USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 2
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128
Color,
No.
RETURN OF THE DEATH
OF
1
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
129
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,
0
Sex, Color,
Date of Death,
189
; 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. §
6
Place of Birth, 5
*Place of Death,
Name of Father .......-
-
Birthplace of Father,.
Maiden name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery).
.· Signature and
A.G. Parkhurst
Dated atAz
place of business
on
189
· of Undertaker. Insim)ord.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
andrew anderson
Age, 504.10 M. ...... D.
Place and Date of Death, }
died at
Weet Cheliefer Jaby 1548900
Disease or Cause of Death, §
Tuberculosis
Duration of sickness,
Har5 months
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
F.E. Varney M. D.
north Chehusfind more
Date of Certificate,
July 16h
18:00
Give also street and number, if any.
+ 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.
No.
RETURN OF THE DEATH
OF
at
Date,
189
Filed,
189
The provisions of chapter 444 of the Aets 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 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 thic city or town in which the death oceurred. (See section 6.)
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. (See section 7.) Penalty for negleet to comply with the requirements of sections 6 and 7, five dollars. (Sec section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required faets. (See section 10.)
Penalty for refusal or neglect, ten dollars. (Sec section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certifieate made In 1 In the hand of
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,
Ratier MS multe
Sex,
Color,
Date of Death,
Fabry 2,2
19010
≥189
..
Age, 21 Years,
.......... Months, ...
.. Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, ... Occupation, Sant Cheenagent mais
*Residence, {If out of town, )
¿ also state fully. 3
Place of Birth,
Sait-Cofa Cmd+primary
*Place of Death,
Name of Father,
Birthplace of Father, Freland
Maiden name of Mother,
Bridget Barrett
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Afin tricks hacer
Dated at
Signature and
on 230
1
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died a
East Chelmsford Feb. 22
1900
Disease or Cause of Death,#
Pulmonary Tuberculosis.
Duration of sickness,
10 months.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
Amara towards
M. D.
of Certifying Physician. 2
Chelmsford claro
Date of Certificate,
426.24
1900
189 -.
* 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 Cause.
180
190€ 189
place of business
of Undertaker.
Katie 6. m& nulty
Age 2/8
.M.
D.
No ..
RETURN OF THE DEATH
OF
at
Date,
189
Filed,
189
..
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 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 Tad hur soption 1. to
13/
Permit No.
RETURN OF DEATH. BOSTON.
Year,
18-105
Years,
Date of death Month,
Year, 19 00 Feti Birth Month, full Age Months,
05
Days, 7
Maiden name, Beretta May Te Gregor
Male.
Sex Conjugal condition Female. X female
Single. Married. X Ara ... Widowed.
Color
White. VIhic Black (Negro or mi.ved). Indian. Chinese. Japanese.
Wife of both & more hall
Place of death ? Street, - Hotelmeford.
Place of birth,
Number, Easton arowe tookCe. There's,
Occupation, nous.
Name of Father, So. N. M. theyer Maiden Name of Mother, Mary J. Incell
Birthplace of Father, Sulle Mais Birthplace of Mother, Weetford M-a 2.
Place of interment, Treat Cheleuegend, Pearl
AD Richardson Northord. Mas
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
Fick 23
1900
Name and age of deceased, ... ms Bertha Marshall Age, 74 years.
Date and place of death,*
Mr. Chelmsford
Disease
Chief cause,.
Contributing cause, 1. Chief cause
Duration Contributing cause,
I certify that the above is true, to the best of my knowledge and belief.
Name and residence ? of physician, 22 Bowdown St. Barton Mass
* If in an institution, state how long an inmate and previous residence.
The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A. M. till | P.M .. except during the months of June, July, August and September, when the office will be closed on Saturdays at 12 M. ; Sundays, 10 A. M. till 12 M. ; Holidays, from 10 A.M. till 12 M .; other days, from 9 A.M. till 5 P.M.
f
Rec
J
Name in full,
Day, 22% Bertha Thay Martial Residence,
Day Wheat Cheveux foro
1
Divorced.
Widow of.
Consumption
H & Mace M.D.
٢٠١٣
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,
Eftercum
Ellatt
Sex, MA
Color,
Date of Death,
Mek 27
19 00
Age, 67
Years,
Months,
26 Days.
Maiden Name,
{ If married, widowed į
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,
Otienesfund Eller)
Name of Father,
ENtrain.
Ethorx
Birthplace of Father,
Maiden Name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Dated at
on diab 28
1900
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,* Ochrana Ellett
Age, . 67 mpix 7mois 27ds.
Date and Place of Death, i - died at. Chelmsford Haus. Fich 27.
Disease or Cause of Death, - (Primary und Secondary.) } Duration of Sickness, -
1900, Cardiac Asthenia following Asthma. Two months I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, Arthur, Sestoria Chebreton, Linux.
Date of Certificate,
Feb 28,
* Or Sex of Infant (not named). If stillborn so state.
t If child died immediately after birth so state. Plate. Ed. December, 1896 .- 5,000.
# If a soldier or sailor who served in the War of the Rebellion.
132
ing fifty dollars.
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 26.
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for reg tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dyi immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certifica stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician no leets or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceedi fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give bc the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negler to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides. SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such c. or town, from the city or town clerk. No sueh permit shall be issued until there has been delivered to such board, or agent clerk, as the case may be, a satisfactory written statement containing the faets required by this chapter to be returned a: recorded, together with the eertificate of the attending physician, if any, as required by section three of this chapter, or in li thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physici cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or a physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the sam When such satisfactory statement and certifieate are delivered to the board of health or to its agent, the board or agent shall fort with eountersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so give shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as t elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not excee
No.
'ETURN OF THE DEATH.
Ephraim Elliott OF
....
Guerra Jones
ate, 1900
,led,
March 1 1900
Acts of 1897, Chapter 444.
EXTRACTS FROM SECTIONS 6, 7, 8, 10, II AND 12.]
r in whose house a death occurs, the oldest person next of kin present at the I, or the person in charge of an institution in which a death occurs, shall, within 1, give notice thereof to the board of health or to the clerk of the city or town in
officer of a vessel shall give notice of the death of any person under his charge f the city or town within the Commonwealth at which his vessel first arrives
to comply with the requirements of sections 6 and 7, five dollars.
has attended a person during his last illness shall forthwith after the death of registration a certificate setting forth the required facts.
sed was a soldier who served in the war of the rebellion, give both the primary of death as nearly as he can state the same. Penalty for refusal or neglect, ten
ig charge of the funereal rites preliminary to the interment of a human body and return it, together with the facts re-
Reco
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,
Meweil E
ker
Sex Male Color, celuites
Date of Death, march 9.
19.00
189 ; Age,:
8
Years
2
Months,
28
Days,
Maiden Name, { If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, wedoner
Occupation, Carpenter
* Residence,
{ If out of town, {
falso state fully f
Dans la habanaford
Place of Birth,
la ligafold.
* Place of Death,
Name of Father, E li 4 Partier
Birthplace of Father,
Maiden Name of Mother, Nancy B Pierce
Birthplace of Mother,
Place of Interment, (Give] name of Cemetery),
Dated at Sa Chelmsford
10 des
March
I
Signature and place of business of Undertaker.
on ..
PHYSICIAN'S CERTIFICATE. -
Name and Age of Deceasedt Newell E. Parker
Age,. 58 Y 2 M 28 D.
Place and Date of Death,
died at
Chelmsford, Mark, March 9,1900.
Disease or Cause of Death, # Servicione Unacucina Plathici Palmonalis.
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.
Arture M. Sestra
M. D.
Date of Certificate.
March 9,
1900,
* 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.
133
6 hebraford
laelmsford. Hart land Of emertary. himal
No.
RETURN OF THE DEATH.
OF
4
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 cer · CE
IO, al
1 Wi c.3 re-
quired by section I, to the board o.
e cle. ¿ of the ( ty c
occurred.
,
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,
Susan
A. Whitemore
Sex, , female Color White
Date of Death,
March 14 1989; Age, 80 Years,
4
Months,
15
Days.
Maiden Name,
or divorced.
{ If married, widowed }
Susan
Varnurin widowed
Husband's Name,
James Whittemore
Single, Married, Widowed or Divorced, widowed Occupation, at home
* Residence,
{ If out of town, {
( also state fully )
North Chelmsford
Place of Birth,
Dracut Mass
* Place of Death,
north Chelmsford
Name of Father,
Joshua Varnum
Birthplace of Father,
Dracut mass
Maiden Name of Mother,
Susan Hildreth
Birthplace of Mother,
Dracut mass
Place of Interment, (Give name of Cemetery),
north Chelmsford
Dated at
"Lawill !.
C. M. youngilo
1
Signature and
place of business
of Undertaker.
33 Prescott It
on
March 14 . 1900
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Susan Whitemore, 80 × 4 × 15 D.
Place and Date of Death, died at north Chelmsford March14.1900
Disease or Cause of Death, #
Sa Brille and asthma
Duration of sickness,
one must.
I certify that the above is true to the best-of my knowledge and belief.
Amara Howard.
M. D.
Signature and Residence S of - CertifyIng Physician. Chelmsford Mass.
Date of Certificate
Mich. 14
1900
* 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.
Ker
2
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 charm of 1.
135
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,
John Mc nalley
Sex.
m.
.Color,
w.
Date of Death,.
Mar, 16,
189
900
; Age, 7 4 Years, - Months, ~Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Molder.
*Residence, { If out of town, } ¿ also state fully. 3
Place of Birth,
Ireland
*Place of Death,
North Chelmsford
Name of Father,
James Mc Halley
Birthplace of Father,
Ireland
Maiden name of Mother,
Mary Ward
Birthplace of Mother,
Ireland
Place of Interment, (Give name of Cemetery),
ST Johns Worcester
Dated at north Chelmsfords
John CA Healy
on
Mar, 17
489
19000
place of business
of Undertaker.
Graniteville Mars
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,* John M: Enally
Date and Place of Death, t -
died at ....
no. Chelmsford mich. 16"
1900
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, -
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
amara
toward M.G.
Date of Certificate,
mch. 17
1900
1800
* Or Sex of Infant (not named). If stillborn so state. { If child died immediately after birth so state. Plate, Ed. December, 1896. - 5,000.
# If a soldier or sailor who served in the War of the Rebellion.
AVALIVIL, BIYE vuLLI Primary and Secondary Cause.
.
Age,
of Chronic Cystitis
No.
RETURN OF THE DEATH
189
189
OF
cate,
Siled,
Acts of 1897, Chapter 444.
ereof to the board of health or to the clerk of the city or town in which the death son in charge of an institution in which a death oceurs, shall, within five days after whose house a death oceurs, the oldest person next of kin present at the time of the ETRACTS . FROM SECTIONS 6, 7, 8, 10, 11 AND 12.]
I was a soldier who served in the war of the rebellion, give both the primary and ation a certificate setting forth the required facts. 's attended a person during his last illness shall forthwith after the death of said comply with the requirements of sections 6 and 7, five dollars. y or town within the Commonwealth at which his vessel first arrives after such death. er of a vessel shall give notice of the death of any person under his charge to the
charge of the funereal rites preliminary to the interment of a human body shall obtain th as nearly as he ean state the same. Penalty for refusal or neglect, ten dollars.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.
SECTION 3. A physieiau who has attended a person during his last illness shall, when requested, forthwith furnish for regis tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which li died, the duration of his last siekness, and the date of his deeease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give botl the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in whieli he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body uutil lie has received a permit so to do from the board of health or its duly appointed ageut, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent of clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lien thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician caunot be obtained, for good and sufficient reasous, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; aud in case of death by violenee the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the deatlı, as the elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exceed- ing fifty dollars.
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