USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 3
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Name and Age of Deceased, t
Gallaghu
.Age,.
.Y.
M. D.
died at
Chelmsford, More,
Heh. 2.2, 190 2.
Disease or Cause
of Death, }
Secondary,
Infantile-
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Arthur 9. Scolaria
M. D.
Signature and Residence
of
Certifying Physician.
Chelmsford, throws.
Date of Certificate,
March 5,
1902.
· 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.
Rice
i thour
Color,
White
1 hour
Place and Date of Death,
Primary,
No.
RETURN OF THE DEATH
OF
at
Date,
190.
Filed,
190_
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
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 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 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 thercfrom, until a permit thercfor 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.
PLC
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,
Hannah Loker
Sex,
.....
Color,
Date of Death,
March 4
1902; Age,
90 Years,
0 Months,
20 Days.
Maiden Name, { If married, widowed )
or divorced.
Hannah Smith
Husband's Name,
Loring Solar
Single, Married, Widowed or Divorced,
Married
Occupation,
Housewife
*Residence, { If out of town, }
? also state fully. 3
Chelmsford
Place of Birth,
Needhary mars
*Place of Death,
Cheletras
Name and Birthplace of Father,
Luther Smith, needham
Maiden Name and Birthplace of Mother,
Hannah Lewis, Dachau (B)
Place of Interment, (Give name of Cemetery),
natick
Dated at
Chelmsford
Signature and
Waltin Perlaw
on
March 4
190 2
place of business
of Undertaker.
Chelmsfordh
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death,
Primary,
-
Disease or Cause
of Death, }
Secondary,
Hamak Sake
Age, SOY. 0 M. 20 D.
died at
Chelisted mars.
Cerebral Hammondago
Duration,
12 hours
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Edward It, Chanelulum
of
.M. D.
Certifying Physician.
183 Sibaty St. forell, mash
Date of Certificate,
march 4th.
1902
* 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 Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Recul ilarch S
Agent of Board of Health.
31
190 2 .-
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 deccased 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 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.
32
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,
Mary alice Lambert~
Female Color, White
Date of Death .
March 13
1902; Age, ................ Years,. Months, 2Days.
{ If married, widowed į
Maiden Name,
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
Luisle
Occupation,
.....
*Residence
{ also state fully,
West thelin ford. Mas
Place of Birth,
temnada
*Place of Death,
Name of Father,
Edmond Lambert.
Birthplace of Father,
Canada
Maiden name of Mother,
La Rosa Reeves
Birthplace of Mother,
Canada Wrowochet RJ
Place of Interment, (give name of cemetery)
St. Joseph Cemetery
Dated at Lowell Mars Signature and
Irupert Albert
on ......
March 13
902
of Undertaker
#57 th St.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased f Mary alice Lambert-
Age, ~ . ~ M, D.
Place and Date of Death,
died at ..
Chebuford March 13
I
Disease or Cause of Death,#
Infantile
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
north Chelles ford
City Physician
Date of Certificate
March 13
1902
* Give also street and number, if any.
Agent Board of Health.
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.
LADER COUNCIL 5
........
{ If out of town }
place of business
Rec.
, 1 14
No. ....
RETURN OF THE DEATH
OF
at
Date,
I
Filed
I
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 1I AND 12.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within " five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which the vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION. 10. 'A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars,
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 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.
A
Ree
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,
Vila Gay
Sex m
Date of Death
mar 14
1902; Age,
78
Years,
4
Months
1
Days.
Maiden Name,
or divorced
Husband's Name,
Single, Martied, Widowed or Divorced,
Occupation,
Kannfacture
[ If out of town }
North Chelmsford
* Residence ( also state fully, §
niagara ny.
Place of Birth,
*Place of Death,
Thatthe Chelmsford
Name of Father,
Mila groy
Birthplace of Father,
Deering (h. H
Maiden name of Mother,
mary Kennedy
Birthplace of Mother,
Lubon,
Ireland
Place of Interment, (give name of cemetery)
Thath Chelmsford
Dated at Thoth Chelmsparce
Signature and
place of business
on
Mar 16
1 9.02
of Undertaker
Lowell
PHYSICIAN'S, CERTIFICATE.
Liba Gay
Age, ..
78 x 4
M,
D.
Name and Age of Deceased
Place and Date of Death,
died at
North Gehehusford Mich 14th , 90 2
Disease or Cause of Death,#
Locomotion Celaxia
Duration of Sickness.
two year
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
M. D.
of
City Physician
north Cheque fort
Date of Certificate
Mich 14-
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.
THADEDURRE COUPE 5
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Fica March 17/02
3.3
Agent Board of Health.
JE Varney
Color, ..
If married, widowed }
No. .
RETURN OF THE DEATH
OF
at
Date,
I
Filed
I
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 1I AND 12.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which the vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION. 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars, 1
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.
34
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,
Ademore Louis Carron
Sex, 3
Date of Death, mar 232
1902 ; Age, ~ Years, /2 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, {
N. Chelmsford Pass
Place of Birth, A Chelmsford Bass
*Place of Death,
Name and Birthplace of Father, Laura P. Carron Canada
Maiden Name and Birthplace of Mother, Rasie Hamel Canada
Place of Interment, (Give name of Cemetery),
Dated at
t. CM. Chelmsford
Signature and
place of business
on
march 28%
1902
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Cidemore Louis Carron
Age,
Y. 10 M /7 D.
Place and Date of Death,
died at
no Chelucdon
Mch 232
190 2
Disease or Cause of Death, ¿ Secondary,
Primary,
Branch Ineumonia
Duration, one week
Duration,
I certify that the above is true to the best of my knowledge and belief.
JE Vaney
M. D.
of Certifying Physician.
H. Chelmsford
Date of Certificate,
mit 23
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.
Rich
Rec
Signature and Residence
S
Color,
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 forthi the required faets.
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 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.
35
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. ALD NAMES TO BE IN FULL.) 1
Name,
OJorn fauthier
Sex
Male
.. Color,
Date of Death
March 28
... 1907; Age,
Years,
Months,
Days.
Maiden Name,
1
or divorced
{ If married, widowed į
Stres vor
Husband's Name,
Single, Married, Widowed or Divorced, .. Occupation, ........
*Residence
{ also state fully, §
§ If out of town }
Place of Birth,
North Chelmsford Dans
0
*Place of Death,
Name of Father,
Gareth
Gauthier
mass
Birthplace of Father,
Maiden name of Mother,
Mary Ellen ( MICHale)
Birthplace of Mother,
Dhvele Island
Place of Interment, (give name of cemetery)
Dated at
Lowell Man
Signature and
on .. March 28 L, 902 place of business of Undertaker
57 8 heever Rt
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t
Gauthier
Age, Y
M.
.......
D.
Place and Date of Death,
died at
north Chelmsford Mich 28
1. 902
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
M. D.
of
City Physician
Date of Certificate
Mich 280
1900
* 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.
Read Mach 28
Agent Board of Health.
TRADES TUEN COUNER 5 10
Still banco
Disease or Cause of Death, #
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 I2.]
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 healthi or to the clerk of the city or town in -- which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which the vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION. 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section ro, 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.
-1 2
........... .... No.
RETURN OF A DEATH
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
George B Hall
Sex
Male
Color,
Date of Death
april 5th
190 2; Age,
5 Years,
4
Months,
26
Days.
Maiden Name,
If married, widowed }
or divorced
Husband's Name,
Single, Married, Widowed or Divorced, ..
Married
Occupation,
Traveling Salesman
*Residence
[ also state fully, §
Place of Birth,
Horst Chefunfund
* Place of Death,
North Chelmsford.
Name of Father,
Harrison Hall
Birthplace of Father,
Quincy Mars
Maiden name of Mother,
Echter Belding
Birthplace of Mother,
north fuld mars
Place of Interment, (give name of cemetery)
Dated at
Lowell
Signature and
place of business
on.
1 902.
of Undertaker
PHYSICIAN'S CERTIFICATE.
George B Hall
Age,
57 × 4
M, 26;
D.
Name and Age of Deceased f
Place and Date of Death,
died at
North Chelmsford april 5th
1 902
Disease or Cause of Death,#
Tuberculosis of the Brain
Duration of Sickness.
Four months
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
F. E Varney
M. D.
of
north Chele Fond.
City Physician
Date of Certificate
april 12
1402
* 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.
TRADES RADILI ESTA COUNCIL 5 10
1
§ If out of town }
North Chilis fond
north to helmshouve
Mounier
Agent Board of Health.
36
Commonwealth of Massachusetts.
No. RETURN OF THE DEATH
OF
1
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 death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred. 1
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 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.
37
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,
Thermann
Jeasten
Sex Female Color,
Date of Death,
April
13th
1900
189; Age, 86 Years,
9 Months,
26 Days.
Maiden Name, { If married, widowed } or divoreed. Morn ans Cromwell
Husband's Name,
Orchard
Weasley
Single, Married, Widowed or Divorced, Widowed Occupation,
*Residence, { If out of town, }
? also state fully. §
West- Chelmolard
Place of Birth,
England.
*Place of Death,
West Chelmsford
Name of Father,
William Cromwell
Birthplace of Father,
England.
Maiden name of Mother,
Imartha baker
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Dated at
Icheine. 23
Signature and
AG Thank hurst
on . April 16th
1902
189
of Undertaker.
IV Chelpor land mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ¡
Place and Date of Death,
Disease or Cause of Death, §
died at
Weet Chelmsford april 13
1802
Organic diecare of heart.
Duration of sickness,
last sickness one day
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
JE Jamey
M. D.
Certifying Physician.
7. chilling food
Date of Certificate,
april 14ª
1890.2
Give also street and number, if any.
t Or 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.
Mayan Prasler
Age, Y. & M. 26D.
hast Chelmotard
place of business
€
Re
No.
RETURN OF THE DEATH
OF
at
Date,
189
..
Filed,
189 .. . .
The provisions of chapter 444 of the Acts 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.)
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