USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 8
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SECTION 5. Penalty for violation not exceeding fifty dollars.
Re
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,
Clara A. H. Adamo
Sex,
female or white
Date of Death,
cduq 29th
1
1900 ; Age,
12
Years
7
.Months, ...
~ Days.
Maiden Name, { If married, widowed )
or divorced.
Widow
Husband's Name,
Thomas &. Adams
Single, Married, Widowed or Divorced
Widow Occupation,
*Residence, { If out of town, )
? also state fully. 3
north Chelmsford
Temple n. H.
Place of Birth,
*Place of Death,
north Chelmsford
Name and Birthplace of Father, Joseph Holt Wilton n. A
Maiden Name and Birthplace of Mother, Clara Y Mansur
Place of Interment, (Give name of Cemetery),
North Chelmsford
b. M. Young & les
Dated at
Sowell
Signature and
on
Aug 30,
190 0
place of business
of Undertaker.
33 Prescott At
PHYSICIAN'S CERTIFICATE.
Name and Agc of Deceascd, t Clara A. H. AdamsAge, 72 87 M .- D.
Placc and Date of Death,
died at.
North Chelmsford Ag 29 1900.
Praemia
Duration,
4 days
Disease or Cause
of Death, ¿
Secondary,
Diecare of Heart Kidneys
Duration,
3 years
I certify that the above is true to the best of my knowledge and belief.
JE Janney
M. D.
north Chekusford
Date of Certificate,
Cinq 30
190 C.
* 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.
1
176
Signature and Residence S
of
Certifying Physician.
Primary,
at home
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 city or town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Rose, Mcnulty
Sex,
Color,
Date of Death,
Sept- 6 +
1900; Age, 24
Years,
Months,
.. Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorceds
Occupation,
Mass
*Residence, { If out of town, )
? also state fully. 3
Chelandlord
Place of Birth,
Chelmsford
1
*Place of Death,
Chelmsford
Name and Birthplace of Father,
Michael M Malty Ireland
Maiden Name and Birthplace of Mother,
Budget Barrett
Place of Interment, (Give name of Cemetery),.
St Patrick Lewelt Mars
Youwell
Dated at Supt 600 1900 on
Signature and place of business of Undertaker.
Jahn 7 Rogeri
0816 Central St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Rose Manually
Age, 24Y
.M.
.D.
Place and Date of Death,
died at
Chelmanni Left
6 th
190
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
of
M. D.
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 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,
Phthisis
Duration,
177
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
No.
RETURN OF THE DEATH
OF
at
Date,
Seht 6
1900.
Filed, 11
190_0
[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 such statement and certificate are delivered to the Board of Health, the board or agent shall fortliwith countersign and transmit the same to the clerk of the city or town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
178
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,
1
L
Date of Death,
Sex ...
Color,
1897; Age, ~ Years,
1
.. Months,
1
Days.
Maiden Name, {
married, widowed į
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
.. Occupation,
*Residence, also state fully. ) [ If out of town, {
Place of Birth,
Grain Lord Mars.
*Place of Death,
0
cori Mais
Name of Father,
Birthplace of Father,
Maiden name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Dated at
It- Nem nd, Mara.
Signature and
Petr Dary
on
1890-0.
place of business
· of Undertaker.
134 Market. Louise
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Leonard Surette
Age, - Y. / M. 14D.
Place and Date of Death, } died at
Disease or Cause of Death, §
Marasmus
Duration of sickness,
one month
I certify that the above is true to the best of my knowledge and belief.
JE harney
M. D.
Certifying Physician.
novot Chekustens
Date of Certificate,
Siff. 7-
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.
18900
Signature and Residence S of
-
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 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. (Sec section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the hysician'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.
-
Rel
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,
James L. Aicholson
Se
Male Color, White
Date of Death,
Lept ">
.. 1900 ; Age, 43 Years, Months, ~ Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Married
North Chelmsford Mass
*Residence, {If out of town, )
¿ also state fully.
*Place of Death,
147 Whitman It North Chelmsford
Name and Birthplace of Father, Daniel Nicholson P.E. Isle
Maiden Name and Birthplace of Mother, Anna Ma Kenzie ..
Place of Interment, (Give name of Cemetery), north Chelmsford
Dated at.
forwell
C. M. young & les
on
Sept 17.
190
Signature and placo of business of Undertaker.
33 Prescott St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t James l. Nicholson Age, 43 8. 5 M. ~ D. no Chelmsford Sept 17 1900. Place and Date of Death, died at Duration,
Disease or Cause | Primary, of Death, Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
Dolan Bartels
M. D.
Date of Certificate,
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.
..
Place of Birth, Prince Edward Island
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 moment 1 YYTI
Board of Health, the board or agent shall forth
registration.
SECTION 5. Penalty for violation
1
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,
Emma Suttle
Sex, 04
Color,
Date of Death,
Seht-19
1900 ; Age,
5'0 Years,
Months, 18 .Days.
Maiden Name, { If married, widowed )
or divorced.
Baker
Husband's Name,
George Little
Single, Married, Widowed or Divorced,
Occupation,
At home
*Residence, ¿ also state fully.
{ If out of town, {
East Chelmsford
Place of Birth,
England
*Place of Death,
East Chelmsford
Name and Birthplace of Father,
Stephen Baker
"1
Maiden Name and Birthplace of Mother, ..
Ann Everett
Place of Interment, (Give name of Cemetery),
Edson Cemetery
Dated at
Lowell Sept 20 1900
Bouvier
on
190
Signature and
place of business
of Undertaker.
Lowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Ans Emma Suttle
Age, 334. - M. 18 D.
Place and Date of Death,
- Primary,
Inanition
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
Certifying Physician.
295-lesutral Str
M. D.
-
Date of Certificate,
Sept 20~
190 0.
* 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.
- Da Holbrook-
180
died at
East Chelmsford
Left-19
1900 .
Disease or Cause
of Death, ţ
Secondary,
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 authoritics. 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 Board of Health, the board or agent shall forthwith countersign and transmit the same to ' < clerk of the city of town registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
Rev 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
Sex.
11
Color,
10
Date of Death,
refs 23
190 0 ; Age,~ Years,
4
Months,
12 Days.
Maiden Name,
{ If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
.Occupation,
*Residence, { If out of town, )
weil
¿ also state fully.
Place of Birth,
Boston
*Place of Death,
Chelmsford
1
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Funny Murphy Nova Scotia
Place of Interment, (Give name of Cemetery),
St Patricks Cem Sowell
Dated at
Chelionel
Signature and
walter & shaw
on
Sept 25
190 5
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Veronica Murphy
Age,
# 8.4 M /S.D.
Place and Date of Death,
died at.
Chebenford, Mais.
Sept = 3,1900.
Marasmus
Duration,
2 months.
Duration,
I certify that the above is true to the best of my knowledge and belief.
Arthur G. Scolonia,
M. D.
signature and Residence § of Certifying Physician.
Chetrasfor, man.
Date of Certificate,
Sept. 25
190 D.
* 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.
Disease or Cause of Death, ţ
Primary, Secondary,
181
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 sueli death.
SECTION 8. Penalty for negleet 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 ease 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
of Health, the For
3 egistration.
SECTION 5. Penalty . violation
Rec FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
James M. Hardy
Sex, M) Color,
Date of Death,
Oct, 1
.
1900 ; Age, 77 Years
.Months,
Days.
Maiden Name, {
or divorced.
Husband's Name,
7
Single, Married, Widowed or Divorced,
Occupation,
Sitired
*Residence, also state fully.
{ If out of town, {
Place of Birth,
Warner, N.N.
*Place of Death,
(hoxerces fora)
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother, shoda (Harvey) ", 11
Place of Interment, (Give name of Cemetery),
Dated at
on October / 1900
Signature and
place of business
of Undertaker.
Leowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
James M. Hardy
Age, 77 Y. M.
.D.
Place and Date of Death,
died at.
fraldas ford
Oct. 1, 1900.
Disease or Cause of Death, # Secondary,
Primary,
Heart Failure
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
Arthur G. Scoloria,
M. D.
Date of Certificate,
Oct. 1
1906.
* 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.
182
Fad
ABluvier
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 thercof 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
SECTION 5. 1enalty
183
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,
Elizabeth Richardson
Sex,
Color,
Date of Death,
Oct 14
1900 ; Age,.
58 Years,
7
Months,
.Days.
Maiden Name,
If married, widowed {
or divorced.
Elizabeth Walker
Husband's Name,
Harman Richardson
Single, Married, Widowed or Divorced,
Married Occupation,
Howwwite
*Residence, { If out of town, )
Chelmsford
¿ also state fully.
Place of Birth,
yorkshire to England
*Place of Death,
Name and Birthplace of Father,
Sco. Walker Yorkshire Co. Eng
Maiden Name and Birthplace of Mother,
Mary Robinen .
Place of Interment, (Give name of Cemetery),
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