USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 5
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Duration of Sickness. .
Rien bisch
I certify that the above is true to the best of my knowledge and belief.
JE Varney
Signature and Residence
of
nort Cheque Low
City Physician
Date of Certificate
May1 8'
1 902
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.
Ried May 19 180 2
TRACES .ALE COINCI 5
1
§ If out of town }
If married, widowed }
4.3
Joseph Albert
#5mleheves
M. D.
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 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 ~f -1th or to the clerk of the city or town in which the death occurred.
Kel
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.)
Date of Death, ...
2/19 190 .
Full Name of Deceased.
Maiden Name,
If a married or divorced woman or a widow give also ( Name of Husband, - Villettea Vouluwych Sex, Je m. u Color, Single, Married, Widowed or Divorced, a/2.11
Age, 56 Years, Ce Months,
5 Days. Occupation,
* Residence {
{ also state fully. )
Place of Death, 11 21 _ Chalmediul
Place of Birth,
1
-
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother, 1
Place of Burial (Give name of Cemetery)
Dated at.
224 190 2,
Signature and
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Jus Cuma Banderson Age, 564.10 M. S.D.
Place and Date of Death,
died at
W. Chelmsford
hay 2121
190Z.
Primary,
Pulmonary Philisio
Duration,
2 years
Disease or Cause
of Death,
Immediate,
16
11
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
G a Harlow
M. D.
Date of Certificate,
may 21
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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Reid May 23/02
Agent of Board of Health.
4'6
Commonwealth of Massachusetts.
> on
{ If out of town, }
No.
RETURN OF THE DEATH
OF
at
Datc,
.190
Filed,
190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a 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. 1
FORM C.
Commonwealth of Massachusetts.
11
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, ..
John Callahan
Sex. Color,
Date of Death
May 25
.... 0 2% Age, 74
Years,
5
Months,-
.. Days.
Maiden Name,
or divorced
Husband's Name,
...........
Single, Married, Widowed or Divorced,
Occupation, retired
*Residence
§ If out of town }
Worth Thelies ford
Place of Birth, Leland
*Place of Death,
Name of Father, Mot funn
Birthplace of Father,
Maiden name of Mother, Mat kennen
Birthplace of Mother ....... ......
Guland
Place of Interment, (give name of cemetery)
Of Patricks weitere
James F. ODonnell
Dated at.
Signature and
place of business
of Undertaker
324 Majet Ut
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t
Shu Callahan
Age, 77 x. 5
M, ...........
D.
Place and Date of Death,
died at
north Chekurland
I
Disease or Cause of Death,#
Duration of Sickness.
one week
I certify that the above is true to the best of my knowledge and belief.
Signature and Residenee
of
City Physician
north Cheluisfon
Date of Certificate
May 20%
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.
TRADES LAUT COUNCIL 5
Reed May 26
5
No.
{ If married, widowed }
North Chelicoford
Vieland
May 25902
FE Janney
M. D.
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 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 t. Inder shall obtain the physician's certificate made in accordance with section 10 and
required by Hut, to the board of th the clerk of aty
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,
Charles WS adams
Sex Inale Color, white
Date of Death,
Vray 24.1902; Age,
51 Years, 5 Months, 21 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced
Married Occupation,
Retired
*Residence, { If out of town, Į
[ also state fully )
north Chelmsford
Place of Birth,
* Place of Death,
Name of Father, Thomas
e adamo
Birthplace of Father,
north Chelmsford
Maiden Name of Mother,
blanc
Holt
Birthplace of Mother,
Terrinaack n. 74.
Place of Interment, (Give name of Cemetery),
north Chelmsford
Dated at
Lowell
C. m. Young Har
on May 25; 1902
Signature and
place of business
of Undertaker.
33 Prescott St-
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Charles Wadams Age, 51 × 5 M 211).
Place and Date of Death,
Disease or Cause of Death, #
died at
no Chelmsford may 2.4. 1902
Heart Exhaustion
Duration of sickness,
short-
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
M. D.
Certifying Physician.
?
Date of Certificate
May 202
1902
* 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 Sallor in the War of the Rebellion, give both Primary and Secondary Cause.
Reach May 27
4.8
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 Io, and return it, together with the facts re- quired by section 1, 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.
Gelin Mu maney
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Sex Color, ......
Date of Death
........
190 2: Age 16 Years,.
Months, Days.
Maiden Name,
or divorced
Husband's Name,
Single, Married, Widowed or Diwereed,
.....
Occupation,
blesk
§ If out of town }
*Residence { also state fully, §
Month Chelmsford hass
Place of Birth, Ireland
* Place of Death, North thelestore hears
Name of Father,
relancer
Maiden name of Mother, Rose Redmund
Birthplace of Mother,
Place of Interment, (give name of cemetery)
St Patrick Sowill Pass
Dated at
Signature and
place of business
of Undertaker
fortell Teurs.
Y goz
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased }
Place and Date of Death,
Disease or Cause of Death,#
died at
Horst Chelinford June 2 , 90%
Cancer
Duration of Sickness.
one year
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
JE Varney
M. D.
of
City Physician
Horst Chelmsford
Date of Certificate
1902
* 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 Sallor in the War of the Rebellion, give both Primary and Secondary Cause.
-
Agent Board of Health.
5
Peter/ Mª Enandy Age, 36 V.
M,.
. D.
cheland
Birthplace of Father,
Mc many
§ If married, widowed }
49 3
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 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 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.
49.1
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
4 cc. 27-1901.
2. Name,
12
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
41 Years, - 2- Months, .. Days. injuries received ly 1.5
Disease or Cause of Death, (Primary and Secondary), # -
6. {Duration of Sickness, . By whom certified,
7. Residence,
8. Oeeupation,
9. Place of Death, .
10. Place of Birth,
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Shah factory that thehurford, Mas.
Signature of Undertaker -
or other person making the Return, .
DATED at- Kllechugard Sives, on June 12-1$902.
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. f If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. September, 1892. - 5,000.
tror Cour bet wayou
Valdez Tilacka
diavester.
Pialdri, Alaska.
Swveders
Olof Versare
1
[Public Statutes, Chapter 32, as amended by /Acts of 1888, Chapter 305; Acts of ISS9, Chapter 224.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his deceasc. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificatc as is required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty collars.
FORM C.
Rec
No.
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.)
Date of Death,
amc 17 -
1902 .
Full Name of Deceased, Sampson Stevens.
Maiden Name,
a married or divorced woman or a Widow give also Name of Husband,
Sex, male Color.
Single, Married, Widowed or Divorced,
Widowand
Age, & t Years, Months, ." .Days. Occupation, Farmer
* Residence
( If out of town, } ( also state fully. §
Cheminford. man.
Place of Birth, Yesford Smaxs.
Name and Birthplace of Father, Samson Stevens, Chamford
Maiden Name and Birthplace of Mother,.
Many Words.
actor mass.
Place of Burial (Give name of Cemetery),
Heart land Cemetery.
Dated at
Billerica Mass.
on
que 18
1902
Signature and
place of business
of Undertaker.
Billeview.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Sampson Iterras
Age, 81 Y. 7 M / D.
Place and Date of Death, died at Chelmsford , Mas
1902.
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Autrer & Scolonia
M. D.
Signature and Residence S
of
Certifying Physician. 3 Date of Certificate, Summe 18 190 Z
Chelmsford, Man
* 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
..............
Agent of Board of Health.
18
50
1
Place of Death,
Senile Debitity- 1 - Disease or Cause Primary, of Death, ¿ Immediate,
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 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 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 or 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.
51
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,
Female color
White
Date of Death June 24,
190 2; Age,
74 years,
-
Months,.
. Days.
{ If married, widowed }
Maiden Name,
or divorced
Husband's Name,
Waswir ambert-
Single, Married, Widowed or Divorced, ..
# West Rehelunsford. Mars
*Residence
{ If out of town}
{ aiso state fully,
Place of Birth,
Canada
*Place of Death
# West Celulunsford, Mass
Name of Father,
Amable. torodeur.
Birthplace of Father,
Joanada-
Maiden name of Mother,
Birthplace of Mother,
.....
Recusado
Place of Interment, (give name of cemetery)
Freth, Albert
Dated at.
·Suse 24 90%
place of business
on ..
of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t
Lucie Lambert-
Age,
74%
M,
.........
.D.
Place and Date of Death,
died at.
Wat Chatuna Serie Marco Sine 24, 902
Disease or Cause of Death, #
Duration of Sickness.
two years
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
M. D.
of
north Chelmsford
Date of Certificate Jane 24
1 902
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.
Name,.
Lucie Lambert
Harrell Occupation,
-
City Physician
Signature and
No.
RETURN OF THE DEATH
OF
at
1
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.
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 d and 7, five dollars.
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