USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1900-1901 > Part 9
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Edson Center, Lowell
Dated at
Chelmsford
Walter Perham
on
Och 15
1900
Signature and
place of business
of Undertaker.
Chelinaford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Elizabeth Richardson Age, 38 Y. 7 M
.D.
Place and Date of Death,
Primary,
Gastritis
Duration,
6 weeks.
Disease or Cause
of Death, }
Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
M. D.
Signature and Residence
of
Certifying Physician.
Chelmsford
-
Date of Certificate,
act.15th
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.
1
€
died at Chelmsford
Oct. 14th
1900.
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 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 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 faets required by section 1, to the board of health or to the clerk of the city or town in which the death oeeurred.
[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 :r a.
registration.
SECTION 5. Penalty fo' was
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 /
Mildred and Martha cho" Sex Blusky Color,
W
Date of Death,
October yt
1900 ; Age ._. Years,-
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.3
N. Chelmsford Mass
Place of Birth, 1. Chelmsford band
*Place of Death,
N. fchelmsford Abass
Name and Birthplace of Father, James Mc Clusky- Scotland
Maiden Name and Birthplace of Mother,
Anisie Towles Baltimore, Maryland
Place of Interment, (Give name of Cemetery),
A. Chelmsford, Mas2
Dated at
Chelmsford
Falu Inarinel 20
on
Mass Olat St
... 1900
Signature and
place of business
of Undertaker.
of Chelmsford Abassi
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Mildred + Martha mccluskey
Age,
... Y.
Place and Date of Death,
Primary,
8720 vin cinin Premature Brich
.
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
JE. Tunney
M. D.
Signature and Residence
of
Certifying Physician.
Northchehar fang
Date of Certificate,
Oct. 9-
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.
.
"level bat few minutes
died at
north chilunfond
Oct. 7
.190 D.
Disease or Cause
of Death, }
Secondary,
184
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 lie 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 thic 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.
SECTION 5. Penalty for violation not exceeding fifty dollars.
Ree
FORM C.
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,
Millian | Xujan
Sex, Male Color,
White
Date of Death,
Oct 230
For, Age,~
Years, >
Months,.
Days.
Maiden Name, { If married, widowed ] or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, .
-
Occupation,
*Residence,
§ If ont of town, }
158 Tunick at Zawell
falso state fully }
Place of Birth,
North talicheddard
11
11
*Place of Death,
Name of Father,
Martin Ryan
Birthplace of Father,
Maiden Name of Mother Mary janes.
Laurie
Birthplace of Mother,
Place of Interment, (Give name of Cemetery), It Patricks Cenulery
Dated at
¿well
Signature and
C. Nillallay
on Oct 23 1 900
place of business
of Undertaker.
Lawell
PHYSICIAN'S CERTIFICATE.
William
JyanAge, Y ... . M
Name and Age of Deceasedt
Place and Date of Death,
Disease or Cause of Death, #
Malnutrition
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief
Am Forster
M. D.
Signature and Residence
5
of
1900 St Johns Hosp
* Give also street and number, if any.
t Give sex of infant not named. If still-born, so state. If chiki died immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Read Det- >3-
Lowell Nase
1
Commonwealth of Massachusetts.
Resident Physician Certifying Physician Oct 232h
Date of Certificate
died at
42 Dumne
St Cct 23, 1900
Ireland
1
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 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 fur real rites preliminary to the interment of a human body shall obtain the physician's certificate mad.
rdance c* on Io, and return it, together with the facts re- quired by : mti) oard of healt1 : clerk of 1 torn in which the death occurred.
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,
Charles w Boucles
Sex,
Color,
,
Date of Death,
art. 26
:
.190
Age, 37
.Years,
-
... Months,
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Painter
*Residence, also state fully.
{ If out of town, }
Chalmsford mars
Place of Birth,
Chelmsford Mass
*Place of Death,
Name and Birthplace of Father,
James Bowley Maine
Maiden Name and Birthplace of Mother,
Catherine Leightone
Place of Interment, (Give name of Cemetery),
At Patrick
Dated at.
Lowest
on act 26
<_ 190/0%
Signature and
place of business
of Undertaker.
70 lockar M
-
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age, ..
.Y
M.
D.
Place and Date of Death, died at.
190
Disease or Cause
of Death, ţ
Secondary,
-
Primary,
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
2
Signature and Residence
of
Certifying Physician.
267 heart 2.
3
Date: of Certificate,
Del-2>
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.
186
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 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. 1
SECTION 5. Penalty for violation not exceeding fifty dollars.
Rec
FORM C.
Commonwealth of Massachusetts. 1
No.
RETURN OF A DEATH.
To the Cierk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
martha & Wyman Sex female Color: White
Name,
Date of Death,
nov
9, 1988; Age, 67 Years,
7
Months, --
Days.
Maiden Name, { If married, widowed }
or divorced.
1
martha & Webster
Husband's Name,
Josiah Wyman
Single, Married, Widowed or Divorced,
Widow Occupation,
at home
*Residence, (If out of town, ) East Chelmsford Mass
{also state fully }
Place of Birth,
Hooksett n. f
* Place of Death,
East Chelmsford
Name of Father,
William Webster
Birthplace of Father,
Dracut mass
Maiden Name of Mother,
Martha
Birthplace of Mother,
Billerica mass
Place of Interment, (Give name of Cemetery),
Edson
Cemetery
Dated at
East Chelmsford 0
Agnature and
L. M. young &les
S
1900
of Undertaker.
33 Prescott St
011
9tf nov
place of business
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
martha & WymanAge,
69 8 7
M
- D.
Place and Date of Death,
died at
East Chelmsford nov. 9, 1900
Pleuritis
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
M. D.
of
Certifying Physician.
267 nes
netto SC-
Date of Certificate
20.10
1 9000
* Give also street and number, if any.
+ Give sex of infant not named. If still-born, so state. If child died immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
15/ 7
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, witha 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. Av nerand haviam At.
(Reo
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,
Fannie a. Randall
Sex,
Color,
Ir.
Date of Death,
November 6
1900; Age, 60 Years,
4
Months,
3 Days.
Maiden Name, { If married, widowed )
or divorced.
Hannie a Danforth
Husband's Name,
My 2. Randall
Single, Married, Widowed or Diyorced,
Married
Occupation,
Housewife
*Residence, { If out of town, )
also state fully.
Chelmsford
Place of Birth,
Bloomfield Conn.
*Place of Death,
Chelmsford
Name and Birthplace of Father, Nathaniel & Danforth, Canterbury 11.H.
Maiden Name and Birthplace of Mother,. agnes Ballow Derfield H1.H.
Place of Interment, (Give name of Cemetery),
Pine Ridge Tom, Chelmsford
Dated at
Chelmsford
Walter Resham
on
1908
Signature and place of business of Undertaker. Chebuford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Primary,
Disease or Cause of Death,} Secondary,
Hamry Q. Randall Age,
608.4 M.3 D.
died at
Chelmsford, Mas. nor. 6.
.1900.
Epidemia Influenza Duration,
Confusional Insanity
Duration,
about 8 mths.
I certify that the above is true to the best of my knowledge and belief.
Arthur O Scoloria.
M. D.
Signature and Residence S of Certifying Physician. Chelmsford, mass,
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.
188
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 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 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
men and certificate are delivered to the been i'ı
The same is the clerk of the city or town for Board
SECTION .. Penalty for violation net exceeding fifty dolla:
Rec
FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Isiah Goudreau
.Sex,.
Color,
Date of Death,
1900; Age, 613 Years, - Months, - Months, Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
A: Chelmsford
*Residence, { If out of town, )
¿ also state fully. 3
Camada
Place of Birth,
North Chelmsford
*Place of Death,
Name and Birthplace of Father, 1- Known
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery), Dr. Patrick Cemetery
Dated at
Lowell Was
Signature and
Dames, If Formell
on Her 12
1900
place of business
of Undertaker.
324 Market St.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at.
North Chebenford
nor 11
190 0.
Disease or Cause of Death, } Secondary,
Primary,
Pneumonia
Duration,
one week
Duration,
I certify that the above is true to the best of my knowledge and belief.
JE Vaney
M. D
Signature and Residence S of Certifying Physician. 3
noch Chiliunfinal
Date of Certificate,
non 12
190 ¢.
* 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.
Recel Avv. 13
159
1
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Occupation,
Carpenter
Isaiah Budream
Age,
63%.
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 IT ~~ 141 r
registration.
ind tr ismit
SECTI
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,
Eugene Journey
Sex,
Color,
Date of Death,
Nov. 14
1900; Age, 12
... Years,
.. Months, ......
.Days.
Maiden Name, { If married, widowed ) or divorced. .
Husband's Name,.
Single, Married, Widowed or Divorced,
Occupation,
* Residence, ¿ also state fully.
Cast beresford
§ If out of town, }
Mass.
Place of Birth,
Ireland
*Place of Death,
Bast thewisford
Name and Birthplace of Father,
Michael
cheland
",
Maiden Name and Birthplace of Mother, lathering Sullivan"
Place of Interment, (Give name of Cemetery)
St. Patrick
Dated at
Source
Signature and
Peter N. Lavage
on
F
Nov. 14
190 0
place of business
of Undertaker.
169 Worther St.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age, 724.
M. D.
· Place and Date of Death,
Primary,
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician. 1
M. D.
Date of Certificate, Www. 15 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, givo both Primary and Secondary Cause.
Countersign and transmit to the clerk 'of the city or. town.
Agent of Board of Health.
Recol 100 14,
190
Www.14
190 0.
Disease or Cause of Death, } Secondary,
No.
RETURN OF THE DEATH
OF
at
Date,
190 -.
Filed,
190
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
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