USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 13
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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 his vessel first arrives after such death.
SECTION S. 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 anthorized 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 seetion 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 fec 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 reecived. 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.
Res
Commonwealth of Classachusetts.
[ACTS OF 1897, CHAP. 444.]
SECTION 13. The clerk of each city and town shall forthwith make certified copies of the records of all births and deaths recorded in the books of said city or town during the previous month, whenever the deceased person or the parents of the child born were resident in any other city or town in this Commonwealth or any other state at the time of said birth or death; and shall transmit said certified copies to the clerk of the city or town in which such deceased person or parents were resident at the time of said birth or death, stating in addition the name of the street and number of the house, if any, where such deceased person or parents so resided, whenever the same can be ascertained; and the clerk of every city or town in this Commonwealth so receiving such certified copies, or certified copies of births, deaths or marriages, from the clerk of a city or town without the Commonwealth, shall record the same in the books kept for recording births, deatlıs or marriages.
Blank to be used in compliance with the foregoing. (FILL OUT WITH INK, ALL NAMES TO BE IN FULL.)
Copy of the Record of a
DEATH
recorded in the books of the. City of Lowell.
(City gr Town.) during the month of march 1903 1899.
1. Date of Death, March 11, 1903
2. Name, Warright m. Bartlett booker
(Maiden Name), . (Name of Husband),
Charles & G. Bartlett
Female, White
3. Sex and Color, .
4. Single, Married, Wid- owed or Divorced,
Widowed
5. Age, :
68 Years,
Months, Days. Pulmonar Hemorrhage
(Disease or Cause of Death, Duration of Sickness, By whom certified,.
Hm I Carolin M. D
7. Residence,
Chelmsford mass. at Home 362 East Merrimack Street Lowell
10. Place of Birth,
Lowell
11. Name of Father,
Isaac Cooper
12. Name of Mother, . (Maiden Name.)
Maria Dinsmore
13. Birthplace of Father,
England
14. Birthplace of Mother, .
Chelmsford mars.
15. Place of Interment, (Name of Cemetery.)
I certify that the foregoing is a true copy.
Attest : Chardt. Dadman
Mar. 21 1903 1899.
Clerk.
(City or Town.)
8. Occupation, .
9. Place of Death, .
Wist Boylston
100
No.
COPY OF A RECORD
OF THE DEATH OF
which occurred in the.
(City or town.)
of.
1899.
Filed
1899.
Ref
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,
march 1H
190 3
Full Name of Deceased,
Carl a.
Quist
Maiden Name, .
we married Or divorced woman or a widow give also Name of Husband,
Sex.
male
Color,
White
Single, Married, Widowed or Divorced,
Single
Age, 23 Years,
6
Months,
/7 Days. Occupation,.
Stone. Cutter
* Residence {If out of town, )
also state fully. }
West
Is helmaford
Place of Death,
Place of Birth,
Sweden
Name and Birthplace of Father, anderes & Quist Sweden
Maiden Name and Birthplace of Mother,
Regina S. Peterson
1/ 1/
Place of Burial (Give name of Cemetery)
West Chelonsford
Dated at
Lowell
Signature and
on
March
1H.
.190 3
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at
weet Chelmsford
Much 14
1903.
Disease or Cause of Death, # Immediate,
Primary,
Pulmonary Intercular
Duration,
two years
Duration,
I certify that the above is true to the best of my knowledge and belief.
F. E Varney
M. D.
Signature and Residence S of Certifying Physician.
Minik Chilisfin
Date of Certificate,
nech 14h
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 Immediato Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
107
Carl Quial.
Age, 23 4. 6 M./7.D.
No.
RETURN OF THE DEATH
OF
Last A. Dimit
at
Date, -... March 14 1903
Filed, 11 16
1903
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose 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 S. 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 funcral, 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 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, March 16
190 3.
Full Name of Deceased, alval Howard Richardson
Maiden Name,.
If a married or divorced woman or a widow give also Name of Husband,
Sex,
Color, w Single, Married, Widowed or Divorced, Married
Age, 69 .Years, 6 Months, / 2 Days. Occupation, farmer
* Residence ( If out of town, }
¿ also state fully.
Chelmsford
Place of Death,
Chelmsford
Place of Birth,
Name and Birthplace of Father,
Elijah R. Richardem Quew for
Maiden Name and Birthplace. of Mother Elizabeth Gruerson 4
Place of Burial (Give name of Cemetery),
Herfathers Cere
Dated at.
Chelmsford
Signature and
To Perhar
on
March 18
1903
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ;
A.H. Richardson
Age,
698. 6 M. 12 D.
Place and Date of Death,
died at
Chilimaford
mich. 16
1903.
Disease or Cause
of Death, ¿
Immediate,
Primary,
Typhoid For
Duration,
2 weeks.
Duration,
I certify that the above is true to the best of my knowledge and belief.
Amara Howard
M. D.
Signature and Residence of Certifying Physician.
Date of Certificate,
190 .
· 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 Immediate Cause.
2
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
108
place of business
No.
RETURN OF THE DEATH
OF
at
...... .
....
Date,
190
Filed,
190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose 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 cor- tifieate required by section 10, enter thereon the facts required by seetion 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.
Rees
Commonwealth of Classachusetts.
[ACTS OF 1897, CHAP. 444.]
SECTION 13. The clerk of each city and town shall forthwith make certified copies of the records of all births and deaths recorded in the books of said city or town during the previous month, whenever the deceased person or the parents of the child born were resident in any other city or town in this Commonwealth or any other state at the time of said birth or death; and shall transmit said certified copies to the clerk of the city or town in which such deceased person or parents were resident at the time of said birth or death, stating in addition the name of the street and number of the house, if auy, where such deceased person or parents so resided, whenever the same can be ascertained; and the clerk of every city or town in this Commonwealth so receiving such certified copies, or certified copies of births, deaths or marriages, from the clerk of a city or town without the Commonwealth, shall record the same in the books kept for recording births, deaths or marriages.
Blank to be used in compliance with the foregoing. (FILL OUT WITH INK, ALL NAMES TO BE IN FULL.)
Copy of the Record of a DEATH
recorded in the books of the City of Lowdle
(City or Town.) during the month of March 190 3 1899.
1. Date of Death,
March 23, 1903
2. Name,
Harriet- M. Kennedy
(Maiden Name), . 1
(Name of Husband),
Gung Ho Kennedy 11 alexander
3. Sex and Color,
Female White
married
5. Age, 37 Years, Months, Days. Fibroid of Uterus ( Sloughing) Peritonitis
Disease or Cause of Death,
(no Operations)
6. Duration of Sickness, By whom certified,.
8. arthur Yage MM. 2.
no Chelmsford mass
7. Residence,
House wife
8. Occupation,
Lowell General Kapital
9. Place of Death, .
Milsom n. 16
10. Place of Birth,
Junge B. alexander
11. Name of Father,
12. Name of Mother, .
(Maiden Name.)
13. Birthplace of Father, .
14. Birthplace of Mother, .
askwith n. H.
15. Place of Interment, .
Gilsum n. 16
(Name of Cemetery.)
I certify that the foregoing is a true copy.
Attest :
Girard 1. Dadurch
Mar. 28 19031899.
Clerk.
(City or Town.).
109
Vanhelia S. Bigno
4. Single, Married, Wid- owed or Divorced,
No.
COPY OF A RECORD
OF THE DEATH OF
which occurred in the
(City or town.)
of ..
1899.
....
Filed
1899.
1
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
Date of Death,
Mar 25
1909
1897 ; Age,
54 Years,
Months,
.Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Chaneloccupation,
1
Farmer
*Residence, { If out of town, )
No thelmetres
¿ also state fully.
Place of Birth, trebamol.
*Place of Death,
Name of Father,
Gotknown
Birthplace of Father,
Maiden name of Mother,
1
1
Birthplace of Mother,
Place of Interment, (Give name of Cemetery).
No Chelmsford
Dated at
Lowell
JA Winbeck
on
2. 5.08 /har
.189 3
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ¡
Place and Date of Death, ;
died at
North Chelafont Mich 25 8903
Disease or Cause of Death, §
Decare of Liver
Duration of sickness,
three months
I certify that the above is true to the best of my knowledge and belief> >
Signature and Residence
of
3
Certifying Physician.
Date of Certificate,
nech, 25
18903
Give also street and number, if any.
t Or scx 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.
Recia March 27 -03
Jillian Mcclure
.M.
D.
Signature and
I. E. Turney
M. D.
110
Se Male Colo Chite
1 +
No.
RETURN OF THE DEATH
1
OF
nu. le Jeune ........
Date,
March 25 18903
Filed, March 27 18903.
The provisions of chapter 444 of the Aets 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 negleet, ten dollars. (See section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certifieate 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 eity or town in which the death oeeurred.
Ri
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Sex,
Color,
Date of Death march 2 F go (3 Age, 32
Years, -
Months,Days.
Maiden Name,
{ If married. widowed }
or divorced
.....
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Into Theles ford
*Residence
" If out of town }
( also state fully
Place of Birth,
* Place of Death,
Northpeleas ford
Name of Father, John paulpin
Birthplace of Father,
mary Saumon
Maiden Name of Mother,
Birthplace of Mother,
Patice bo Quetes
Place of Interment,
(Give name of cemetery)
Dated at Lat Pull &Mass
Signature and
of Undertaker on marchalA : 903 place of business
1324 maget It
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased;
Ellen Varkin
Age,.
32%.
M,
............ D.
Place and Date of Death,
Disease or Cause of Death, #
Mettivis
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Eller. S.Welch
M. D.
of
1
2. Runals Blog
Date of Certificate
Certifying Physician
March 28
1903
Agent Board of Health.
*Give also street and number, if any.
. tGive sex of infant not named. If stili-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.
Nech warch 30
Whichand
died at
no. Chelmsford March 28
No
RETURN OF THE DEATH
OF
1
at
I
Date,
I
Filed,
1
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 occurcd.
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.
1 ~1. _ 11 SECTION 12. Any person having charge of the funcreal rites preliminar 7
n section 10, and ret or town in which
112
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.)
Date of Death,
7th
april
190.3 .
Full Name of Deceased, Viola 2 miller
Maiden Name, Viola R. Miller
or divorced woman or a widow give also
Name of Husband,
Sex Female Color, White Single, Married, Widowed or Divorced, Single
Age, ~ Years, ... 4 Months, 2 3 Days. Occupation,
* Residence {
{ If out of town, {
north
Chelmsford
[ also state fully. §
Place of Death,
Place of Birth,
Name and Birthplace of Father,
William Miller Novascotia
Maiden Name and Birthplace of Mother,
Carrie Richard, England
Place of Burial (Give name of Cemetery),
No. Chelmsford?".
Dated at
Lowell
Signature and
S
on april 8 190 3
place of business
3
of Undertaker.
33 Piescoll Sf-
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Viola Ruth Mille Age,
Y. G/ M. 2 3D.
Place and Date of Death,
- Primary,
Disease or Cause
of Death, }
Immediate,
Duration,
2 mo.
acelé meunicité
Duration few hours
I certify that the above is true to the best of my knowledge and belief.
Is Ce Harlow
M. D.
Signature and Residence § of Certifying Physician.
2
Tyngsboro
Date of Certificate,
apr. 7
1903.
* 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
died at.
Chelmsford
190 3.
malnutrition
No.
RETURN OF THE DEATH
OF
Viola Quificier
at
Date, 1.903 ........... .
Filed,
1.900
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honseholder in whose house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death oceurs, 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 anthorized 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 deccascd was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate canse 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 snch 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.
113
FORM O.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Trans
te ate
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex Female Color,
white
Date of Death,.
190 3; Age,.
.. Years,
Months,
Days.
pour
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
*Residence, { If out of town, )
¿ also state fully.
North Chelmsford
man
Place of Birth,
7 . 7
*Place of Death,
Peter Cote
Canada
Maiden Name and Birthplace of Mother, Delia Cervello ~
Place of Interment, (Give name of Cemetery), St Joseph Ce metary Chelmsford
Dated at Lowell Mars
Signature and
Joseph alberto
on Caril 10Th .10 3 , of Undertaker.
place of business
57 le heever LL
PHYSICIAN'S CERTIFICATE.
one hour
Tary
Coté'
Age, ...
.Y.
M D.
Place and Date of Death,
died at
framaten besch Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
FE ramas
.M. D.
Date of Certificate, Cifril 10 .190 2
* 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.
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