USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 6
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SECTION 10. A physician who has attended a person during his last illness sliall 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 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 elerk 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 certifieate 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.
162
Rec FORM C.
Commonwealth of glassachusetts.
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,
Mary of De Gastaret
Color,
2
Date of Death,
July 10 th
1900 ; Age, 33 Years, 11 .Months, 13 Days.
Maiden Name,
or divoreed.
Mary J. Ellis
Husband's Name,
John De Carteret
Single, Married, Widowed or Divorced,
*Residence, { If out of town, )
also state fully.
N. Chelmsford Mass
Place of Birth,
Island of Jersey { British Isles}
*Place of Death,
N. Chelmsford Mass
Name and Birthplace of Father, John Ellis & Birthplace Unknown
Maiden Name and Birthplace of Mother, Rachel Le Hever Jersey Island
Place of Interment, (Give name of Cemetery),
EN. Chelinsford
Dated at
N. Chelmsford Mass
e and
John Marinel fr
on
July 10th
1900
place of business
of Undertaker. A. Chelmsford Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ț
Mary & De Canteril
Age,
33 X11 M/3D.
Place and Date of Death,
-
Primary,
Disease or Cause of Death, }
Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
FE Tammery
M. D.
Signature and Residence
of
3
Certifying Physician.
Date of Certificate,, forly 100
190
* 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.
died at
Child birch
Juli 10
190 ő .
Duration,
1
Occupation, housewife
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 elerk 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 1 1 :- rund in the
163
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,
Ernest W Hall
Sex,
Color, W.
Date of Death, July 18th
1900 ; Age,
+ Years,
8 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.
CA. Chelmsford
masa
Place of Birth,
Chelmsford
mass
*Place of Death,
f. Chelmsford
mask
Name and Birthplace of Father,
Isaac Hall Nashua N 16
Maiden Name and Birthplace of Mother,
Abbie & Newman Lawell Mask,
Place of Interment, (Give name of Cemetery),
Flints Corner Cemetery Tyngsboro has
Dated at
N. Chelmsford
John Marine 2.
on
1900
Signature and
-
place of business
of Undertaker.
A Chelmsford mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at.
July H No. Chelunford July 11
190 8.
Meningite.
Duration,
one week,
Duration,
I certify that the above is true to the best of my knowledge and belief.
F & Varney
M. D.
Signature and Residence S
of
Certifying Physician.
North Chibusfert
Date of Certificate, Mely 12
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.
Primary,
Disease or Cause of Death, } Secondary,
Emment ir Stall
Age, ~ Y. 8 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 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 nermit shall he issned until a written statement. as required by law, has
Sex ON a. PeDan.
Rev
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,
Timothy
Adams
Sex,
In.
Date of Death,
July 15
1900; Age, 69
Years,
4
Months,
19 Days.
Maiden Name, {If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Carmen
" Residence,
[ If out of town, {
falso state fully
Chelmsford
(Mass
Place of Birth,
Carlisle
"
*Place of Death,
Chelmsford
Name of Father,
Benjamin teams
Birthplace of Father,
Carlisle
Maiden Name of Mother,
Thi Heald
Birthplace of Mother,
Carlisle
"
Place of Interment, (Give name of Cemetery),
Carlisle
Dated at .
Lowell
Signature and
on
July
16.1900
place of business
of Undertaker.
Lowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Place and Date of Death,
died
at
Chelmsford Mast July 15, 1990
Disease or Cause of Death, #
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Antun H. Sotona
M. D.
of Certifying Physician.
Chelousfort, Man.
Date of Certificate
Und 16
1900
* Give also street ånd 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 Sajlor in the War of the Rebellion, give both Primary and Secondary Cause.
X
Timothy Adams
Age,
69 %.
4
.M
19 D.
164
Color,
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 r, to the board of health or to the clerk of the city or town in which the death occurred.
165
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,
Sex,
Color,
Date of Death,
July 16th
You, Age, - Years,.
~ Months,
1
Days.
Maiden Name,
{ If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Billenca St, Chelmsford
* Residence,
{ If out of town, {
( also state fully )
Place of Birth,
*Place of Death,
Name of Father,
John Pada
Birthplace of Father,
Maiden Name of Mother,
Birthplace of Mother, Palieka limiter
Place of Interment, (Give wayre of Cemetery),.
Dated at ULU Maso
I
900
Jules 16
Signature and place of business of Undertaker. 31324 Mairet St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Date and Place of Death,t -
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.
Arthur V. Scoloria Chelmsford, man
Signature and Residence of Certifying Physician, .
Date of Certificate,
Inès 16
1900
* 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.
-
Roddy
Age,
1 day.
died at .. Tebelford, mass.
And 16, 1980
1891
1
of Premature.
= =
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.]
holder in whose house a death occurs, the oldest person next of kin present at the Cidre, or the person in charge of an institution in which a death occurs, shall, within cdeath, give notice thereof to the board of health or to the clerk of the city or town in
Sling officer of a vessel shall give notice of the death of any person under his charge Nerk of the city or town within the Commonwealth at which his vessel first arrives
geglect to comply with the requirements of sections 6 and 7, five dollars.
o who has attended a person during his last illness shall forthwith after the death of Ch for registration a certificate setting forth the required facts.
cleceased was a soldier who served in the war of the rebellion, give both the primary Cause of death as nearly as he can state the same. 1 Penalty for refusal or neglect, ten
Shaving charge . de funereal rites preliminary to the intermer human body
Sicate made in accordance with . ction Io, and return it, toge'' uth the facts re-
of health or to the cl rk of the city or town in which the det urred.
ing fifty dollars.
www www. nul v food, unapter 224; Acts of T893, Chapter 263.]
SECTION 3. A physician 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 belicf, the name of the deceased, his age, the disease of which he 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 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, ne shall be punished by a fine not exceeding fifty dollars. In case the deccased 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 he can state thic same. If a physician refuses or neglects
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
to make such certificate lie shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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 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 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 in lieu thereof a certificate 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, 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 sueli certificate as is required of the attending physician ; and in case of death by violenee the medical cxaminer 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 elerk 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 the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
Ree
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,
Lassie Mc Lin
Sex,
Color,
Date of Death,
July -1945
189 UD Age,
19
Years
Months,
Days.
Maiden Name, ({ If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divoreed,
Occupation,
*Residence, {If out of town, )
falso state fully }
Place of Birth,
Ireland
* Place of Death,
no chelmsford ihans
Name of Father,
Michael WI Fire
Birthplace of Father,
Ireland
Maiden Name of Mother
Harman
-ul
Birthplace of Mother,
Freland
Place of Interment, (Give name of Cemetery), .. St Patricks deawell pas.
Dated at
Signature and
place of business
of Undertaker.
- Roger
011
1000
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Carrie M= Fire
Age, 19 Y.
M
D.
Place and Date of Death,
died at
North chelisting Mars July 18'
1 900
Disease or Cause of Death, $
Thermie Fever
Duration of sickness,
3 hours
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S-
of
JE Varney
M. D.
Certifying Physician. novofchilens fing
Date of Certificate
July 18.
* 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.
Rece hug 14
166
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 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.
/67
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,
Violet O'Keefe Kelly
Sex,
71
Color,
W
Date of Death,
July 230
_Years,
0
Months,
4.
.Days.
Maiden Name, ( married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced. Occupation,
*Residence, { If out of town, )
Chelunsford, Mass.
¿ also state fully.
Place of Birth,
Tewksbury
2
*Place of Death,
Name of Father,
Eugene Q. Kelly
Birthplace of Father,
Galway Detand
Maiden name of Mother,
Ellen (O' Keefe
Birthplace of Mother,
Parconstown Kingo Co Ireland
Place of Interment, (Give name of Cemetery),
Pine Ridge, Chelmsford
Dated at ...
Chelmsford
Signature and
5
Water Paskam
on
July 250
18900
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death, ;
died at
Chelmsford Mass. July 23 #14.00
Disease or Cause of Death, §
Convulsions.
Duration of sickness,
one day
I certify that the above is true to the best of my knowledge and belief.
Signature and Residenee
of
Certifying Physician.
Chelmsford Dass.
Date of Certificate,
July
24 0
1900
Give also street and number, if any.
masa Award
M. D.
Violet OK. Kelley
Age,
I. V. D. M. 4D.
t Or 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.
Rec
No.
RETURN OF THE DEATH
OF
at
1
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 oceurred. (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 certificate made in accordance with section 10, and return it, together with the facts required by seetion 1, to the board of health or to the clerk of the city of town in which the death occurred.
Rue
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,
Artemias Parker
Sex, male Color,
white
Date of Death,
July 25th
1900
189
;
Age, ..
84 Years,
8
Months,
23 Days.
Maiden Name,
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, medower Occupation,
*Residence, { If out of town, )
? also state fully. § -
South Chelmsford Massachusetts.
Place of Birth,
learliste.
*Place of Death,
South Chelmsford
Name of Father, Jonas Parker.
Carlisle
Birthplace of Father,
Bailey
Townsend
Place of Interment, (Give name of Cemetery),
learliste. Green Leméteres
Dated at ......
To 6 net mask and
Signature and
Daniel y Byany
on July 24 1990
place of business of Undertaker. To Cheirode Horn
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death, }
Disease or Cause of Death, §
died at
Se. Chelmsford, Mass. July 25,789 1900
Asthenia following Influenza!
Duration of sickness,
About five months.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
Arthur.
Y Sestoria
M. D.
Certifying Physician.
Chelmsford, mass.
Date of Certificate,
Only
26
189/900.
Give also street and number, if any.
+ Or sex of iufant 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.
Antenas Parker
Age, 84%. 8 M. 23D.
Maiden name of Mother,
Olive
Birthplace of Mother,
168
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. (Sce 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.)
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