USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 11
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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 the 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 10, and return it, together with the facts required by sect- ion I, to the board of health or to the clerk of the city or town in which the death occurred. "
Reci FORM C.
91
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,
James
M: Jarry
Sex,
Color,
Date of Death
Dec 11
1902 ; Age, 72
Years,
Months,
- Days.
Maiden Name, 1 or divorced
( If married, widowed }
Husband's Name,
..........
Single, Married, Widowed or Divorced, Occupation, North Chelmsford
* Residence
( If out of town }
{ also state fully )
Creland
Place of Birth,
Mª Chehurford *Place of Death,
Name of Father,
. Patrick M= James
Birthplace of Father,
Maiden Name of Mother, ..... Pese
Birthplace of Mother,
Place of Interment, (give name of cemetery) St. Patrick Beneting
Dated at
Laurel Mars
place of business
on
Dec. 12
1902.
of Undertaker
PHYSICIAN'S CERTIFICATE.
James Mc Jawey
Age, 2 V
M, ............. D.
Place and Date of Death, died at Hent Chelios find Dec !! 1202
Disease or Cause of Death, #
Bacomolis Citaxia
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence JE Vany
M. D.
of
M. Cheleuten
Certifying Physician. Dec 12
1902
Agent Board of Health.
*Give also street and number, if any. tGive 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.
TRADES HILLOUEL 9
1 -x1/3
Name and Age of Deceasedt
If lavin Wieland
Signature and
5. O Donnell. Jonas
324 Market Se
Date of Certificate.
Three years
No. ....... .....
No.
RETURN OF THE DEATH OF
at
I
Date,
Filed,
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 the 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 certifi " made in accordance with section 10, and return it, together with the facts required by sect- ion I, to the board of health to the clerk of the city or town in with the death occurred.
42
FORM C.
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,
alfred & hallon
Sex, Color,
Date of Death
Dec 17
.1902; Age,
4 Years,
6
.. Months.
9 Days.
Maiden Name,
{ If married. widowed ]
or divoreed
Husband's Name,
Single, Married, Widowed or Divorced, .Occupation,
* Residence
[ If out of town }
( also state fully }
North Chemsford
Place of Birth, North Chemsford
*Place of Death, North Chemsford
Name of Father,
Edward Hallon
Birthplace of Father,
Lowell
Maiden Name of Mother,
Mary a Gorman
Birthplace of Mother,
...............
North Chemeford
Place of Interment, (Give name of cemetery)
It Patrick
Dated at
How Ell Mass
Signature and
place of business
on
Dec 17 902
of Undertaker
James H. Mc Dermott
70 & orhan 5%.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
(Cefred i). Fallon
Age,
4 ×, 6 M, 9 D.
Place and Date of Death,
Disease or Cause of Death, #
died at
71: Whiteford he. 17ª 1902
Membranous Croute.
Duration of Sickness.
Ksw dais.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
(Imara Howard-
M. D.
of
Certifying Physician
Date of Certificate
Mile. 17 ch.
1902.
Agent Board of Health.
*Give also street and number, if any. tGive sex of infant not named. If still-born, so state If child died immediately after birthi, so state.
#If a Soklier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Rec
No. ......
--
No.
RETURN OF THE DEATH
OF
9
at
Date,
1
Filed,
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 AND 12.]
....
X
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 occured.
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 the 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 10, and return it, together with the facts required by sec- tion 1, to the board of health or to the clerk of the city or town 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,
Hanmah A Night
Sex,
tue
Color,
Date of Death
Dec 26
190 2- Age ......
68 Years,
Months,
Days.
Maiden Name, 1
or divorced
Husband's Namc,
Samuel J Wright
Single, Married, Widowed or Divorced,
Widau Occupation,
at france
North Chelmsford Mass
*Residence
{ If out of town }
{ also state fully }
Placc of Birth, ...
Dunstable nisz
*Place of Death,
North Chelmsford Mass
Name of Father,
Charles I leuning
Birthplace of Father,
Lundalle Wass /
Maiden Name of Mother,
Hannah Littletall
Birthplace of Mother,
Ilimitable mass
Place of Interment, (give name of cemetery)
Dated at
Lawell mass
Signature and
John F Nemback
on.
Dec 27
902
of Undertaker
080 Middlesen St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt Hannah a Night.
Agc,
68%.
M, ............
D.
Place and Date of Dcath,
died at
north Chilis font Dec 26 , 902
Disease or Cause of Death,
Organic disease I heard-
Duration of Sickness. two years
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
JE Varney
M. D.
of
R
Certifying Physician. Dec 27
1902
Agent Board of Health.
*Give also street and number, if any.
tGive 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.
TRADES RECO 9
Date of Certificate
place of business
93
{ If married, widowed }
Hannah A learning
No ...
RETURN OF THE DEATH
OF
at ..
I
Date,
I
Filed,
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 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 the 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 10, and return it, together with the facts required by sect- ion I, to the board of health or to the clerk of the city or town in which the death occurred.
FORM C.
Res
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.)
Date of Death,
January 6
Full Name of Deceased,
Hannah H. Perhay
1903.
Maiden Name, Hannah of Mayfield
If a married or divorced woman or a widow give also Name of Husband, Samuel P Pertany
Sex,
Color,
20.
Single, Married, Widowed or Divorced, ..
Cordoved
Age, 76 Years,
Months,
7
Days.
Occupation,
* Residence
{ If out of town, }
Chelmsford
( also state fully.
Place of Death, "
Place of Birth,
Exeter Mains
Name and Birthplace of Father,
nathan n. Mayfield, Exeter Me.
Maiden Name and Birthplace of Mother, Hannah Hill, Jouden U.H.
Place of Burial (Give name of Cemetery)
Edem Cora. Forde
Dated at
Chelmsford
Signature and
Halten Perhang
place of business
on
190.3
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
- Primary,
Disease or Cause of Death, ¿ Immediate,
Hannah H. Perham Age, 76 8. 5 M. 7 D.
died at.
Chimieford
Jan. 6 1903.
Neuritis
Duration,
00
8 months
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
Certifying Physician.
LimaNa
M. D.
Date of Certificate,
1903.
* 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
94
No.
RETURN OF THE DEATH
OF
at .....
Date,
190
Filed,
190
EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whosc house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, canse notice thereof to be given to the board of health or to the town clerk.
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 shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts.
SECTION 11. If the deceased was a soldier or sailor 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 samc. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS. ]
SECTION 38. No undertaker or other person shall bury a human body in a city, or town or remove thercfrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- with countersign and transmit it to the clerk of the city or town for registration. Penalty for violation not exceeding fifty dollars.
Rec
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Gardwork. Ripley
Sex,
Male.
Color, White.
Date of Death, January the
1903 ; Age, 24 Years, 4 „Months, 9 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Single
.Occupation,
Mechanic
*Residence, { If out of town, )
? also state fully. 3 North Chelmsford, Mara.
Place of Birth, 11
*Place of Death,
11
Name and Birthplace of Father, F.T. Ripley, North Chelmsford Mare.
Maiden Name and Birthplace of Mother, Josephine a Vidder. Werthond Mark.
Place of Interment, (Give name of Cemetery),
Riverside Cemetery, North Chelmsford."
Dated at Anth Chelmsford Signature and
Albert Richardson
8 0
190 3
place of business
of Undertaker.
Westford Mass.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Disease or Cause Primary, of Death, Secondary,
Gardiner K Ripley Age, 24 x 4 M. 9 D.
died at
North Enciuestinal
.1903.
Duration, Several year
Duration,
I certify that the above is true to the best of my knowledge and belief.
FE Early
M. D.
Signature and Residence S of Certifying Physician.
Fuenf Chelenford
Date of Certificate,
190 3.
* 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.
FORM C.
75
"NO.
1
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 deathi oeeurs, 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 oecurs, 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 oecurred.
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 sueh 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 seetion 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 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.)
Date of Death, 7 am. 16H2
190 3.
Full Name of Deceased, Willard Brooks Gumm Quinmings
Maiden Name,
If a married or divorced woman or a widow give also Name of Husband,
Sex, Male Color, While Single, Married, Widowed er Divorced, Age, 91 Years, 11 Months, 4 Days. Occupation, Blacksmut
* Residence [ If out of town, }
( also state fully. } Jungsbravo.
Place of Death, Anth Gutms ford
Place of Birth, Pangolino.
Name and Birthplace of Father, John Cummings Timetable mas
Maiden Name and Birthplace of Mother,
Sally
11
Place of Burial (Give name of Cemetery), J Sivans Cemetery Syregotero 11 11
Dated at
Somett
Lecce Butterfield
on
13th Jan
190 G
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at No Chelafend
Jan 11th
1903.
Old age
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
G. a. Harlow
M. D.
Signature and Residence § of Certifying Physician. Tyngsboro mass
Date of Certificate, fan Jan. 11"
1903 .
* 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 Immediato Cause.
Countersign and transmit to the clerk of the city or town.
Reach Jan/3
Agent of Board of Health.
- Primary,
Disease or Cause
of Death, ¿
Immediate,
Willard " Cummings Age, 9/8.11 N. 4 D.
No.
RETURN OF THE DEATH
OF
at
Date,
190
Filed,
190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whosc house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
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 shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts.
SECTION 11. If the deceased was a soldier or sailor 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. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city, or town or remove therefrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- with countersign and transmit it to the clerk of the city or town for registration. 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.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
George Day
scMale Color: White
Date of Death Jan 29th 1903; Age, 83
Years,
3
Months,
11 Days.
Maiden Name,
{ If married. widowed ]
or divorced
Husband's Name,
Single, Married, Widowed or Divorced MolowerOccupation,
Chelmsford mass
*Residence
[ If out of town }
[ also state fully )
Place of Birth, Pera Brincarale
* Place of Death,
Name of Father, Jacob
Birthplace of Father,
Margaret Golfeitte
Father &
Maiden Name of PokerChlad England
Birthplace of Mother,
Place of Interment, (Give name of cemetery)
Dated at
Donnell
Signature and
Det Nembeck
place of business 80 triotellesey on 29 kum 903 of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Georga Day
Age, 83 Y,
.M,
.D.
Place and Date of Death,
Disease or Cause of Death, #
died at ..
Chelmsford Masa
Jan. 29,
1903
Manual shock from a fall
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence (
C.E. Simpson
M. D.
Certifying Physician
1
of
Lavel mass
Date of Certificate
Jan 30
....
1903
Agent Board of Health.
*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.
97
England
No ..
RETURN OF THE DEATH
OF
at
I
£
Date,
u Filed, I
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 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 occured.
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 the 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
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