USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 6
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19
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.
Varney-
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,
Sarah m. Fletcher
Sexfemale Color,
White
Date of Death
June 22
1902; Age, 73 Years,
10
Months, .................
Days.
Maiden Name,
If married, widowed }
Sarah Im Fisher
Husband's Name,
Welcome &
fletcher
Single, Married, Widowed or Divorced Widow Occupation,.
Chelmsford Maso
*Residence also state fully, §
Lyndon Of
*Place of Death,
Place of Birth, Chelmsford mass
Name of Father,
Ephraim If fisher
Birthplace of Father,
Lundin Ut
Maiden name of Mother,
Zelfsha Wellman
Birthplace of Mother,
Brookline
Place of Interment,
(give name of cemetery)
Edson
Cemetery
Dated at Sowell
Signature and
b. m. young ter
on June 22 902 of Undertaker
3
33 Prescott It
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t-
Sarah In. Fletcher Age, 73 8. 10 M, -D.
Place and Date of Death,
Disease or Cause of Death,
died at ...
Chelmsford June 22, 902
Sciatic Rheumatisme
.
Duration of Sickness. Several months.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence Amara Howard M. D.
of City Physician
Date of Certificate Jane 23rd
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 both Primary and Secondary Cause.
Rec'd June 25
10
1
or divorced
at home
§ If out of town {
place of business
1
No.
RETURN OF THE DEATH
OF
at
I
1
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 on 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 liealth or to the clerk of the city or town in which the death occurred.
Rec
FORM G.
No.
Commonwealth of Massachusetts.
[EXTRACT FROM ACTS OF 1897, CHAP. 444.]
SECTION 13. The clerk of each city and town shall forthwith make certified copies of the records of all * * * deaths recorded in the books of said city or town during the previous month, whenever the deceased person * * * was a
* * death ; and shall resident in any other city or town in this Commonwealth or any other state at the time of said *
* * was a resident at the transmit said certified copies to the clerk of the city or town in which such deceased person *
time of said *
*
* death, stating in addition the name of the street and number of the house, if any, where such deceased
person * * * resided, whenever the same can be ascertained ; and the clerk of every city or town in this Commonwealth so receiving such certified copies, or certified copies of * *
* deaths * from the clerk of a city or town with- out the Commonwealth, shall record the same in the books kept for recording * deaths
Blank to be used in compliance with the foregoing. (FILL OUT WITH INK, ALL NAMES TO BE IN FULL.)
Copy of the Record of a
DEATH
recorded in the books of the Town of Tewksbury Mars, (City or Town.)
during the month of July 1902.
1. Date of Death, .
June 18 de 1902.
2. Name,
Mary F Jucker
(Maiden Name), . (Name of Husband),
Marc F. lehandler
Charles He. Tucker
3. Sex and Color, . ·
Female: Ch
4. Single, Married, Wid- owed or Divorced,
Married
5. Age, .... Years, .. 6 Months,. 18 Days. Malignant disease of the uterus.
Disease or Cause of Death,
-
arthur J. Scolaria M. D.
7. Residence,
8. Occupation,
Housewife.
9. Place of Death, .
Tewksbury Mass.
10. Place of Birth, South Boston Mass.
11. Name of Father,
James M. Chandler
12. Name of Mother, (Maiden Name. )
13. Birthplace of Father, .
Tewksbury Mass,
South Boston Mars.
14. Birthplace of Mother, .
Centre been Tewksbury Mars.
15. Place of Interment, . (Name of Cemetery.)
I certify that the foregoing is a true copy.
Attest : John Ho. Chandler
July 3rd I 1902
(City or Town.)
6. Duration of Sickness, By whom certified,.
Chelmsford Mass.
Susan 8. Harris
No.
COPY OF A RECORD OF THE DEATH OF
which occurred in the
(City or town.) of
190
Filed. 190 .
54
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,
Halare MC
Pullups
Sex
Color,
Date of Death
190 2; Age, ~ Years, - Months, 1 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 j
Place of Birth,
11
* Place of Death,
11
11
Name of Father,
Michael MC Oficinas
Birthplace of Father,
Irland
Maiden Name of Mother,
Gathering 110 imate
Birthplace of Mother,
ruland
Place of Interment, (give name of cemetery)
i Garcialic, Penetra Powell
michael Incphillipo
on
of Undertaker
PHYSICIAN'S CERTIFICATE.
·
Name and Age of Deceasedt
Helen M: Fullif
Age,
Y,
.M,
D.
Place and Date of Death,
died at
Disease or Cause of Death, +
Infantile
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
JE Varney
Signature and Residence
M. D.
of
north Chelevote
Certifying Physician.
Date of Certificate
1902
Agent Board of Health.
*Give also street and number, if any.
tGive sex of infant not named. If still-born, so state. If child died immediately after birth, so state.
#If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
9
,
Signature and
place of business
1900
Dated at
quero 902
Rec
No.
RETURN OF THE DEATH OF
at
Date,
I
1
Filed,
Į
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 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 sect- ion I, to the board of health or to the clerk of the city or town in which the death occurred.
FORM C. Rec
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,
Le amas Deand
Jebali o White
Date of Death
1902; Age, ..
23
.Years,
7
Months,
Days.
Maiden Name,
or divorced
Husband's Name,
Single, Married, Widowed or Divorced Angle
Occupation, . atthod
*Residence
§ If out of town {
¿also state fully, §
Chelmsford maar
Place of Birth,
*Place of Death, Thelineing mar
Name of Father,
Silbert for Slund
Birthplace of Father, .......
Maiden name of Mother,
Charlotte ot Pierce
Birthplace of Mother, .....
Place of Interment, (give name of cemetery)
To chen berg Lowell hacer
Dated at.
Lowell
Signature and
let Weinbach
on
10 th
.902
of Undertaker
88 middlesea
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased t
......
Age, ........... Y. ....
M,.
............ D.
Place and Date of Death,
died at ..
.....
......
I
Disease or Cause of Death,+
Laumit Peretnies
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence R. 6. Bu
M. D.
of City Physician
Date of Certificate I
* 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.
REAL,
Agent Board of Health.
5
/
place of business
( If married, widowed }
.....
At tahune / 1B
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 of health or to the clerk of the city or town in which the death occurred.
3
56
FORM C.
Commonwealth Massachusetts.
No. .... .
RETURN OF A DEATH To the Clerk of the City or Town in which the death occurred.
Name,
Florida
Libraull~
Sex,
Color,
Date of Death July 12 1902 Age, -Years,
5 Months, 15 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 §
Lavell Pharm
Place of Birth,
*Place of Death,
Chilin ford Center
Name of Father,
Birthplace of Father,
Canada
Maiden Name of Mother, Ffilia Bibeault
Birthplace of Mother,
barrada Joseph
Place of Interment,
(give name of cemetery)
Dated at Paull
Signature and
place of business
on
of Undertaker
738 menunoch
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Age, .. Y,
.M, D.
Place and Date of Death, died at Cholera Infantum I
Disease or Cause of Death, #
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Benji Benoit M. D.
of
58 Dannteenth St
Date of Certificate July. 12 th , 9020
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.
TANCES |AP/ COUNCIL) O
recep que 13/08
Rec
SA Archambault
July 12,912
Certifying Physician.
(FILL OUT WITH INK,ALL NAMES TO BE IN FULL.)
No. RETURN OF THE DEATH OF
...
at
430%
Datc,
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 sect- ion 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,
chrank Santamour
Sex,
/m
Color,
. Date of Death
July 16
1902; Age, 53
.Years,
Months,
Days.
Maiden Name,
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
Chelmsford
§ If out of town }
*Residence
[ also state fully,
Canada
Place of Birth, .....
*Place of Death,
& helmstad
Name of Father,
michael Santarnow
Birthplace of Father,
Canada
Maiden name of Mother,
Birthplace of Mother,
Place of Interment, (give name of cemetery)
Chelmsford Centre
Dated at
Lowell
Signature and
SAG una
on
July 17
902
of Undertaker
3
Lowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased f
Franta Santamon Age, 59 Y.
.M,
......... D.
Place and Date of Death,
died at.
Chelmsford July 16
r. 902
Disease or Cause of Death,#
Pneumonia + Empeacuna
Duration of Sickness.
3 works.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Artur Y. Scobona
M. D.
of
City Physician
Date of Certificate
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 NAM COUNCE
S
place of business
57
§ If married, widowed }
Occupation,
Laborer
"
No.
RETURN OF THE DEATH
OF
Branky Santamon
Phrasesford at.
Date,
6/ cely / 6, 1902
Filed, //
17, 902
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 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.
58
FORM C.
Commonwealth of Massachusetts.
RETURN OF A DEATH To the Clerk of the City or Town in which the death occurred.
Name,
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.) Gray
Sex,
Male
Color,
Date of Death
26 /
1902;
Age,
Years, -....
.Months,
Days.
Maiden Name,
1
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
*Residence
{ If out of town }
¿ also state fully )
Mass
Place of Birth,
1.
21
*Place of Death,
Name of Father,
George H Gran
Birthplace of Father,
Oblanco
Canada
Maiden Name of Mother,
I Stanton
Birthplace of Mother,
Ireland
Place of Interment, (give name of cemetery)
West Cemetary W Chelmsford
Dated at
Trest Chelmotard
Signature and
N & Parkhassel
Salz 26th
1902
of Undertaker
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Age, Y, ~M, -D.
Place and Date of Death,
died
Chelmsford July 26 , 902
Disease or Cause of Death, #
still born
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
S
of
a
north chefine food
M. D.
Certifying Physician.
Date of Certificate July 26"
1902
Agent Board of Health.
*Give also street and number, if any.
tGive sex of infant not named. If still-born, so state. If child died immediately after birth, so state. #If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Reed July 28-02
9
on
place of business
W Chelmsford masd
No ..
{ 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, II AND 12.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which the vessel first arrives after such death. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION IO. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION II. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by sect- ion I, to the board of health or to the clerk of the city or town in which the death occurred.
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,.
Neil Callahan
Sex,
Color,
Date of Death.
July 31
190 2:
Age,.
.. Years,
[ ... Months,
5 Days.
Maiden Name,
{ If married, widowed }
or divorced
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
* Residence
North Chelmsford
{ If out of town }
{ also state fully i
Place of Birth,
North chelsford Incass
*Place of Death,
North chelmsford
Name of Father,
John Fi Callahan
Birthplace of Father,
Lowell
Maiden Name of Mother,
annie Bradley
Birthplace of Mother,
Lowell
Place of Interment, (give name of cemetery)
st Patrick
Dated at ..
July 31
1902
of Undertaker
70 gockann st
PHYSICIAN'S CERTIFICATE.
neil Callahan
„Age,
Y, / M, 5 D
Place and Date of Death,
died at
Disease or Cause of Death, #
Inanitan
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence + E Jamner
M. D.
of
nevet Chalin fine
Date of Certificate.
Certifying Physician July 31
1902
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.
THADE TRAM COUNLEO
Recalling 1.
59
I Helle Dermott
Signature and
place of business
on
Name and Age of Deceasedt
1901
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 ncarly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by sect- ion I, to the board of health or to the clerk of the city or town in which the death occurred.
60
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,
Henry a Merrill
Sex,
Color,
Date of Death,
aug. 17
1902; Age, 56 Years,
5
Months,
13
.Days.
Maiden Name, { If married, widowed ) or divorced.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.