USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 7
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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.)
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City of Town in which the death occurred.
(FILL OUT WITH INK. . ALL NAMES TO BE IN FULL.)
Name,
Sex,
Color,
an
Date of Death,
189 ; Age,
20 Years,
Months,
Days.
Maiden Name, {}
Husband's Name,
Single, Married, Widowed or Dinoveel,
Occupation,
*Residence, { If out of town, )
79 Thurman ST Liels ..
[ also state fully }
Place of Birth,
* Place of Death,.
Name of Father,
Areth. Purcell.
Birthplace of Father,
England.
Maiden Name of Mother,:
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
SA Pal Comiday.
Dated at
on
Jul 31
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Jennie Purcell
Age,
20 v
M ..
D.
Place and Date of Death,
died at
7% Sherman Ft,
Aly 31
900
Disease or Cause of Death, #
Phitticis
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
signature and Residence
Seward Y. Welch
.M. D.
of
Certifying Physician.
2 Runeli Kedy
Date of Certificate
I 900
* 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 tile War of the Rebellion, give both Primary and Secondary Cause.
t
Signature and
place of business
of Undertaker.
Len- Melch 169
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 1. 11
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,
Mary Blaulding Shed
Sex,
Color,
w.
Date of Death,
august 3
1900 ; Age,
96 Years,
10
Months,
.Days.
Maiden Name, { If married, widowed )
or divorced.
Mary Spaulding
Husband's Name,
amos Shed
Single, Married, Widowed or Divorced,
Widowed
Occupation,
Housewife
*Residence, { If out of town, )
? also state fully. }
Chelmsford
Place of Birth,
"
*Place of Death,
Sheribiah Spaulding Chelmsford(?)
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Relied Grabber, Probably Beverly
Place of Interment, (Give name of Cemetery),
Chelmsford Center
Matter Perham
Dated at
flug. 3
on
1900
Signature and
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
--
many Spaulding theo,
Age, 96 8. 10 M.
.D.
Place and Date of Death,
died at Celulunsfor Mans.
ang. 3, 1900.
-
Primary,
Cholua Morbres
Duration,
about/week
Disease or Cause
of Death, }
Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
Arthur G. Scotoria
M. D.
of
Certifying Physician.
3
Chelmsford, mans.
Date of Certificate,
3
1900.
* Give also street and number, if any. t Give sex of infant not named. If stillborn, 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.
....
170
No.
RETURN OF THE DEATH
OF
at
Date,
190.
Filed, 190
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.] :
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, how been furnished, with a physician's certificate of the cause of death. When such statement and de in cate a Board of He-14 " cand or agent show with countersign and transmit the same to the clerk of the en . tow registration
SECTION 5. Penalty for v! not exceeding fifty, dollars. 1 0
MSA
J
FPM
T
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,
Carleton Mr. Pickard
Sex,
Male color, white
Date of Death,
Auq 8
1900 ; Age, .....
Years,
5
Months,
2 4 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Single Occupation, at home
*Residence, { If out of town, )
¿ also state fully. 3
Chelmsford
Mass
Place of Birth, Chelmsford Mass
*Place of Death, Chelmsford Mass
Name and Birthplace of Father, George W Pickard Littleton Mas
Maiden Name and Birthplace of Mother, Bertha Wilson Boston Mas
Place of Interment, (Give name of Cemetery), Chelmsford Cemetery -
Dated at
Lowell
6. W. young vlo
on
Aug 8th
190 0
· Signature and
place of business
of Undertaker.
33 Prescott St. +
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t barletou M. Pickard Age, / Y. M. 23D.
Place and Date of Death,
died at.
thelongford
Cung.8%
1908.
Primary,
Whooping Cough
Duration,
2 weeks .
Disease or Cause
of Death,
Secondary,
Convulsions
Duration,
2 days.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
Certifying Physician.
Amasy Steward
M. D.
Date of Certificate,
ana, 8
190 g >
* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
t 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.
-
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 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.
[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 anch statement ~~~ certif . are delivered to the Board and 1 , he clerk of th. city or town for regia
I . 5.
ion not
fifty dollars.
Reo
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Mary a M? Fully
Sex. Color,
Date of Death,
aug 11
190 0, Age 28 Years, - Months, ~ Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
at Home
* Residence,
[ If out of town, }
¿ also state fully.
Gast Theles ford mass
Place of Birth,
,
*Place of Death,
Name and Birthplace of Father, Michael M: fully- Ireland
Maiden Name and Birthplace of Mother, Budget Bains
Place of Interment, (Give name of Cemetery),
OF Paris canelitas
Dated at
:True Mass
on
190 0
Signature and
place of business
of Undertaker.
324 Market St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Mary a. M= Nully Agre, 28%.
M.
D.
Place and Date of Death,
Primary,
Phthisis
Duration,
Disease or Cause
of Death, }
Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Edward J. Walch
signature and Residence S
of
Certifying Physician.
Date of Certificate,
Qua
12 0to
1900
* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
t 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
E. Chelmsford aug 11th
.1900.
M. D.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
No.
RETURN OF THE DEATH
OF
at
Date,
190
Filed, 190.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the cit known for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
Rex 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,
Mathias Hutchins Sex,
Color,
Date of Death,
Aug. 24
1900 ; Age, 74 Years,
Months,
.. Days.
Maiden Name, { If married, widowed } or divorced.
Husband's Name,
Single, Married, Widowed or Divoreed,
M
Occupation,
*Residence, {If out of town, )
¿ also state fully.
Cheers ford
Place of Birth,
Partiste
*Place of Death,
felices ford
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother, * Phobe (Spaulding) barliste
Place of Interment, (Give name of Cemetery), Carlisle
Thomas & Green.
Dated at
Signature and
on
Aug 200
1900
place of business of Undertaker.
barticle hass.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
-
Matthias Hutchin
Age,
74x
.M .D.
Place and Date of Death,
died
Chelmsford, Mais.
-
Primary,
Cholera morbus
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Arthur
2. Scoloria
M. D.
Signature and Residence S
of
Certifying Physician.
Chelmsford, man."
Date of Certificate,
aug 25,
1900.
* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
t 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
1900).
Disease or Cause
of Death, }
Secondary,
173
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 deatlı occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are 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.
174
FORM O.
Rep
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,
Kate & Knowlton Sex,
7
Color,
W.
Date of Death,
Eng, 26,
190 0 ; Age, 42 Years,
2 Months,
17 Days.
Maiden Name, { If married, widowed )
or divorced.
ucan tate Hoy
Husband's Name,
George H. Knowlton
Single, Married, Widowed or Divorced,
Occupation,
House wife
*Residence, { If out of town, )
¿ also state fully. 3
Chelmsford
Place of Birth,
Montville, Maine
*Place of Death,
Chelmsford: Mass.
Name and Birthplace of Father, ,.
Robbert Hory Montville Me.
Maiden Name and Birthplace of Mother,
Catherine Bond atlantic Ocean
Place of Interment, (Give name of Cemetery),
Montville, Maine.
Dated at
chelmsford Wars:
Walter Vechai
on Greg 27
190 0
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Rate J. Knowlton
Age, 424. 2 M/7 D.
Place and Date of Death,
died
Checkus food, Mon.
aug. 26, 1900.
Disease or Cause - Primary,
of Death, # Secondary,
Cerebral harmonhogyz.
Duration,
24 days
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
Arthur. M Scolaria
M. D.
of
Certifying Physician.
Chelmsford, man.
Date of Certificate,
ang.
28
1900.
* Give also street and number, if any. t Givo sex of infant not named. If still-born, so state.
{ If a Soldier or Sailor in the War of the Rebellion, givo both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Thatwe of Skull and
Duration,
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 deatlı 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.] 1
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are 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.
Rue
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,
2
Sex.
,
Color,
Date of Death, ...
190 ; Age ......... Years, ...... Months,
, 4 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. 3
Place of Birth,
test &. Welunsford Mass
*Place of Death,
It- ref Clicking ford, Mais
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,.
Place of Interment, (Give name of Cemetery), ist- Inchwind & Casa.
Dated at
Signature and
Ivrea & Parkeret
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Frederick Westberg Age,
Y. 6M. B.D.
Place and Date of Death,
died at
Week-Chelunsford-
aug 30
190 0.
Primary,
Whooping Cough
Duration,
one work
Duration,
I certify that the above is true to the best of my knowledge and belief.
JE Varney
M. D.
Signature and Residence S of Certifying Physician.
north chehurting
Date of Certificate,
1900.
* Give also street and number, if any. | Give sex of infant not named. If still-born, so state.
{ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Disease or Cause of Death, } Secondary,
1900.
place of business
of Undertaker.
175
No.
RETURN OF THE DEATH
OF
at
Date,
190
Filed,
190. ..
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate arc delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
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