USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 2
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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 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 section I, 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
Ruth E leilidel
Female for Marte
Date of Death
Feb itt
190 2; Age, 57
.Years,
Months,.
Days.
{ If married, widowed }
Ruth & Salad
Maiden Name,
or divorced
5
Edward levolidge
Husband's Name,
Single, Married, Widowed or Divorced, ed Inarzila cupation, daniel Write
*Residence
{ If out of town }
( also state fully, }
Great Falle NIX
Place of Birth,
*Place of Death, Chelmsford (mark
Name of Father,
Serige M Garland
New Hampshire
Birthplace of Father,
Maiden name of Mother,
Ruth of
Birthplace of Mother, ........
il
cemeter
Place of Interment, (give name of cemetery)
Dated at.
Jewell
Signature and
Cleinbeck
7 th Jel
1902
of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t
Rash G. Coolidge
Age, 57%.
M,
.......... D.
Place and Date of Death,
Disease or Cause of Death, #
1902
Tuberculous Peritonitis,
Duration of Sickness.
about / Mr-
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Auction D. Scotoria
M. D.
of City Physician Telelensfor, Mans.
Date of Certificate
girls. 8
1902
Agent Board of Health.
* Give also street and number, if any.
t Give sex of infant not named. If still-born, so state. If child died immediately after birth, so state.
TRADES MAIN COUNC
5
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
place of business
988 Middlece
on
died at
Chelmsford, Mans Fiel, 7th.
23
Lehelmeford (hacer
No. RETURN OF THE DEATH
OF
at
Date,
I
Filed,
I
Acts of 1897, Chapter 414. [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 deatlı, 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 sect and return it, together with the facts required by section I, to the board of health or to the clerk of the city .. ... ] in which the death occurred.
-
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,
Sarah & Paige
Sex,
te
Color,
White
Date of Death,
Feb 2"
190 2 ; Age,
77
Years,
3
Months,
27 Days.
Maiden Name, {
or divorced.
( If married, widowed }
Sarah & Leavitt
Husband's Name,
Ödman Paral
Single, Married, Widowed or Divorced.
Stidaw Occupation,
at thank
( If out of town, }
*Residence, {also state fully.
North Chelmsford Mass
Place of Birth,
Merideth N.H
* Place of Death,
North
Chelmsford Mass
Name of Father,
Nehemiah Leavitt
Birthplace of Father,
Unknown
Maiden Name of Mother,
Nancy
Daran
Birthplace of Mother,
Unknown
Place of Interment, (Give name of Cemetery),
Riverside
Cemetery-
Dated at
NChelmsford
Signature and
S
Lotus marineda
011.
Masz Hele 24 th
1902
place of business
of Undertaker.
N. Chelmsford Marca.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Sarah L Paige
Age, 7.7 x 3 M 27 D.
Place and Date of Death,
died at
Nath Lewelmsford Feb 2, 90%
Senile
Disease or Cause of Death, #
Duration of Sickness,
I certify that the above is true to the best of my knowledge and belief.
Umasa Howard
Signature and Residence
S
of
Date of Certificate.
1902
Chelmsford.
Mass.
5
TRAGES NASIL COUNCIL
* Give also street and number, if any.
t 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.
M. D.
City Physician.
Fil. 3rd
24
No. RETURN OF THE DEATH
OF
1
1 at
1
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 or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which, his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION IO. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts .. SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. 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 Io, and return it, together with the facts required by section I, to the board of health or to the clerk of the city or town in which the death occurred.
1
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,
Nathaniel ances Slikder
Sex,
Color,
1902 ; Age, 70 Years.
2
Months
29 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Married Occupation,
7
Marmer
*Residence, {If out of town, )
? also state fully.
Chelansford
Place of Birth,
Silford, VIA.
*Place of Death,
Chelmsford
Name and Birthplace of Father, Jasper E Glidden Salford UH.
Maiden Name and Birthplace of Mother,
abiak Ores
Receurugo
Place of Interment, (Give name of Cemetery),
Sowell Cemetery) Forefathers Canisters
Dated at.
Chelmsford
Walter Perhan
Signature and
on Stab 23
1902
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death,
Primary,
Disease or Cause
of Death, #
Secondary,
nathaniel a. Glidden Age, 76 8. 2 M. 29 D.
died at.
Chelmsford Mass
Diabetes Mellitus
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
Certifying Physician.
183 Silently Str. Srock
M. D.
Date of Certificate,
24th
19.0 2.
* 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 Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Date of Death,
Heb- 22
No.
RETURN OF THE DEATH
OF
at
.
Date,
190
-
Filed,
190
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death oceurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the 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 arc delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
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,
Ralph Gilbert Lemay
Sex nale
Date of Deatlı,
eper 23
190 2; Age, .... .....
Years,
Months,
.. Days.
Maiden Name, {
( If married, widowed {
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
* Residence, {also state fully. §
Place of Birth, Went Chelmsford mars
* Place of Death,
Name of Father,
Birthplace of Father.
Maiden Name of Mother, Newman
Birthplace of Mother, ...
Place of Interment, (Give name of Cemetery),
Dated at Nia, Che interval
Joseph Divent
O11 .... 1202
Signature and place of business of Undertaker.
2 57 Cheever Lt
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Ralph Geburt, Germany Age,
.Y.
M
D.
Place and Date of Death,
died at
Weet Chelcanfind Taky 23℃
902
Disease or Cause of Death, #
premature bit
Duration of Sickness,
I certify that the above is true to the best of my knowledge and belief. 1
Signature and Residence
JE Varney
M. D.
of City Physician.
7. Cheliefert
Date of Certificate
Fibi 231
1902
* Give also street and number, if any.
t 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 Canse.
5
26
1
Color,
( If out of town, }
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 or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars. SECTION IO. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts. SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. 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 ro, and return it, together with the facts required by section I, to the board of health or to the clerk of the city or town in which the death occurred.
Reco FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Stillhorn
Sex, male
.Color,
muito
Date of Death,
Feb 23%
1902; Age, ~Years, -Months,
.Days.
Maiden Name, { If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
*Residence, ¿ also state fully.
, { If out of town, {
dr. Chelmsford
Brass
Place of Birth,
masz.
*Place of Death,
Chelmsford
mask
Name and Birthplace of Father,
Charles 2 br. Ennis Vilhelmford
Maiden Name and Birthplace of Mother,
Clara. Hodgson
glad England
Place of Interment, (Give name of Cemetery), Riverside Gerneting
Dated at.
on
1902
Signature and place of business of Undertaker. Es. Chelmsford Bruk
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Mª Enis
Age, ..
.. Y.
.M.
Place and Date of Death,
died at
H. Chequefort
July 23
190 2
Disease or Cause - Primary,
of Death, Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
JE Jamey
M. D.
Certifying Physician.
n Chefunfund
Date of Certificate, Fely 24
190 2
· 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 Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Recel Feb 25
27
John Marinelys
still born
Duration,
Signature and Residence S of
No.
RETURN OF THE DEATH
OF
at
Date,
190.
Filed,
190.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the samc. 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 arc delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
Rec
FORM C.
No.
RETURN OF A DEATH
To the Clerk of the City or Town in which the death occurred.
7
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Robert Maldini Sex,
Color,
Date of Death
1. Feb 28
1902 ; Age,.
7 Years,
8
Months,
Days.
Maiden Name,
{ If married, widowed }
or divorced
Husband's Name,
.
Single, Married, Widowed or Divorced, . Occupation, Retired
*Residence
§ If out of town {
{ also state fully, }
Place of Birth,
*Place of Death, (Seems ford
Name of Father,
Birthplace of Father,
Scotland
Maiden name of Mother,
Agnes- Sim:
Birthplace of Mother,
Scotland
Place of Interment, (give name of cemetery)
Dated at
Chelmsford
Signature and
S
place of business
Lowell
on
Main/
.. 1902
of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased f
Robert Meldung Age,
7/ 8.8
M
.....
.D.
Place and Date of Death,
died at.
therefore, teb, 28 ,902
Disease or Cause of Death,#
Result of aproperty
Duration of Sickness.
Serial years
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Auchun S. Acoloria
M. D.,
of
Chelmsford, mans.
City Physician
Date of Certificate
Thrauch 1, 1902.
Agent Board of Health.
* Give also street and number, if any.
t Give 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 bothi Primary and Secondary Cause.
TRADES KANN COUNCIL 5
08
Commonwealth of Massachusetts.
No ... RETURN OF THE DEATH
OF
at
Date,
I
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 deatlı, 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 tlie 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, tell 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 Io, and return it, together with the facts required by section t, to the board of health or to the clerk of the city or town in which the death occurred.
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
.
i amning
Sex, M, Color,
Date of Death March. 1
190 2; Age, Years, Months, Days.
Maiden Name, or divorced
Husband's Name,
Single, Married, Widowed or Divorced, Ho. Chelmsford 3
" If out of town {
* Residence
{ also state fully, }
Place of Birth,
*Place of Death,
Name of Father,
John J. tanning
Birthplace of Father, Seat Barrington Mac.
Maiden name of Mother, Clara Baule
Birthplace of Mother,
Place of Interment, (give name of cemetery) StPeters centura
Dated at.
Signature and
on ..
I
of Undertaker
place of business 324 Market Si
PHYSICIAN'S CERTIFICATE.
Willun Fan ning
Age,
.Y.
M,
15 D.
Place and Date of Death,
died at 7. Chelmsford: March 12 1 902
Disease or Cause of Death,#
premature birch
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
JE Varney
M. D.
of
City Physician
n. Chelmsford
Date of Certificate
March 17
.. 190 2
* Give also street and number, if any.
t 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.
Reed March &
Agent Board of Health.
TRACES TIÊU COUNCIL 5
29 9
{ If married, widowed }
Occupation,
12
11
2
Canada
Name and Age of Deceased t
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 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 section t, to the board of health or to the clerk of the city or town in which the death occurred.
Rec
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.)
Name, Gallagher Sex Male
Date of Death,
Her, 22
1902 ; Age, ..
.. Years,.
.Months,
......
.Days.
Maiden Name, { If married, widowed ) , { I or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
* Residence,
{ If out of town, {
¿ also state fully.
Place of Birth,
Chelmsford
*Place of Death,
Chelmsford
Name and Birthplace of Father,
Edward Gallagher, Maine
Maiden Name and Birthplace of Mother,
Nellie Gallagher Bangor Maine
Place of Interment, (Give name of Cemetery),
Carlisle, Mass,
Dated at
Carlisle
Signature and
Thomas A. Green
on
Mar. 2
190 2_
place of business
of Undertaker.
Carlisle, Mass,
PHYSICIAN'S CERTIFICATE.
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