USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 7
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Husband's Name,
-Single, Married, Widowed or Divorced,
Married Occupation,
Harmer
*Residence, { If out of town, )
¿ also state fully.
Chequeford
Place of Birth,
Hudson 11H
*Place of Death,
Chelmsford
Name and Birthplace of Father,
Benj. a Merrill Hudson l. H.
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Edson Cemetery, Lowell
Dated at
Chelmsford
Hatten Perhan
on
lug 18
190 2
Signature and
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
- Primary,
Rheumatic Fever -
Duration,
Several weeks
Duration, .......
I certify that the above is true to the best of my knowledge and belief.
Cimara Stowvarel
M. D.
Signature and Residence
of
Certifying Physician.
Date of Certificate,
Ling. 18
190 2
* 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.
....
Agent of Board of Health.
%
Hem C. Menil Age. 56 8. 5 M. 13 D.
died at
Chelmsford
aug. 17 1902.
Disease or Cause
of Death, ţ
Secondary,
Rec
FORM C.
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 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 section 1, to the board of health or to the clerk of the city or towu iu 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.
Red
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.) Margaret Kilbourne Se female Color : White
Name,.
Date of Death
bong 19 th
1902; Age, 80 Years, 7
Months,
Days.
Maiden Name, 1 or divorced
{ If married, widowed }
Margaret Barter
Husband's Name,
Single, Married, Widowed or Divorced .. Occupation, thelinford
*Residence
{ If out of town }
¿ also state fully
. 8
Place of Birth,
*Place of Death,
Name of Father,
1
1
Birthplace of Father,
to be helmond mars
Place of Interment, (give name of cemetery)
Signature and
Dated at
200g
1902
place of business
of Undertaker
88 Unidade
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Margaret Kilburn Age, 80%, 8 M,
D.
Place and Date of Death,
died at
North Chelmsford Ling 19, 902
Disease or Cause of Death, #
Uraemine Could
Duration of Sickness.
two years
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
JE Varney
M. D.
of
Hort Chelmsford
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.
1
1
Maiden Name of Mother,
1
Birthplace of Mother,
on
61
Commonwealth of Massachusetts.
No.
RETURN OF THE DEATH OF
at
Date,
I
Filed,
I.
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 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 aceordance with section 10, and return it, together with the.cts required by sect ion I, to the board of health or to the clerk of the city or town in which the death occurred.
.62
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,
Daniel W Lady
Sex,
, Male Color,
White
Date of Death
Aug 22
1902; Age, 48 Years,
10 Months,. ..
Days.
. Maiden Name,
1
or divorced
( If married, widowed }
Husband's Name, .....
Single, Married, Widowed or Divorced,
Occupation,
Stone Cutter
* Residence
{ If out of town )
{ also state fully {
School It North Chelmsford
Place of Birth, Ireland
*Place of Death,.
School It North Chelmsford
Name of Father,
Daniel
Birthplace of Father,
Ireland
Maiden Name of Mother,
Ellen ting
Birthplace of Mother,
Ireland
Place of Interment, (give name of cemetery)
Catholic
Grantvill mask
Dated at Lawell
Signature and
E.t. Malloy
on 22 Aug
1902
of Undertaker
Lawell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Daniel Casey
Age, H8Y, 10 M, ~D.
Place and Date of Death,
Disease or Cause of Death, #
died at.
School It North Chicheshard Auch : 0 2
Pulmonary Tuberculosis
Duration of Sickness.
pix months
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence JE Varney
M. D.
of
North Chelafinal
Certifying Physician. aug 22-
1902
Date of Certificate Tal. I. Scoton am, LAgent Board of Health.
*Give also street and number, if any.
Aur a. Howard M, 8.
+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.
TRADE'S KABEL COUNCIL 9
place of business
.
No.
RETURN OF THE DEATH
OF
1
2.at
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 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.
63
Commonwealth of glassachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City of Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Sex, Color,
Date of Death,
Aug 17.
1902; Age,-Years, - Months.
7
Days.
Maiden Name, { If married, widowed } or divoreed.
Husband's Name,
Single, Married, Widowed or Divorced,
.Occupation,
*Residence, { If out of towu, }
No. there fore
? also state fully.
Place of Birth,
No.
*Place of Death,
Name of Father,
refrece f1 09 2220
Birthplace of Father,
Maiden namc of Mother,
Anna (Hoblue
Birthplace of Mother,
Chelmsford
Place of Interment, (Give name of Cemetery),
Dated at
Quercus ford
Signature and
Q. S. The Flow
on
1
place of business
18902
of Undertaker.
no. Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Percy Reno
M. 7 D.
Place and Date of Death,#
died at
North Chekarfans aug. 17 1802
Disease or Cause of Death, §
Inanition
Duration of sickness,
one work.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of
I. challengeso
Date of Certificate,
Soft- 18h
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.
1
1
JE Varney
M. D.
Certifying Physician.
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.)
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 ... (See 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. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
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.
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,.
Mary 98Spaulding
Sex, .. .......... Color,
Date of Death
Saffi
1902;
Age, 1.3.
.Years, Months, 2 3 Days.
Maiden Name,
( If married, widowed {
or divorced
Mary
98 Jenkins
Husband's Name, Beni J. Spaulding
Single, Married, Widowed or Divorced,
Occupation, .. Housewife
* Residence
{ If out of town }
( also state fully §
Chelmsford
Place of Birth,
Lo Bostori
*Place of Death,
Chelmsford
Name of Father, Sauil Jenkins
Birthplace of Father,
Balaton
Maiden Name of Mother, Sarah Hunting
Birthplace of Mother,
Randolph (21)
Place of Interment, (give name of cemetery) Hartford Cemetery
Dated at Chelmsford
Signature and
place of business
Scha 2
1902
of Undertaker
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Mary a D. SpauldingAge, 73 %, - M, 2 D.
Place and Date of Death,
Disease or Cause of Death, #
died at
Chelmsford Sell. 12 ,902
Enteritis
Duration of Sickness.
Three days
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence JE Varney
M. D.
of
Certifying Physician.
Date of Certificate.
8
1 902
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.
TRADES LAUCH 0
Reca Se/t 3
Walter Pertan
on
64
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 dcath 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.
Rel
FORM O.
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 Elizabeth Battles Parkhurst Sex,
Color,
Date of Death,
Sept. 2
1902 ; Age,.
83 Years,
6
Months, 10 Days.
Maiden Name,
§ If married, widowed }
or divorced.
Mary Elizabeth Battles
Husband's Name,
Sewall Parkhurst
Single, Married, Widowed or Divorced, Widowed Occupation,
*Residence, { If out of town, )
52 arlington St, Lowell.
Place of Birth,
Dorchester Mass
*Place of Death,
South Chelmsford.
Name and Birthplace of Father,
Benjamin
Stoughton.
Maiden Name and Birthplace of Mother,
Charlotte Smith, Stoughton
Place of Interment, (Give name of Cemetery)
Chelmsford Centre
Dated at.
So. Chelmsford
Signature and
OB Courrier
on
Sept. 2,
190
place of business }
of Undertaker.
Lowell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Disease or Cause of Death, #
Primary, Secondary,
Man E, Battles
Age, 83 x 6 M /V D.
died at.
So. Chelmsford
Seht:2
190 2.
Senile
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
Cineva Howar- M. D.
Date of Certificate, 2 190 ?
* Give also street and number, if any. t 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.
Agent of Board of Health.
Read Soft 3
65
? also state fully.
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 deatlı 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 thercof 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 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.
66
Plate.
[ACTS OF 1889, CHAP. 208.] AN ACT IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS
Be it enacted, etc., as follows :
SECTION 1. The clerk or registrar of each city and town shall on the first day of each month makc a certified copy of the record of all deaths and births recorded in the books of said eity or town during the previous month, whenever the deceased person or the parents of the ehild born, were resident in any other eity or town in this Commonwealth at the time. of said death or birth; and shall transmit said certified eopies to the elerk or registrar of the eity or town in which sueh deceased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where sueh deceased person or parents so resided, whenever the samc can be aseertained ; and the elerk or registrar so receiving such certified copies shall record the same in the books kept for recording deaths or births. Sueh certified eopies shall be made upon blanks to be furnished for that purpose by the seerctary of the Common- wealth. SECTION 2. This aet shall take effect upon its passage. [ Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the. City of Lowell
(City of Town/) during the month of. September 1902 18
1. Date of Death,
September 5 1902
2. Name,
James Riley
(Maiden Name), . (Name of Husband),
male Single
3. Sex, and whether single, Married, or Widowed,
4. Color,
5. Age,
50 Years, Months, Days. acute Labar Incumonia
Disease or Cause of Death,
6. {Duration of Sickness, By whom certified,. Daniel a. 6 Learn m. D
1
7. Residence,
8. Occupation, .
St. John's Hospital Lowell
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, . I certify that the foregoing is a true copy.
St Patrick Cruitery Lowill mass
Lan
Sept. 15 1902.18
Attest : Chiard @Bachmann
City Clerk.
(City or Town.)
Ed. Jan. 23, 1894. 5,000.
Rec
north Chelmsford
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,
Edward H. Lovering
Sex,
M
Date of Death,
Sefa 13
(1902; Age, 0 Years,
6 Months, 20 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
*Residence, { If out of town, )
Chelmsford
? also state fully. §
Place of Birth,
Chelmiting
*Place of Death,
"
Name and Birthplace of Father,
Minot H Lowering Boston
Maiden Name and Birthplace of Mother,.
Sarah a wood, Lawrence
Place of Interment, (Give name of Cemetery),
Pine Ridge Com
Dated at
Chelmsford
Signature and
Walter Perkam
on
Sehr14
1902
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Edward It. Hovering
Age, . Y. 6 M ZUD.
Place and Date of Death,
died at
Chelmsford
Disease or Cause
-
Primary,
Duration,
1 day
of Death, ±
Secondary,
Extention
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Edward It, Chambulimi
M. D.
of Certifying l'hysician. 2 183 Stents St, Sowell Mann
Date of Certificate,
Silv.
14 "
1902
* Give also street and number, if any. t 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.
Rece Scheint 12
Agent of Board of Health.
1
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 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 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.
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