USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 4
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The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. (See section 7.) Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars. (Sec section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts. (Sec section 10.)
Penalty for refusal or neglect, ten dollars. (Sec section 11.)
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 section 1, to the board of liealth or to the clerk of the city or town in which the death occurred.
(her)
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH
To the Clerk of the City or Town In which the death occurred.
Name,
Date of Death
a/0 14
.
190,Age,
-
.. Years,
Months,
. Days.
Maiden Name, 1 or divorced
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
§ If out of town {
Chair Fra
* Residence { also state fully, )
Place of Birth,
*Place of Death, ..... Hartt Chermaland 1 PC
Name of Father,
Birthplace of Father, .....
Maiden name of Mother, Josephine Boucheau)
Birthplace of Mother,
garza du It Mdach, East flu hurford
Place of Interment, (give name of cemetery)
Dated at
on.
. 902
Signature and place of business of Undertaker
738 Merrimack
PHYSICIAN'S CERTIFICATE.
Biecheau
stillborn
Age,
.. Y. M,
........
D.
Place and Date of Death, .
died at
NorthCheliefert april 14,902
Disease or Cause of Death,
premature bitch no sign
of life when bour.
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
Date of Certificate
Cifull 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.
TRADES UTEN COUNCIL 5
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Agent Board of Health.
3C
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
.Color
{ If married, widowed }
Of arth Chelmsford
A Auchanibault
Name and Age of Deceased t
No.
RETURN OF THE DEATH
OF
at
7
I
Date,
Filed,
I
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 AND 12.]
SECTION 6. Every householder in wliose 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.
FORM C.
Commonwealth of Massachusetts.
RETURN OF A DEATH
To the Clerk of the City or Town in which the death occurred.
Name,
Charles Hade
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death
april 26
1901; Age,.
.. Years,
Months,
Days.
Maiden Name,
( If married, widowed }
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
If out of'to
Mouth Chelmsford
* Residence { also state fully, §
Francestown RH
Place of Birth,
*Place of Death,
Thathe Chelmsford Muss
Name of Father,
William Heyde
Avon Gowns
Birthplace of Father,
Maiden name of Mother,
Alice marshall
Birthplace of Mother,
................
Billerica mass
Place of Interment, (give name of cemetery)
hatte le helmost foul
Dated at
Lowell
Signature and
place of business
on: April 26
IEaz
of Undertaker
Lowell
PHYSICIAN'S CERTIFICATE.
Charles Hyde
Age, 82 Y.
M,
.. .
. D.
Place and Date of Death,
died at
Harth Chelmsford april 26, 902
Disease or Cause of Death,#
Exhaustion following pneumonia
Duration of Sickness.
six weeks
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence F. E. Vanny M. D.
of
City Physician
Michelin feral
Date of Certificate
april 26 ch
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.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
NADE NA COUKKELL5
Recol April 28 00
30
No.
Name and Age of Deceased t
Sex L
Color,
Occupation,
No.
RETURN OF THE DEATH
OF
at
I
Date,
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.
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 section t, to the board of health or to the clerk of the city or town in which the death occurred.
Rec
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,
angella Grace Byan Sex female Color, White
Date of Death, april 28
1902; Age, 05 Years, 4 Months, 27 Days.
Maiden Name,
( If married, widowed )
or divorced.
-
Husband's Name,
-
Single, Married, Widowed or Divorced, Occupation,
*Residence, { If out of town, ) also state fully.
Place of Birth,
South Chelunsford, mase.
*Place of Death, 11 11 Name and Birthplace of Fatherofnow a Bram South Chehusford mars. Maiden Name and Birthplace of Mother Grace M Hutchins Hestfund
Place of Interment, (Give name of Cemetery),
Hart Pond
Dated at
So Chelmsford
Signature and
Daniel & Beam
on april 29
190.2
place of business
of Undertaker.
So Chelmotard
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
- Primary,
Disease or Cause of Death, 1 Secondary,
Age, 5 × 4 M. 2.7D.
avalla G. By ane
died at So. Chelmsford Wars
atom, 28
190 2.
Diphthuia
Duration,
10 days_
Duration,
I certify that the above is true to the best of my knowledge and belief.
Arthur M. Scoforia
M. D.
Signature and Residence S
of
3
Chelmsford Man.
Date of Certificate,
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.
1
40
1
1
Certifying Physician.
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 ease 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 ean 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 eity 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 certifieate 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.
Rec
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,
Charles Perry
Sex,
Color,
Date of Death,
May 1
1902 ; Age, 85 Years,
7
Months, ..
6 Days.
Maiden Name, §1
3
or divorced.
{ If married, widowed }
Husband's Name,
Single, Married, Widowed or Divoreed,
Married Occupation,
Shoemaker
*Residence, { If out of town,
? also state fully.
Pohelmsford
Place of Birth,
Sherborne Mars
*Place of Death,
Chelmsford
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Deborah amas Thors
Place of Interment, (Give name of Cemetery).
Pine Ridge Cem. Chelmsford)
Dated at
Chelmsford
on May 1
1902-
Signature and
place of business
of Undertaker.
-
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Charles
Perry
Age, 8 5 8. 7 M. 6 D.
Place and Date of Death,
died at
Cheleford
May 1at 1902.
Primary,
Senile
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
Comasa Howard
M. D.
of Certifying Physician.
Chelmsford.
Date of Certificate,
Mar 1
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.
Ried May 1
41
alter Perhan
Disease or Cause
of Death, }
Secondary,
1 1
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 oeeurs, 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 oeeurs, 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 sueh 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 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 ean 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 aeeordanee with section 10, and return it, together with the facts required by seetion 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 eity 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 sueh 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.
Rev
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH
To the Clerk of the City or Town in which the death occurred.
Name,
Still Bour
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex.
Female Color,
Femalecolor. While
Date of Death
May 1st
190 2; Age, .~ Years,
Months,
Days.
Maiden Name,
1
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
# North Chelenstore Inass
§ If out of town
*Residence
( also state fully, §
Place of Birth,
4
*Place of Death,
Name of Father,
Presse Poté
Birthplace of Father,
Canada
Maiden name of Mother,
Telia Verville
Birthplace of Mother,
Canada
Place of Interment, (give name of cemetery)
C ...
Dated at
Lowell Mars
Signature and
place of business
on
May 1st.
: 902
of Undertaker
PHYSICIAN'S CERTIFICATE.
Coté
Name and Age of Deceased t
Age, ~ . ~ M. D.
Place and Date of Death,
died at
North Cheliefer May 19 902
Disease or Cause of Death, #
Fremaleta
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
J. E. Varney
M. D.
of
I. Chehelfen
City Physician
Date of Certificate
may 10.
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.
Read May 2
Agent Board of Health.
TRADES IMOT COUNCIL 5
1
tanetot Allbert
42
{ If married, widowed }
Occupationy.
No ... RETURN OF THE DEATH
OF
1
at
I
Date,
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.
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 fun real sit's interment a human body shall obtain the physician's certificate made in accordance with Jest 'sturn it, together with the facts
required by section I, to the board of health or to the clerk of the city of . .. 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,
marion & Dochley
Sex.
Color Au
Date of Death
1May H
1902; Age, 72
.. Years,
Months,
Days.
{ If married, widowed į
Thurbune
Maiden Name,
or divorced
Husband's Name,
Steames & Ripley
Single, Married, Widowed or Divorced,
Occupation, ...
It home
( If out of town }
Thatk Chelmsford Prask
* Residence { also state fully, §
Place of Birth, Tyngsboro.
* Place of Death,
Thorthe Chelmsford
Name of Father,
Thomas & Sherburne
Birthplace of Father,
Tyngsboro .. (Mask)
Maiden name of Mother,
Betsey & paulding
Birthplace of Mother,
Place of Interment, (give name of cemetery)
motto Chelmsford
Dated at
Lowell
Signature and
place of business
on
may 5
1902
of Undertaker
Lowell mass
PHYSICIAN'S CERTIFICATE.
Marion Ripley
Age,
.. Y.
M,
D.
Place and Date of Death,
Disease or Cause of Death, #
1 902
Bright's Disease / Kidney
Duration of Sickness.
3years
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
JE Vany
M. D.
of
City Physician
y. cheharfure
Date of Certificate
May 4th
19.2
Agent Board of Health.
* Give also street and number, if any.
+ 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 WHAT COUNC 5
Reed May 5
<3
Dunstable ."
Name and Age of Deceased t
died at
1. Chelunferd May 4~
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 tlie 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.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
(FFOUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
William Monster
Sex,
Color,
Date of Death,
I90
; Age, 74 Years,
7
Months,
Days.
Maiden Name, or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Single.
.. Occupation, .... Hammer
*Residence, {also state fully. §
( If out of town, }
East Chelmsford
Place of Birth,
Horksel nth
* Place of Death, E Chelmsford
Name of Father,
William
Birthplace of Father,
Dracut
Maiden Name of Mother,
martha Frost
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Oakland
Dracul
Dated at
Source
Signature and
place of business
Novac ElaxSon
O11.
may 12
190 2
of Undertaker. '
212 Hund 8h
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Age, 72%.
M ... . .. . D.
Place and Date of Death,
died at.
Disease or Cause of Death,¿
Disease of Heart
I
Duration of Sickness,
I certify that the above is true to the best of my knowledge and belief.
No Mich Medical Exfre
Signature and Residence of City Physician/ 267 hunthe St-
Date of Certificate
May 10 - 1902-
* Give also street and number, if any.
+ Give sex of infant not named. If still-born, so state. If ehild died immediately after birth, so state.
# If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
5
TRADES NEI COUMCH
{ If married widowed }
44
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 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 sanie. 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.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH To the Clerk of the City or Town In which the death occurred.
Name, ..
Hello on Or poisverts
,
(FILL OUT WITH-INK. ALL NAMES TO BE IN FULL.)
Sex
Color
While
Date of Death
May 17
190 2 Age,
-
Years,
Months,
Days.
Maiden Name,
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
# Nest lehelmotor Mass.
*Residence
( also state fully, §
Place of Birth,
Next Chelmeto mars
* Place of Death,
Next Cliclinefor Mass
Name of Father
Albert tobevert
Birthplace of Father,
Canada
Maiden name of Mother,
Maggie Higgins Evan
Birthplace of Mother,
Trecand 010
Place of Interment, (give name of cemetery)
Dated at. Showall Mass
Signature and
on
Mary 17
1 902
place of business
of Undertaker
Beturned In dis Pa: hover
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased f
Frederick N Boisvert.
Age, - v. 9
M,
D.
Place and Date of Death,
died at
Heat Chelunsford May 17
I.
902
I ty du uph alus and Spina bifida
Disease or Cause of Death, #
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