USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 5
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Name,
Seth Homestead Patter
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex.
M
Color, M
Date of Death, May 18
18900; Age, 68 Years,
9 Months,
14 Days.
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Married Occupation,
Harmer
1
* Residence,
{ If out of town,
also state fully.
Chelmsford
Place of Birth,
Pittsfield Maine
*Place of Death,
Chelmsford
Name of Father,
Moody Pattern
Birthplace of Father,
Pittsfield the
Maiden name of Mother,
Hannah H Homestead
Birthplace of Mother,
Pittsfield me
Place of Interment, (Give name of Cemetery), ..
Pittsfield Me.
Dated at.
Chelmsford
Walter Perham
on May 19
18900
Signature and
place of business
of Undertaker.
Chelmsford Mars
3
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Sulle It, Partie
Age, 68 Y. 9 M. 14 D.
Place and Date of Death, ¿
died at ...
Chelmsford Ware May 18th.
189-
1900
Disease or Cause of Death, §
Paralysis
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
Chelmsford,
M. D.
Date of Certificate,
May
tu
19 " 1900-189.
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.
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 aud 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 pre" .. .
Ation 10, and return town in which the death
ios 1, to th
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,
Harriet Publan
Sex,
Color,
Date of Death, .
May 24 th
1900
189
; Age, 56 Years,
5
Months, - . Days.
Maiden Name, { If married, widowed )
or divoreed.
Harriet Rayner
Husband's Name,
William
Pullan
Single, Married, Widowed or Divorced,
Occupation,
housewife
*Residence, { If out of town, )
A Chelmsford house.
? also state fully.
Place of Birth,
Nidderdale Yorkshire England
*Place of Death,
dr. thelenford mask
Name of Father,
William Rayner.
Birthplace of Father,
Coverdale Yorkshire England
Maiden name of Mother,
Elizabeth Hammel
Birthplace of Mother,
Coverdale Yorkshire England
Place of Interment, (Give name of Cemetery),
Chelmsford Mask
Dated at
Ar Chelmsford
Signature and
John marine( f)
on may 24 h
1.200
2189
place of business
of Undertaker.
dr. Chelmsford mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death, ¿
died at
north Chelmsford
may 24 8900
Disease or Cause of Death, §
Una mia
Duration of sickness,
36 hours
I certify that the above is true to the best of my knowledge and belief.
F & Varney
Signature and Residence S of
M. D.
Certifying Physician.
norsk Chilinofene
Date of Certificate,
May 26
18:00
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
154
Itaniel-Pullan
Age, 51 Y. 5 M. D.
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 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 oeeurred. (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 facts. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
certi! health
the city
rites preliminary to the interment of a human body shall obtain the physician's 1 l return it, together with the facts required by section 1, to the board of che death oeeur
Rev
Ed. June, 1890. 5,000.
[ACTS OF 1889, CHAP. 208.] AN ACT
Plate,
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each city and town shall on the first day of each month make a certified copy of the record of all deaths and births recorded in the books of said city or town during the previous month, whenever the deceased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time of said death or birth; and shall transmit said certified copies to the clerk or registrar of the city or town in which such deceased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained ; and the clerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Such certified copies shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a DEATH
recorded in the books of the City of Haverhill (City or Town. )
during the month of June 1900. 18
1. Date of Death, .
May 30, 1900.
2. Name,
Sophronia Oakes Dutton
(Maiden Name), . (Name of Husband),
Sophronia Oakes Lawrence
Charles H. Dutton
Female
3. Sex, and whether single, Married, or Widowed,
Married
4. Color,
White
(Disease or Cause of Death, -
(1) Chronic (valvular) heart disease. (2) Angina&pulmon-
ary oedema (4) Coma
J. F. Croston M. D.
North Chelmsford Mass
7. Residence,
Housewife
8. Occupation,
# 102 Chestnut Street ( Haverhill)
Cohasset Mass.
George Lawrence
Everline Vinal
13. Birthplace of Father, .
Scituate Mass.
14. Birthplace of Mother, .
Scituate Mass.
North Chelmsford Mass.
I certify that the foregoing is a true copy.
Attest : William It. Coberto
June 1, 1900. .
City Clerk.
(City or Town.)
5. Age,
60 Years, 1 Months, 26 Days.
6. Duration of Sickness, By whom certified,.
9. Place of Death, .
10. Place of Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name.)
15. Place of Interment, .
ora of
I
2
٢٦/٢
.siat ATrahiot
156
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,
alfred E. Parlee
Date of Death,
June 1
18900; Age,
0 Years.
8
Months,
8 Days.
Maiden Name, If married, widowed } or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
*Residence,
§ If ont of town, }
Chelmsford
¿ also state fully. §
Place of Birth,
*Place of Death,
Name of Father,
Why MM. Parler
Birthplace of Father,
Waterford, New Brunswick
Maiden name of Mother,
May Fr Peters
Birthplace of Mother,
Blue Hile Maine
Place of Interment, (Give name of Cemetery),
Pine Ridge Cen, Chelmsford Center
Dated at
Chelmsford
Signature and
Walter Restor
on
18900
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,¿
died at
Chelmsford Jime 12 1906.
Disease or Cause of Death, §
Convulsions with Marasmus.
Duration of sickness,
Several weeks .
I certify that the above is true to the best of my knowledge and belief.
Amaia Stoward
M. D.
Signature and Residence S
of
Certifying Physician.
}
Date of Certificate,
N
189
1900
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.
alfred E. Parler
Age,
. 8. 1 8
D.
Sex,
Color,
No.
RETURN OF THE DEATH
OF
at
.....
Date,
189
...
Filed,
189.
Walter Perhall
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 funcreal 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.
Ruc
No.
Commonwealth of Classachusetts.
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 E.
Shepherd
Sex,
Color,
Date of Death,
Jame pt
189
; Age,~ Years,
عر
Months, 14 Days.
1800
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
*Residence, { If out of town, )
¿ also state fully. §
Chelmsford
Place of Birth,
LT
*Place of Death,
.
Name of Father,
Swo. & Shepherd
Birthplace of Father,
England
Maiden name of Mother,
Gertrude E. Moore
Birthplace of Mother,
Welles Maine,
Place of Interment, (Give name of Cemetery),
1. Chelmsford mass
Dated at
A. Chelmsford
on June 2nd
18000
Signature and place of business of Undertaker. 1.A. Chelmsford mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ¡
Place and Date of Death, ;
Discase or Cause of Death, §
died at
north Cheleurferyjne/ 189,00
Meningitis
Duration of sickness,
one week
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
JE Varney
M. D.
of Certifying Physician.
Date of Certificate,
48,00
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.
t
57
Ella & Shepherd
Age, ~ Y. 7 M. /XD.
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 occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the elerk of the eity 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 faets. (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 certifieate made in accordance with seetion 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.
158
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,
Delia
kendrick
Sex female Color, white
Date of Death,
June 6. 1900
189 ; Age, 56 Years, Months, ................- Days.
Maiden Name, { If married, widowed )
or divorced.
Delia
Gregg
Husband's Name,
John Hendrick
Single, Married, Widowed or Divorced,
Married Occupation,
at home
*Residence, { If out of town, )
falso state fully §
No Chelmsford Mass
England
Place of Birth,
* Place of Death,
north Chelmsford
Name of Father,
unknown
Birthplace of Father,
unknown
Maiden Name of Mother,
unknown
Birthplace of Mother,
unknown
Place of Interment, (Give name of Cemetery),
Edson Cemetery
Dated at
Sowell
Signature and
la M youngoles
011 lune 6, 900
place of business
of Undertaker.
33 Prescott If
2
PHYSICIAN'S , CERTIFICATE.
Name and Age of Deceasedt Delia Kendrick Age, 56 Y-
- M -
- D.
Place and Date of Death,
Disease or Cause of Death, $
died at
North Chelmsford June 6. 1900
Paralysis
Duration of sickness,
Several months
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
mexastoward.
M. D.
of
Certifying Physician.
Date of Certificate
Jime
6
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.
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 re- quired by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
Arwar
159
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,
Janet M. Brown
Sex Female Color,
Date of Death,
June 8
1897; Age, 27 Years,
Months, 3 Days.
Maiden Name, { If married, widowed ) or divoreed.
Husband's Name, .....
Single, Married, Widowed or Divorced, Single Occupation,
*Residence, {If out of town, }
tweet chelmsford dans
¿ also state fully. §
Place of Birth, Lowell Mass
*Place of Death,
Name of Father,
James Brown
Birthplace of Father,
Scotland
Maiden name of Mother,
Mary Plunkett
Birthplace of Mother,
Scotland
Place of Interment, (Give name of Cemetery),
Dated at
West Chelmsford
Signature and
A & Par Khual-
on
June 9th
place of business
of Undertaker.
Weet Chelmsford mark
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Samuel-M Brown Age. 27 8. 7 M. 3 D.
Place and Date of Death, } died at. Weet Chekusfin xen 8h. 18900
Disease or Cause of Death, § Organic Disease Afteral-
Duration of sickness,
two months
I certify that the above is true to the best of my knowledge and belief.
JE Varney
Signature and Residence S
of
Certifying Physician.
norskchekustens
M. D.
Date of Certificate,
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.
11960
L
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 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 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 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 faets. (See section 10.)
Penalty for refusal or negleet, 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 elerk 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.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Maluco
eColor,
: white
Date of Death,
lune 12. 1999; Age,
77
Years, - Months, ...
....... Days.
Maiden Name, { If married, widowed {
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Married Occupation,
Carpenter
* Residence,
" If out of town, {
north Chelmsford maso
(also state fully y
nova Scotia
Place of Birth,
* Place of Death, North Chelmsford Mass
Name of Father,
John Wotton
Birthplace of Father,
Nova Scotia
Maiden Name of Mother,
unknown
Birthplace of Mother,
unknown
Place of Interment, (Give name of Cemetery),
north Chelmsford
Dated at
Lowell
b. M. youngvles
on
June 13th,
I
900
Signature and place of business of Undertaker. 4
33 Prescott st
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
John I Watton Age, >> Y - M .D.
Place and Date of Death,
Disease or Cause of Death, #
died at
north Chelmsford June 12. 1900
Back Eneritis
Duration of sickness,
four weeks
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
S
JE Varney
M. D.
of
Certifying Physician.
Date of Certificate 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.
160
Name,
John I. Wotton
Sex,
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 I, to the board of health or to the clerk of the city or town in which the death occurred.
16/1
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,
Mary of Webster
Sex, Lemale Color,
White
Date of Death,
July 9 1
1900 ; Age, 64 Years, -Months, -Days.
Maiden Name, { If married, widowed ) or divorced.
Mary +
Herson
Husband's Name,
Sohn N. Webster
Single, Married, Widowed or Divorced. Widow Occupation,
at home
*Residence, { If out of town, )
? also state fully.
North Chelmsford Mass
Place of Birth,
Bennington
*Place of Death,
north Chelmsford
Name and Birthplace of Father, Moses B Ferson Francistown n. H.
Maiden Name and Birthplace of Mother, Sally Colly Bennington, M. H
Place of Interment, (Give name of Cemetery), Nashua n. A
Dated
Lowell
G. M. Young & les
on
July 10
190 0
Signature and
place of business
of Undertaker.
33 Prescott St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at
north Cheluisend
190 0.
Primary,
Caries of Shine
Duration,
one year
Duration,
I certify that the above is true to the best of my knowledge and belief.
F. E. Vaney
Signature and Residence
of
Hans Chilusfert,
Certifying Physician.
Date of Certificate, July 10cl
190 0.
* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
1
1 1
1
Many a tekater
Age, 64 Y.
M. D.
Disease or Cause of Death, # Secondary,
M. D.
,
No.
RETURN OF THE DEATH
OF
at
Date,
190
Filed,
190.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death 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.
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 negleet to comply with the requirements of sections 6 and 7, five dollars.
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