exceeding fifty dollars.
KCU 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,
Ella Si/ moore
Sex,
Color,
Date of Death,
billy 12 1901 ; Age, 99 Years,
Months,
Days.
Maiden Name,
{ If married, widowed }
or divorced.
Gilchrist
Husband's Name,
George & Moore
Single, Married, Widowed or Divorced,
Occupation,
At home
*Residence,
Tho, Chelunsford Mask
Place of Birth,
Spowell.
*Place of Death,
no. Chelmsford
Name of Father,
George & Gilchrist
Birthplace of Father,
Maiden Name of Mother,
Chancy Joule
Buxton me.
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Lowell Cemetery Lowell
Dated at
Spowell
Signature and
GBbanier
on.
July 13 1991
I
place of business
of Undertaker.
Lowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Uns Ella D'moore
Age,.,
49
Y.
M
D.
Place and Date of Death,
Disease or Cause of Death, #
Panalysis of Bowls.
Duration of sickness,
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.
1901.
* Give also street and number, if any.
+ Give sex of infant not named. If still-born, so state. If child dled immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Lic, Jag 13
238
died at
Tto Chelmsford ( Mass July 12 1901
Know me.
{ If out of town, {
[ also state fully }
No.
RETURN OF THE DEATH.
OF
at
I
-
Date,
Filed,
I
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, II AND 12.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION IO. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section Io, and return it, together with the facts re- quired by section 1, to the'board of health or to the clerk of the city or town in which the death occurred.
..
FORM C.
Commonwealth of Massachusetts.
No
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Margaret Su kin
(FILL OUT WITH INK.
ALL NAMES TO BE IN FULL.)
Sex, Color,
Date of Deatlı, . July 25d
1001; Age, 26
Years, .. ..... . Months,
Days.
Maiden Name, { or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation, Highland over worth Theles ford
*Residence, { also state fully. §
§ If out of town, }
Lowell Mass
Place of Birth,
* Place of Death,
Highland air with Chilcuster
Name of Father, John Laitin
Queband
Birthplace of Father,
Maiden Name of Mother, Mary Saumon
Birthplace of Mother,
Place of Internaent, (Give name of Cemetery).
Dated at will Maso
July 25g
Signature and place of business of Undertaker. '
3
324 market
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Margaret Larkin 26 ... Y. M. D.
Place and Date of Deatlı,
died at North Chuliusfor July 23 1401
Disease or Cause of Death, #
Concuculitica
Duration of Sickness,
six month
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
e )
Hench chilundo
Date of Certificate. July 23 1401
* 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
23%
Irland
Stabucks center
Age,
FE Varney M. D. of City Physician.
{ If married, widowed }
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 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 Io, 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.
ther
FORM C.
Commonwealth of Massachusetts.
No
RETURN OF A DEATH. 4 To the Clerk of the City or Town in which the death occurred.
Name,
Daniel Lo Sleeper
Sex,
In
Date of Death,
July 26 1991
189 ; Age
63
Years,
6
Months,
10
Days.
Maiden Name, { If married, widowed } or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,.
*Residence, { If out of town, ) Thor Chelmsford IMask
{ also state fully )
Apsweek ..
Place of Birth,
* Place of Death,
No. Chelmsford
Name of Father,
Jonathan lo Sleeper
Birthplace of Father, Grafton h.H.
Maiden Name of Mother,
Hannah Melmurphy
Birthplace of Mother, houth Chelmsface
Place of Interment, (Give name of Cemetery),
Dated at
Lowell
3
on ..
July 27 1991
Signature and
place of business
of Undertaker.
Lowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt Daniel Na Gleeher Age, 63 %.
M.
D.
Place and Date of Death,
Disease or Cause of Death, #
General Paralysis
Duration of sickness,
two years
I certify that the above is true to the best of my knowledge and belief.
JE Janney
M. D.
Signature and Residence of
North Chelinford
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 Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Je vairés
... ...
died at
no Chelmsford July 26 1901
Alexandria R.H.
Certifying Physician. July 27 9
240
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Color,
No.
RETURN OF THE DEATH.
OF
at
I
Date,
Filed,
1
I.
Acts of 1897, Chapter 444.
[EXTRACTS FROM SECTIONS 6, 7, 8, 10, II AND 12.
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION IO. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section Io, and return it, together with the facts re- quired by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
24/
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,
Alma Graziella Jaurence Sex, female color,
¿ Sex Female color: White
Date of Death,
July 30
190 ; Age,
-
Years ....
Months,
Days.
If married, widowed {
-
Maiden Name,
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,.
# Chelmsford leinter Mass
( If out of town, }
Place of Birthı,
* Place of Death,
Name of Father,
Fraule Lawrence
Birthplace of Father,
Stalis-
Maiden Name of Mother,
Sarah Frazer
Birthplace of Mother,
Canada
Place of Interment, (Give name of Cemetery),
Ir Joseph Cemetery
Dated at
Powell Mars
Signature and
place of business
of Undertaker. !
#5% lehever
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt Alma Graziella Surmage,
Y.
M.
D.
Place and Date of Death,
Disease or Cause of Deatlı,#
died at
Claudineford Center)las, July 301901
Premature Birth
Duration of Sickness,
Lived 24 hours,
2
I certify that the above is true to the best of my knowledge and belief.
Vitamina
.M. D.
546 Middleware Sh~ Date of Certificate July 20th 1901 I
Lowcle met
* 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.
5
TRADES NON EJUNCK
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
guy 8.1 3.1
Signature and Residence S of City Physician.
Joseph Albert
011 ..
July 30
1907.
Occupation,
-
*Residence, { also state fully. §
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.
shall o ..! required
Les fre. what is the interment of a bridan sod rate made in accordance with section to, and return it together with the facts v. Board of health or to the clerk of the city or town in which the death occurred. "
Parkhurst .
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,
Frances & Brown
Sex female olor, white
Date of Death,
aug
8.
190/ ; Age,
63 Years, 7
Months,
15 Days.
Maiden Name,
{ If married, widowed }
Frances S Samphere
or divorced.
Husband's Name,
Hiram of Brown
Single, Married, Widowed or Divoreed,
Widow Occupation,
*Residence,
[ If out of town, }
Chelmsford
( also state fuby,)
Hartford Vermont
* Place of Death,
Chelmsford Centre
Name of Father, . Levi Lamphere
Birthplace of Father,
Hartford Vermont
Maiden Name of Mother,
Fannie C. Laurier
Birthplace of Mother,
Hartford V.
Place of Interment, (Give name of Cemetery), Chelmsford
Dated at
Sowell
Signature and
011 aug 8
1901
place of business
of Undertaker. 1
3. Prescott At
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Frances Li Brown
Age,
63%. 7 M /S .D.
Place and Date of Death,
died at
Chelmsford
Imam.
aug. 8 901.
Disease or Cause of Death, #
Prim. Inalig maut Disease [fir.
Secondary.
"1
n
Stomach.
Duration of Sickness,
9 months +
I certify that the above is true to the best of my knowledge and belief.
Antie y. Scorria
signature and Residence §- of
Chelms por ondas
M. D.
City Physician.
Date of Certificate
Hug. 9,
19/01.
* 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.
# 11 a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Canse.
5 at home Centre I Place of Birth, C. m. young bles 3 242 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 required by section 1, to the board of health or to the clerk of the city or town in which the death occurred. - Reo Commonwealth of Massachusetts. No. RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred. i (FILL OUT WITH INK. ALL NAMES TO BE IN FULL.) Name, Samuel loan Sex .. male Color, Date of Death ana, 21 st 1901, 189 ; Age, 56 Years. 10 Months, Days. Maiden Name, { If married, widowed } or divorced. Husband's Name, Single, Married, Widowed or Divorced, Married Occupation, Atrecuttiv *Residence, {If out of town, ) Str. Philment Mask also state fully. Place of Birth, freetown forthand. *Place of Death, Dr. Philmetod Mass Name of Father, Samuel Obrán Birthplace of Father, freetown Scotland. Maiden name of Mother, anni Queen Birthplace of Mother, Place of Interment, (Give name of Cemetery), to Chelmsford Hart ford Dated at So Chelmsford Signature and Damal Y Byan. (Cemetery on ana 22 190 1 of Undertaker. So Themohard Man PHYSICIAN'S CERTIFICATE. Name and Age of Deceased, t Place and Date of Death, } died at So. Chelmsford 189 Discase or Cause of Death, § Duration of sickness, I certify that the above is true to the best of my knowledge and belief. wat phnom D. Signature and Residence of Sowill Mes Date of Certificate, Aug. 22 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. Read Cing 2-2 243 Samuel Loan Age, 568.10 M. D. Certifying Physician. 1901 place of business 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 of town in which the death occurred. Re FORM C. D 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 tud 31 190/ ; Age, . Years, Months, Days. Maiden Name, or divorced. wed ! Husband's Name, Single, Married, Widowed or Divorced, Occupation, { If out of town, } Forth Chelunsford *Residence, {also state fully. § Place of Birtlı, * Place of Death, Patrick North Walesford Birthplace of Father, Maiden Name of Mother, Birthplace of Mother, D. Jatriks Cemetery foule Mass. Place of Interment, (Give name of Cemetery), Dated at 011 Lug. 31 Signature and place of business of Undertaker. 1 169 Worden DAlaisty Total Mass. PHYSICIAN'S CERTIFICATE. Mariorix. Ward Age. 13. M. D. .. Name and Age of Deceasedt Place and Date of Death, died at North Ofelmafre aug2 901. 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 Residenee fameo M. D. Lowell ·Date of Certificate of City Physician. Sezt 1 1901 * Give also street and number, if any. t Give sex of infant not named. If still-born, so state. If ehild died immediately after birth, so state. * If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Canse. 5 TRADES LALE COUNER Sex, Color, Date of Death, { If married, widowed { 244 Peter the Javado Name of Father, No. RETURN OF THE DEATH OF * at r . Date, I Filed, I C 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 forthi 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 1, to the board of health or to the clerk of the city or town in which the death occurred. 1 245 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, Michael Holland Sex, Color, .... Date of Deatlı, . Sept 9 1901; Age, 86 Years,. Months, . Days. { If married, widowed { Maiden Name, { or divorced. Husband's Name, Single, Married, Widowoder Divorced, .. Occupation, Labores ( If out of town, } *Residence, ¿ also state fully. ] North chel sford Place of Birth, duland * Place of Death, North chelmsford mass Name of Father, Patrick Holland Birthplace of Father, Juland Maiden Name of Mother, unknown Place of Interment, (Give name of Cemetery), Dated at Lowell J. H. Mc Dermott O11 .. Sept 9 1901 Signature and place of business of Undertaker. : 70 Gorhan At PHYSICIAN'S CERTIFICATE. Name and Age of Deceasedt Place and Date of Deatlı, died at Forthe Chelmsford Mars Sep. 19.01 Disease or Cause of Death, Old age Duration of Sickness, I certify that the above is true to the best of my knowledge and belief. signature and Residence § Quees Porti M. D. of City Physician. 253 Central 5% I * 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 THADES LABEL COUNCIL Lefort , 10 Date of Certificate. Kuchael Holland Age, : 86 y. M. D. Birthplace of Mother, duland St Patrick 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. I11 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 returist, 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. 246 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.) Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.