USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 14
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19
Countersign and transmit to the clerk of the city or town.
...
2/1/1
Agent of Board of Health.
L
ahmet 10 1903.
Disease or Cause of Death,¿ Secondary,
Primary,
Signature and Residence S of Certifying Physician.
H- Chelutan
Rec.
Name and Age of Deceased, t
Name and Birthplace of Father,
No.
RETURN OF THE DEATH
OF
r
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 potice 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 causc 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 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.
114
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,.
15- 190 3.
Full Name of Deceased,
Maiden Name, ............
If a married or divoreed woman or a widow give also S Name of Husband, ........
Sex, Sauce , Color, Single, Married, Widowed or Divorced,
Age,. ~ Years, ~ Months, Days. Occupation,
* Residence { also state fully. § { If out of town, }
Place of Death,
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother, Acer A Barrett Lowery
Place of Burial (Give name of Cemetery),
Edrone Panelery, 20well
Millian 16 Lee
on
Dated at April 16 1903
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Infant finale child
Age, × Y. X M. X D.
Place and Date of Death,
Primary,
Still born
Duration,
Duration,
1
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
Certifying Physician.
M. D.
Date of Certificate,
CEfr. 16
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.
-the. 16
Agent of Board of Health.
died at
Chelmsford
at. 15
.190 3.
Disease or Cause
of Death, ¿
Immediate,
Place of Birth,
No.
RETURN OF THE DEATH
OF
at
Datc,
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, 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 sccondary 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.
115
FORM C.
Commonwealth of Massachusetts.
No
RETURN OF A DEATH To the Clerk of the City or Town in which the death occurred.
Name,
Ahn Sung
Unn
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex,
Color,
Date of Death May 4,
1903; Age,
80
Years,
Months,
... Pays.
Maiden Name, If married. widowed }
or divorced
Husband's Name,
Single, Married, Widowed or-Divorced, ..
... Decupation, Retired
* Residence
{ If out of town !
falso state fully }
Aust- Chaletoch Muss.
Place of Birth,
* Place of Death,
Name of Father,
Birthplace of Father, .....
1.6.
Maiden Name of Mother,
.5.z.
Priland
Birthplace of Mother, .....
Place of Interment, (Give name of cemetery)
St Patricks Fourth Mass.
Dated
Signature and
place of business
1943.
of Undertaker
1324 Market Si Rounil Mas
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
John Dunn
Age,
80 %, - M, - D.
Place and Date of Death,
died at
meet Chelmsford, may 4
Disease or Cause of Death, #
Senility
Duration of Sickness.
Confined to bed one year
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
JE Varney
M. D.
of
Non Chelmsford
Certifying Physician
Date of Certificate May 5 1903
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 immellately after birth, so state. #If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
7
wed site 6-1903
. 903
Ruland
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 whosc 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 ir. turn it, together with the icts required by sec- . the board of health or to the cle .. dcath occurred.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred. Nagy 11lt 196 3
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death, Debati & Cochrane 1903.
Full Name of Deceased,
Denralf Cercherai
Maiden Name,
= = married or divorced
woman or a widow give also
Name of Husband,
William J Ca@hran
-
Sex, Color, Single, Married, Widowed or Divorced,
Age, 4 Years, Months, Days. Occupation,
* Residence ( If out of town, } also state fully.
Place of Death,
Place of Birth,
Vera Kunnemole
Name and Birthplace of Father
Maiden Name and Birthplace of Mother, Elisabell Julkaum
Place of Burial (Give name of Cem
Lewell
fax Membre
Dated at
12th May 1903
on
Signature and place of business of Undertaker. well mars
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Deborah Cochran Age, 468 M. D.
Place and Date of Death,
died at
North Chelives ford
May 100 90 3.
Primary,
Pneumonia
Duration,
6 days
Disease or Cause )
of Death, #
Immediate,
Duration,
I certify that the above is true to the best of my knowledge and belief.
I El'ancy
M. D.
of Certifying Physician.
Mint Chelun dert.
Date of Certificate,
May 13
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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
116
Signature and Residence
S
No.
RETURN OF THE DEATH
OF
at
Date,.
190
Filcd,
190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every houscholder 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 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 O.
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, april !!
190-3.
Full Name of Deceased, Still
Born
(Vickery)
Maiden Name,.
3 = = married or divorced woman or a widow give also Name of Husband,
Sex,
Color,
Single, Married, Widowed or Divorced,
Age, ..
0
.Years,
0
Months,
0
.Days. Occupation,
* Residence
{ If out of town, }
also state fully. }
Place of Death,
Chelmsford
Place of Birth,
Name and Birthplace of Father,
H. a Vicker Yarmouth 11.05.
Maiden Name and Birthplace of Mother, Lengie V. Allen, Yarmouth U.S.
Place of Burial (Give name of Cemetery),
Pine Ridge Com. Chelmsford
Dated at Chelmsford
WPerhour
on
april 11
1903
Signature and
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age,
.Y.
M.
.D.
Place and Date of Death,
died at
Cleliaford
(1/2).11
190
Primary, - Disease or Cause of Death, } Immediate,
Still-bon.
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Climaza Howard.
M. D.
Signature and Residence
of
Certifying Physician.
2
Date of Certificate,
6.0/12-1-2
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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Rica May 18 03
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF
at
Datc,
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 deeeascd 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 liuman 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 certifieate, shall forth- with countersign and transmit it to the clerk of the city or town for registration, Penalty for violation not exceeding fifty dollars.
118
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,
Patrick Duffy
Sex, Color,
Date of Death
May 15
1905; Age,.
64 Years, -- Months, -Days.
Maiden Name, {If married. widowed }
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation, Pelina
* Residence
{ If out of town }
{ also state fully §
Place of Birth,
*Place of Death, Diren Farm Chelmsford Center
Name of Father,
Birthplace of Father, ......
n
Maiden Name of Mother,
Birthplace of Mother, ..........
Place of Interment, (Give name of cemetery)
Dated at Loures Vas
Signature and
place of business
on1 ..... 1
of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Patrick Duffy
Age,
64x,
м, .D.
Place and Date of Death,
Disease or Cause of Death,
nephritis
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Cámara Haward
of
(
M. D.
Certifying Physician
Chilinieford
Date of Certificate
Man 13 ª.
1903
Agent Board of Health.
*Give also street and number, if any. tGive sex of Infant not named. If still-born, so state If chilld died immediately after birth, so state. #If a Soidler or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
died at
Chilmustard May 130
19.03
So "Patrick Cemetery
No ...
RETURN OF THE DEATH
OF
at
Date,
I
Filed,
I
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, II AND 12.]
SECTION 6. Every houscholder 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 S. 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 funercal 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 J, to the board of health or to the clerk of the city or town in which the death occurred.
FORM C.
Rel
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, .....
May
190 3.
Full Name of Deceased, arthur Bell
Maiden Name,
If a married or divorced woman or a widow give also Name of Husband,.
Sex,
Color,
Single, Married, Widowed or Divorced,
Age,
63
Years,
6
Months,
4
Days.
Occupation,
Laboren
* Residence
{ If out of town, }
Chefsford
{ also state fully. §
Mass.
Place of Death,
Chelmsford, Mass
Place of Birth,
Orelanch
Name and Birthplace of Father, arthur Bell.
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery)
Edson Cemetery, Lowell.
Dated at.
Chelmsford
Signature and
place of business
3
on
May 14,
190 3
of Undertaker.
Chelmsford.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Citron Bile
Age, 63 8.6 M 4 D.
Place and Date of Death,
died at Chelmotorle Mans May / c/ 190 3.
Disease or Cause of Death, } Immediate,
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.
M. D.
Date of Certificate,
.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.
119
Commonwealth of Massachusetts.
-
No.
RETURN OF THE DEATH
OF
at
Datc,-
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 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 fce 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.
120
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,
May 18
190 3.
Full Name of Deceased,
ann March
Maiden Name, nichole
If a married or divorced woman or a widow give also ( Name of Husband, Dwight March
Sex,
Color,
W
Single, Married, Widowed or Divorced, Undowed
Age, 71 Years, 4
Months,.
7
... Days. Occupation,
* Residence { also state fully.
( If out of town, }
Chelmsford.
Place of Death,
Chelmsford
Place of Birth,
Hardwick UX
Name and Birthplace of Father, asa Nichols Concord UX
Maiden Name and Birthplace of Mother,
Elize Hitcherch Westmorel
Place of Burial (Give name of Cemetery),
Edson Cemetery Lowell
Dated at
Chelmsford
Signature and
To Pertany
on
May 18
1903
3
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ;
Place and Date of Death,
Primary,
Disease or Cause of Death, ţ Immediate,
died at
Chelmsford
-May 18
1903.
Endocarditis
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
Canada Howard
M. D.
Date of Certificate,
18
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.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.