USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 19
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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 feturn it, together with the facts required by section t, to the board of health or to the clerk of the city or town in which the death occurred.
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,.
alexandra orange
Sex
Mali,
.Color,
White
Date of Death.
Dec 10
190 /; Age,
3 Years,
Months,
... Days.
Maiden Name,
{ If married, widowed ] ..
or divorced
Husband's Name,
Single, Married, Widowed or Divorced
-
Occupation,
If out of town }
# Chileford leenter Mass.
*Residence
( also state fully,
Place of Birth,
Thelostora Center Mass
*Place of Death,
hilmiford Center mass-
Name of Father,
Rohov Baptiste Palavras
Birthplace of Father,
Carlada
Maiden name of Mother,
Birthplace of Mother,
Canada;".
Place of Interment, (give name of cemetery)
St. Joseph Cemetery
Dated at.
will mass
Signature and
place of business
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t
Place and Date of Death,
Disease or Cause of Death,#
Duration of Sickness.
5 des )
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
DronBoulets
M. D.
of
City Physician
730 Marnach
Date of Certificate
Que 10
Agent Board of Health.
* 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.
Rich DeL/C
TRADES AT COUNGE 5
.......
.....
Dec 10
. 901
ofUndertaker
# 5M leherer
Mexandere Roberge
Age, 3 Y. 5º
.. M,
........... D.
died at.
Laurea
-Que La
No. RETURN OF THE DEATH
OF
at
Date,
I
Filed,
I
..
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 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 the 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 t, to the board of health or to the clerk of the city or town in which the death occurred.
Pochette.
1
Ret
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,
anastasia. V Ne Larney
Sex
Color,
Date of Death
Dec 15
190 L; Age,
là.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,
Source
*Place of Death,
Chelmsford
Name of Father,
James a de Larey
Birthplace of Father,
Lowell
Maiden name of Mother,
Rose Mc Nally
Birthplace of Mother,
Ireland
Place of Interment, (give name of cemetery)
At Patrick
Dated at
Lowell
Signature and
Hore Dermott
on Die 16
1201
of Undertaker
place of business
3
70 gorkan st
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased f
Age,
18 %.
M,
D.
Place and Date of Death,
died at
Rattusco
Disease or Cause of Death,#
Duration of Sickness.
Signature and Residence
of
City Physician
Date of Certificate
1981
Agent Board of Health.
* 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.
TRADES MASK COUNCIL 5
1
I .....
M. D.
No.
RETURN OF THE DEATH
OF
at
Date,
I
Filed,
I
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 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 the 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 t, to the board of health or to the clerk of the city or town in which the death occurred.
12
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, ..
Canna Servert
Sex, Amalolor,
Schitz
Date of Death
Dec 20
190/ ; Age,
2 Year
/Years,
Months,
Days.
Maiden Name,
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
§ If out of town {
# West Chelmsford Masse
*Residence
( also state fully,
Place of Birth,
Westford Mais
*Place of Death,
# Mest Chelmsford, Mass
Name of Father,
Albert Bourvert
Birthplace of Father,
Canada
Maiden name of Mother,
Maggie Hearging
Birthplace of Mother,
Place of Interment, (give name of cemetery)
It Joseph Cemetery
Dated at.
Forall Arass
Signature and
place of business
on Die 20
I
907
of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t
Place and Date of Death,
Disease or Cause of Death, #
anna Boisvert
Age,
2 x.
4 M.
..... D.
died at.
West Cheliefert Dec 20.
1 907
Duration of Sickness.
8 days.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
JE Varney
M. D.
of
City Physician
7. Chehus Serl
Date of Certificate
Dec 20
1901
Agent Board of Health.
* 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.
SLAB COUNCIL 5
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
S .
Joseph Albert
# 57 Relever
Rei FORM C.
( 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, 11 AND 12.]
SECTION 16. 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 the 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 t, to the board of health or to the clerk of the city or town in which the death occurred.
13
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,
Sex,.
.Color,
Date of Death,
Dec. 2,0-
190/ ; Age, 2 Years,
4 Months,
.. Days.
Maiden Name,
{ If married, widowed }
or divorced.
1
Husband's Name,
Single, Married, Widowed or, Divorced, Occupation,
*Residence, { If out of town,
¿ also state fully,
Place of Birth,
Sheetford, Mand
*Place of Death,
Shealth Suchu, ford, trans.
Name and Birthplace of Father,
Albech Greenwood, Canada
Maiden Name and Birthplace of Mother, Margarch Gran, Ireland
Place of Interment, (Give name of Cemetery),
Ro Catholic Lowil ( Max)
Dated at.
on
20th Day Of Dec
190 /
Signature and
place of business
of Undertaker.
WW Chelmsford Alors
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death,
Primary,
Diph theria
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of
JE Varney
M. D.
Certifying Physician.
HorasChelunfinal
Date of Certificate, Dee 20-
190
* 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.
Agent of Board of Health.
annie Green word.
Age, 2 x. 4 M.
D.
died at
at WeetChelunsford
Dec 20
190/.
Disease or Cause of Death, } Secondary,
1
No.
RETURN OF THE DEATH
OF
at
....
Date,
190
Filed, 190.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate 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.
FORM C.
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,
Henrietta m Dutton Sex,
Color,
Date of Death,
December 28 190/; Age, 63 Years,
9
Months,
18 Days.
Maiden Name,
{ If married, widowed }
or divorced:
Henrietta In m & questen
Husband's Name,
Engene I S Button
Single, Married, Widowed or Divorced,
Occupation,
Stava Gutter
*Residence, { If out of town, )
? also state fully. §
A. Chelmsford nasa
manchester New Hampshire
Place of Birth,
*Place of Death,
Chelmsford mars
Temple mi Questen Litchfield
Name and Birthplace of Father, Betty Phelps, Groton 1 86. Maiden Name and Birthplace of Mother,
-1.26
Place of Interment, (Give name of Cemetery),
-1: Chelmsford Riverside Cemetery
Dated at.
1. Chelmsford Mak.
Signature and
John married 98
on Dec 28 15/.
190/
place of business
of Undertaker.
Ich Chehistoire /
#+4.22
PHYSICIAN'S, CERTIFICATE.
Name and Age of Deceased, t -
Place and Date of Death,
Primary,
Disease or Cause
of Death, į
Secondary,
died at
Cerebro Spinal meningitis
Duration,
Junks
Duration,
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.
7. Chelmsford.
Date of Certificate,
Dee 28'
190/.
* 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.
Occul Sec. 30 , 0l 1
Agent of Board of Health.
14
Henriette M Dutton
Age, 634.9 M. 18D.
190/ .-
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 faets.
SECTION 11. In case the deccased 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 eity 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 such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate arc delivered to the Board of Health, the 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.
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