USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 16
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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.
ROY 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, June 22
1903.
Full Name of Deceased, Mary ann Cross.
Maiden
Name,
Higgins
If a married or divorced woman or a widow give also (
Name of Husband,
Sex, Color, .
Single, Married, Widowed or Divorced, Widowed
Age,. 81 Years, 11 Months, 15 Days. Occupation,
* Residence
( If out of town, }
¿ also state fully. [ ....
Chelmsford
Place of Death.
Chelmsford
Place of Birth,
Brunswick maine
Name and Birthplace of Father,
Ruben A Higgins Brunswick Ner.
Maiden Name and Birthplace of Mother, Rachel Cary, Bath ME
Place of Burial (Give name of Cemetery),
Barnard That
Dated at
Chelmsford
Signature and
Halten Pertany
on
June 22
1905
of Undertaker.
Chelmsford.
11
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Primary,
Disease or Cause of Death, } Immediate,
Mr. Many of Cross
Age,.
8.11 M 15 D.
died at
Chellesford, man.,
June 22,190 3
Duration,
15 miths.
Duration,
I certify that the above is true to the best of my knowledge and belief.
Antie & Scolonia
M. D.
Signature and Residence S of Certifying Physician.
Elleford, mais,
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.
Recal June 22
Agent of Board of Health.
-
place of business
128
No.
RETURN OF THE DEATH
OF
at
Datc, -.
190
........
Filed,
190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honseholder 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 offieer 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 fucts 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.
Rue
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.)
Sex, 2
Color,
Date of Death
1903; Age, 75 Years, - Months,
Days.
Maiden Name,
1
or divorced
{ If married, widowed }
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
*Residence
{ If out of town }
( also state fully §
East- Cheie ord.
Place of Birth,
Sieland
* Place of Death,
· East Crimeston?
Name of Father,
Daniel Reardon
Birthplace of Father,
Lulaull.
Maiden Name of Mother,
Johanna Coughlin
Birthplace of Mother,
balance
Place of Interment, (give name of cemetery) St. Patricks
Dated at
Signature and
John & OConnell ×1
place of business
of Undertaker
509 Laurence S1. Lowelt
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Age, 75 Y M. D.
Place and Date of Death,
died at
East Checkno fre Jun 27th, 1903
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
&
Certifying Physician.
Date of Certificate
June 27
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 immediately after birth, so state. #If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Read 114 287
s.J. on musel
M. D. A.s. Billanicy, Mas.
Disease or Cause of Death, #
on
funnel 27
1903
129
Name,
No.
RETURN OF THE DEATH
OF
at
.
I
Date,
I
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 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.
C
130
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, July
190 2.
Full Name of Deceased.
Maiden Name,
If a married or divorced woman or a widow give also ( Name of Husband,
Sex, Ya el Color,
Single, Married, Widowed or Divorced, Age, ~ Years, Months, .Days. Occupation,
* Residence also state fully. S
Place of Death,
Place of Birth,
Herelow Service
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery),' 19
Dated at 410 Chelucoslo
Signature and place of business of Undertaker.
on
190
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at
North Cheliceo towa
July 4
.1903.
Disease or Cause of Death, ţ Immediate,
- Primary,
still born
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician. July 4th 190-3
north Chilfuzion M. D.
Date of Certificate,
· 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.
Reed
Agent of Board of Health.
Age, -Y -M -D.
{ If out of town, }
Herelow
FORM C.
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 offieer 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 sceondary 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 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 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.
13%.
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, July 9 all
Full Name of Deceased,
ym F. Shinkwin
1903 .
Maiden Name,
If a married or divorced woman or a widow give also ( Name of Husband,
Sex, Color, Single, Married, Widowed or Divorced,
Age, Years, 5 Months, Days. Occupation, ....
* Residence { also state fully. §
( If out of town, }
Place of Death, East Chelmsford
Place of Birth,
Name and Birthplace of Father, Daniel Shistwin .
Maiden Name and Birthplace of Mother, Maggie Shinkwin
Place of Burial (Give name of Cemetery), St. Patricks lum. Sowell.
Dated at
Chelmsford
Signature and
place of business
of Undertaker.
John So. Rogere.
on
Jul 10
190 3
3
Central St. Lowell,
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ¡
Age,
Y. 5 M. 7 D.
Place and Date of Death, died at. Schulenford
Jah 9
190 3.
Disease or Cause of Death, # Immediate,
- Primary,
Chakra Dotantum
Duration,
4- days.
Duration,
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, Ong 10 190 3.
· 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.
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 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 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.
see
132
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, .
William J. Stevens
Sex,
Color,
W.
Date of Death July 100
1
.. 190 3; Age, 63
Years,
0
Months,
Days.
Maiden Name, SI married, widowed }
or divorced
5
Husband's Name,
Single, Married, Widowed, or Divorced,
Single 0
Occupation,
Farmer
*Residence
Chelmsford, mass.
§ If out of town }
¿ also state fully §
Twoksbury
Place of Birth,
Chelmsford, mass
*Place of Death,
Cabos Stevens
Birthplace of Father,
Shaftsbury Ut.
Maiden Name of Mother, Servials Parkhurst.
Birthplace of Mother,
Chelmsford, Mass
Forefathers Cemetery
Place of Interment,
(Give name of cemetery)
Dated at chelmsford, Mais
Signature and
place of business
on July 12 1903
of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
In Q. Stevens
Age, 63 Y, 5 M, 16 D.
Place and Date of Death, died at. July 10 903 Shock following Planitic Elfacion. Disease or Cause of Death, #
Duration of Sickness ..
2 months
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician
S
1
Cimara toward
M. D.
Date of certificate
July 12
1903
Agent Board of Health.
*Give also street and number, if any.
1Give 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.
. Reell 13
1
,
Name of Father,
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 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 of 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 sh
obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by sec- tion I, to the board of health or to the clerk of the city or town in which the death occurred.
C-C 4042
133 1
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,
Still Born Child
Sex,
Color,
Date of Death
July 16
1903 ; Age, ~ Years,.
-
„Months, ...
.Days.
Maiden Name, S If married, widowed }
or divorced
Harrington
Husband's Name,
Single, Married, Widowed, or Divorced,
Occupation,
*Residence
S If out of town }
¿ also state fully $
Eastchelmsford Mass
Place of Birth,
Eastchelmsford
*Place of Death,
Eastchel stord
Name of Father,
Sincathy Barrington.
Birthplace of Father,
Ireland
Maiden Name of Mother,
Catherine nulline
Birthplace of Mother,
Ireland
Place of Interment,
(Give name of cemetery)
St Peters Lowell Mass
Dated at
Lowell
Signature and
J HMle Dermott
on July 16
1903
of Undertaker
70 Gorham It
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Hammarton
Age,
.Y,
M.
.D.
Place and Date of Death,
Disease or Cause of Death, į
died at
East Chelms Ford,
July16 , 903
Still born
Duration of Sickness.
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
Indf 16
1903
Agent Board of Health.
*Give also street and number, if any. IGive 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.
Reci Jordy 16
Ret
Commonwealth of Massachusetts.
place of business
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 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 sh obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by tion I, to the board of health or to the clerk of the city or town in which the death occurred.
C-C
Rec
134
FORM C.
Commonwealth of Massachusetts.
No ........
RETURN OF A DEATH To the Clerk of the City or Town in which the death occurred.
(FILLOUT WITH, INK. ALL NAMES TO BE IN FULL.)
Name,
Date of Death Leap 5
190 3; Age,
J8 Years,
2
Months,
.Days.
Maiden Name,
If married. widowed }
or divorced
Husband's Name,
Single, Married, Widowed or Divorced, 110 Carlisle D. L& Cheknsford
* Residence
( If out of town }
¿also state fully
Porland
Place of Birth, 110 CarlisleSt. Co Chelmsford
* Place of Death,
michael
Name of Father,
Garland
Birthplace of Father,
Maiden Name of Mother, (Bridget
Birthplace of Mother,
Dr. Patricks Cemetery
Place of Interment,
(Give name of cemetery)
Dated at
awEle
Signature and
on Aug. 5, 903
place of business
of Undertaker
169 Шыхнян И.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
John Devine
Age,
58 Y, 2 M,
.. D.
Place and Date of Death,
died at
E. Chelmsford
ang. 5
1 903
Disease or Cause of Death, #
Cancer of intestines !.
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence Cininen Atoward M. D.
of
1
Certifying Physician
Date of Certificate
1003
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 Canse.
Delos A.Garage
Sex, Color, ............
No.
RETURN OF THE DEATH
OF
..
at !
I
Date,
Filed,
I
F --
.
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 obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by sec- tion I, to the board of health or to the clerk of the city or town in which the death occurred.
,
135
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, ...
Joseph&may
Sex,
ex Male
.Color, White
Date of Death ......
Cinq. 11to
1903;
Age,.
62 Years, 10
Months,
Days.
Maiden Name,
or divorced
§ If married, widowed ?
Husband's Name,
Single, Married, Widowed, or Divorced,
Occupation,~
*Residence
" If out of town }
¿ also state fully §
Chelmsford Mass
Place of Birth,
Canada
*Place of Death,
Chelangford Mass
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