USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 3
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136
FORM C.
Commonwealth of Massachusetts.
No
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Lanul Daily
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex, Color
Date of Death,
March 239 900, Age, 60
Years,.
Months, .....
Days.
Maiden Name, {If married, widowed ) or divorced.
Husband's Name,
-Single, Married, Widowed or Divorced,
Occupation,
mouldy oftrong
"Residence,
( If out of town, }
[ also state fully )
Anth Chelunsford Mass
Place of Birth, Auchand Inth Chelesford Mass * Place of Death,
Name of Father, not known
Birthplace of Father,
Maiden Name of Mother, 1 ,
Birthplace of Mother,
1
Place of Interment, (Give name of Cemetery),
Dated at a. Kul Ataes
Signature and place of business of Undertaker.
324 market St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Daniel Laley
Age, ...
60 % - M. -
D.
Place and Date of Death,
died at
north Chelmsford mich: 23,900
Disease or Cause of Death, #
Pneumonial
Duration of sickness,
one will.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S Umara Itawards
of
Date of Certificate.
Clubmeford. M. D. Certifying Physician. nich, 24 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.
231 march , 900
on
2011
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 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 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
.
.1. the forts re-
Rec
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,
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,. Nvouet Occupation, Machinist
*Residence, { If out of town, )
¿ also state fully. y
Place of Birth,
%
*Place of Death,
Name of Father, 1 -UN.
Birthplace of Father,
Maiden name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
2. we
I.H. Brooks
Dated at
on
189. ... of Undertaker.
. Signature and place of business Awall Mans
Name and Age of Deceased,*
Missulice ugnen
Age, 2 Typo.
Date and Place of Death, t - died at. Ix Cheline Lord Mass. March 202 . 1900
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, -
of
Complication of Diseases 1
I certify that the above is true, togthe best of my knowledge and belief.
Signature and Residence of Certifying Physician, Hartford Mass:
Date of Certificate,
March 23"
1900
.
* Or Sex of Infant (not named). If stillborn so state.
{ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
# If a soldier or sailor who served in the War of the Rebellion.
137
..
.... .
189
189
OF
No.
f 1897 require that every householder in whose house a death occurs, the death of any of his kindred, or the person in charge of an institution in the date of such a death, give notice thereof to the board of health or to
curred. (See section 6.)
notice of the death of any person under his charge to the board of health honwealth at which his vessel first arrives after such death. (See section 7.) ements of scctions 6 and 7, five dollars. (See section 8.) ing his last illness shall forthwith after the death of said person, upon forth the required facts.
See section 11.)
$ preliminary to the interment of ~ 1
vsician »
(See section 10.)
.I'd of
RN OF THE DEATH
[Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 2
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for res tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which A. 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 dyit immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthiwith furnish for registration a certificat 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 leets 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 case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as lie 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 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 he 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 eity or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or 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 iu lieu thereof a certifieatc as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, carly enough for the purpose, the chairman of thic 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 certificatc as is required of the attending physician; and in case of death by violence 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 death, as tlic clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
L
1
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
Charlotte A Karididier
Femalecolor Ahile
Date of Death,
March 2,6 th
1900
189
; Age,
Years,
€ 6 Months,
3
.Days. 4
Maiden Name, { If married, widowed )
or divorced.
Charlotte Bruce (lader)
Husband's Name,
painer (tie Dictates
Single, Married, Widowed or Divorced,
Hvidew Occupation,
Housewife
*Residence,
{ If out of town, {
Youth Chelmsford 84.4.2.2
¿ also state fully.
Place of Birth,
Svarlbovo Frank
*Place of Death,
To thelinefordi Harp
Name of Father,
Lewis Brance
Birthplace of Father,
Maiden name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
thermen
Dated at.
Her Hand
Signature and
A & Richardson
March26. 1900-189
place of business
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ;
Place and Date of Death,
died at
north Chelmsford Mich 26 9 86,900
Disease or Cause of Death,#
Cerebro Spinal Meinungitis?
Duration of sickness,
Four days
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.
north Chelmsford
Date of Certificate,
March 265
189
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.
138
of Undertaker.
Westand Plass
Charlotte 7 Kidder Age. 668.3 M. 16 D.
Sexc
Etwale Color
-
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 oeeurs, 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 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 ean 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 nhucinion'a anotifianta undain
C
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,
Patrick Duringan
1900
Sex
Color,
Date of Death,
april 2
189 ; Age,.
59 Years,-
Months,
-
.. Days.
Maiden Name,
married, widowe
or divorced.
Husband's Name,
Single, Married, Widowed of Divorced,
Occupation,
Moulder
* Residence,
falso state fully y
jif out of town. ¿.
North Chelmsford
Place of Birth,
Ireland
*Place of Death,
North blue stord
Name of Father,
Edward Duringan
Birthplace of Father,
Ireland
Maiden Name of Mother,
Catherine corrigan
Birthplace of Mother,
Ireland
Place of Interment, (Give name of Cemetery), St Patrick Lowell watt
Dated at
Signature and
J Alle Dermott
011
april 2.
1950
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Patrick DuringanAge, 4 9%.
M.
D.
Place and Date of Death, die No chelmsford apr 2 1900
Disease or Cause of Death, #
Pneumonia
Duration of sickness,
9 days
I certify that the above is true to the best of my knowledge and belief.
& a Harlow
M. D.
Signature and Residence of Certifying Physician. S 2
Date of Certificate afin. 2
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.
place of business
of Undertaker.
70 Gorkane it
139
A
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
Rec
FORM O.
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,
Javed
Fischer
Sex,
Male Color,
white
Date of Death,
April. 2. 1996; Age 89
Years,
3
Months,
11
Days.
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Widow Occupation,
Harmer
.......
*Residence,
{ If out of town, {
( also state fully )
West Chelmsford Mass
Place of Birth,
Charlotte Maine
*Place of Death,
West Chelmsford
Name of Father,
David Fisher
Birthplace of Father,
Francis town
Maiden Name of Mother,
Nancy Chandler
Birthplace of Mother,
Peterborough
Place of Interment, (Give name of Cemetery),
Billerica
Dated at
Lowell
l. M. Having & leo
on Abril 2, 1 900
Signature and
place of business
of Undertaker.
33 Prescott It
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
David Fisher Age 89 × 3 M
11 D.
Place and Date of Death,
Disease or Cause of Death, #
died at
West Chelmsford April 2, 1900
Service Dability
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
1
Signature and Residence
M. D.
of
Certifying Physician.
Chilmapas Make
Date of Certificate
1900.0
* 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.
140
No.
RETURN OF THE DEATH.
OF
. ...
at
Date,
I
1
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 tor 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
Rec
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,
Surge William Lemay-
4900
Sex
Male
Color,
while
Date of Death, April 3 rd
189
; Ag ......- Years,
1
Months, - Days.
Maiden Name, { If married, widowed )
or divoreed.
-
Husband's Name,. -
Single, Married, Widowed or Divorced,
Single
.Occupation,
*Residence,
{ If out of town, }
* Wish Chelmsford frass
¿ also state fully.
Place of Birth,
* Wish Chelmsford mass
*Place of Death,
Nach Chelmsford mass
Name of Father,
Lemay-
Birthplace of Father,
Canada
Maiden name of Mother,
Suzanne human
Birthplace of Mother,
Canada
Place of Interment, (Give name of Cemetery),
In Joseph ComebreT-
Dated
Lowell Mars
Signature and
South Albert
on CApril 3rd
189
place of business
of Undertaker.
27 Chuver
PHYSICIAN'S CERTIFICATE.
George W Lemay
Age, Y. M. XD.
Place and Date of Death, ¿
died at mal Chelucfeny april 3d
18.700
Disease or Cause of Death, §
Convulsion
Duration of sickness,
18 hours
I certify that the above is true to the best of my knowledge and belief.
JE Varney
Signature and Residence S of
M. D.
Certifying Physician.
Date of Certificate,
april 3y
18800
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.
1
1
Name and Age of Deceased, t
1900
141
--
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 oecurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death 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 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 seetions 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 faets. (See section 10.)
Penalty for refusal or negleet, ten dollars. (See section 11.)
Any narean having shares of the funeral witha nuoliminary to the interment of a human body shall obtain the physician's
1
Ree FORM C.
142
Commonwealth of Massachusetts.
No. .....
RETURN OF A DEATH. To the Clerk of the City or Town In which the death occurred.
Name, ...
Charles & A Bartlett
Sex(
Color,
Date of Death,
Which 4 1900
189 ; Age,
63
Years,
5
Months,
30
Days.
Maiden Name, { If married, widowed ]
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
* Residence,
{ If out of town, }
Chelmsford
Mads
Place of Birth,
Chelmsford
* Place of Death,
Chelmsford
Name of Father,
De John & Bartlett
Birthplace of Father,
Maiden Name of Mother,
Maria 4 teams
Birthplace of Mother,
.....
Chelmsford
Place of Interment, (Give name of Cemetery), Chelonsford
Dated at
Lowell
Signature and
place of business
on ...... April 4 1900
I
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Charles & & Bartlett Age,
63 × 5
M. 30
.D.
Place and Date of Death,
died at
Chelmsford Abril H 1900
Disease or Cause of Death, +
Sugar
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
6. It, Chambulin
M. D.
of
Certifying Physician.
Date of Certificate
1900.
* Give also street and number, if any.
t Give sex of infant not named. If stili-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.
1
of Undertaker.
Lowell
Charlestown Mass
{ also state fully )
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
No.
RETURN OF THE DEATH.
OF
at
Date,
I
٠٥٠
· 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 .... 1
shall obtain the physician's certif
quired by section 1, to the board o
1
www. city
4
143
FORM C.
Commonwealth of Massachusetts.
1
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,
James, D. Boynton
Sex, Color,
Date of Death,
Avril 6
1$900; Age, 62 Years, - .Months, ..... Days.
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
*Residence, { If out of town, {
West Chelunsford
( also state fully }
Place of Birth, Sommerville Mars
* Place of Death,
West lehelmsford
Name of Father, Samuel Boynton
Birthplace of Father, not known
Maiden Name of Mother,
Nancy Sawyer
Birthplace of Mother,
Place of Interment, (Give name of Cemetery), St Patrick Catholic
Dated at
on the 6
I
Signature and
place of business
of Undertaker.
2.324 Market For
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased farmer Bogulow 62
Age
.Y ...
M .-. ..... D.
Place and Date of Death,
died at
Tweet Chelines fing april 6th,900
Lacomolis Clavia
Disease or Cause of Death, #
Duration of sickness,
one year
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
+ E Jamen
M. D.
of
Certifying Physician.
Date of Certificate
april 6°
1900
* 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.
No.
RETURN OF THE DEATH.
OF
at
1
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 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 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.
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