Deaths 1902-1903, Part 8

Author: Chelmsford (Mass.)
Publication date: 1902-1903
Publisher:
Number of Pages: 306


USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 8


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 5. Penalty for violation not exceeding fifty dollars.


68


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.)


Date of Death, Sift 16


190 2


Full Name of Deceased, REquale a DE Carteret


Maiden Name,


If a married or divorced woman or a widow give also Name of Husband,


Sex, Much Color,


Single, Married, Widowed or Divorced,


Age, Years, .2 Months, 14 Days. Occupation,


* Residence { If out of town, } Vynastoro


{ also state fully. §


Place of Death,


Place of Birth,


1


no Chelunsford


Name and Birthplace of Father, Ajuste De Content


Maiden Name and Birthplace of Mother,


Maryann Brak Jenny England


Place of Burial (Give name of Cemetery)


Rever Side Currently no. Chelwasfor mass


Dated at


Tyma Sporo


Signature and


place of business


on Left/11/


190 2


of Undertaker.


1


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Place and Date of Death,


-


Primary,


Disease or Cause of Death, } Immediate,


Reginald a de Carteret Age,


Y. 2 M. /4 D.


died at Tyngsboro


Enteritis


Duration,


3 necho


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence of Certifying Physician. 3


Sept. 16th 1902


Date of Certificate, Sept-16th


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 Immediato Cause.


Countersign and transmit to the clerk of the city or town.


Recce Schl 18


Agent of Board of Health.


-------


FORM C.


Rec


Duration, a Harlow M. D.


Turupbero


A


depr- 16th


190 2.


No.


RETURN OF THE DEATH


OF


at


.....


Date, -.


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 anthorized 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 canse 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- tifieate 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, nntil 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.


Ruc FORM C.


Commonwealth of Massachusetts.


No.


RETURN OF A DEATH.


To the Clerk of the City or Town in which the death occurred.


Date of Death,


Sept. 18


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


190 2.


full Name of Deceased, Merrill &


Maiden Name,


If a married or divorced woman or a widow give also ( Name of Husband,


Sex,


Color,


20


Single, Married, Widowed or Divorced,


Age, 60 .Years, 8 Months, 19 Days. Occupation, Famer


* Residence ( If out of town, )


{ also state fully.


Chelmsford, mass.


Place of Death,


Place of Birth,


Westend


Name and Birthplace of Father, Maison & levens, Westfind, Mas.


Maiden Name and Birthplace of Mother ... Eder P. Wright,


Place of Burial (Give name of Cemetery), ......


7100


Pine Ridge Genety Chelmsford, Mas


Dated :


Sept. 19.


190.2


on


place of business of Undertaker. Cheliveford


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Sherrie SterEns,


Age, CO 8. 8 M. 17 D.


Place and Date of Death,


Disease or Cause of Death,


Primary, Immediate,


Macarele Cachexia


Duration,


Duration,


I certify that the above is true to the best of my knowledge and belief.


Antver & Serforis


M. D.


Signature and Residence S


of


Certifying Physician. 2 Date of Certificate, 18 1902.


Chalme ford mari,


* 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 Immediate Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of Health.


Sept, 19


69


Hatier Perhary


Signature and


died at


Chelunsford mais.


Lept. 18


1902.


No.


RETURN OF THE DEATH


OF


at


Date,


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- tifieate 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, nntil 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.


Ree FORM C.


Commonwealth of Massachusetts.


No. ....


RETURN OF A DEATH To the Clerk of the City or Town in which the death occurred.


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


Name,


Kich


Sex, Malı Color,


Date of Death Seht 20


1902; Age,


Years,


Months,


Days.


Maiden Name,


1


or divorced


1


Husband's Name, ....


Single, Married, Widowed or Divorced,


..... Occupation,


Place of Birth,


212 Chelunsford


* Place of Death,


1.9.11.


v.1


VI


Name of Father,


Kuch


Birthplace of Father,


Carrie Tylise


Maiden Name of Mother,


Birthplace of Mother,


Buffon Maine


-


Place of Interment, (give name of cemetery)


Dated at 90 Chelmsford


Signature and


on Sept 20 1902


place of business of Undertaker


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceasedt


Much


Age, Y, ~M, _D.


Place and Date of Death,


died at


north Chelwefind Sell-20


Disease or Cause of Death, #


Still bom


Duration of Sickness.


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence


FiE Varney


M. D.


of


Certifying Physician.


Date of Certificate


Luft 20


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.


TRADES KANCOUNCIL 0


Self-20


70


Andre City


1902


-


north Cheluc ford


{ If married, widowed }


** Residence


{ If out of town }


( also state fully )


No.


RETURN OF THE DEATH


OF


at


I


Date,


I


Filed,


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,.


Robert Fletcher


Scx,


Color,


1902; Agc, 73 .Years, 10 Months, 20 Days


Maiden Name,


1


or divorced


Husband's Name, .......


Single, Married, Widowed or Divorced,


Married


Occupation,.


mermer


* Residence


( If out of town }


¿ also state fully i


Chelmsford


Place of Birth,


Scotland


*Place of Death,


Name of Father,


William Fletcher


Birthplace of Father,


Scotland


Maiden Name of Mother,


Birthplace of Mother,


Scotland


Hart Pond Cemetery So Cheliford


Dated at


Chelmsford


Signature and


Walter Perhan


on Sept 21 1902


of Undertaker


place of business


Chelmsford


PHYSICIAN'S CERTIFICATE.


Robert Fletcher


Age, 13 × 10 M 20 D.


Place and Date of Death,


Discase or Cause of Death, #


Diabolet the result- 1. malarial forsin way In many years confining


Duration of Sickness.


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence JE Vaney


of


Certifying Physician.


Date of Certificate


Sept. 21


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.


TRACES KANN COUNCIL 9


Hace. Seful: 21


1


7. Chibufer M. D.


Name and Age of Deceasedt


died at Chelmsford Seft- 21 , 902


Place of Interment, (give name of cemetery)


71 :


Date of Death


LifA 21.


( If married, widowed }


No ...


RETURN OF THE DEATH


OF


at


Date,


I


Filed,


4


1


Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, II AND 12.]


SECTION 6. Every householder in whose house a dcath 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 acco ١٠ irn it, together with the facts required! ! ath occurrr -1.


ion I, to the board of health or to the .


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,


margaret E Stearns


. Sex Female Color, white


Date of Death.


Sept 24 1902: Age, 81 Years,


9


Months,


2 5 Days.


Maiden Name,


{ If married, widowed }


margaret & Berrick


or divorced


Husband's Name,


Edwin S. Stearns


Single, Married, Widowed or Divorced, Widow Occupation, at home


Chelmsford


*Residence


( If out of town }


¿ also state fully j


Place of Birth,


forwell mass


* Place of Death,


Chelmsford mass


Name of Father,


Harmonus


Berrick


Birthplace of Father,


Germany


Maiden Name of Mother,


Herion


Birthplace of Mother,


Germany


Place of Interment, (give name of cemetery)


Edson Cemetary


Dated at


Lowell


Signature and


b .m. Showing Her


place of business


on« Sept 24, 902


of Undertaker


33 Prescott &/-


PHYSICIAN'S CERTIFICATE. Name and Age of Deceased Margaret E. Stearnage, 818, 9 M, 2SD.


Place and Date of Death,


died at .: Frwell Sept 24,902 Chelmsford, hans,


Disease or Cause of Death, #


Malignant duran of large intestine


Duration of Sickness.


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence


Arthur C. Scolonia


M. D.


of


(hebreford) man.


Certifying Physician.


Date of Certificate


Sujet,


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.


72


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 prelimin to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and retu gether with t' by sect-


ion I, to the board of health or to the clerk of the city or town in which the ('. curred.


nel FØRM C.


73


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,


George R


Dickes


Sex


male


Color, White.


Date of Death


Sept 25 1902 Age, 49


Years,


11


Months,


Days.


Maiden Name,


1


or divorced


1


Husband's Name,


Single, Married, Widowed or Divorced,


Married Occupation,


Carpenter


3 gumby


ave


*Residence


{ If out of town }


also state fully


Canada


Place of Birth,


* Place of Death,


Chelmsford mars


Name of Father,


Enoch Dickey


Birthplace of Father,


unknown


Maiden Name of Mother,


Edith Lagrange


Birthplace of Mother,


unknown


Place of Interment, (give name of cemetery)


Edson Cemetery


Dated at


forwell


Signature and


b. m. Showing Her


on Sept 26 1902


of Undertaker


place of business


33 Prescott et


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceasedt


George R. Dickey


.... Age,


Y,


M ............


D


Place and Date of Death,


died at


Chelmsford Left 25.1902


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


of


Certifying Physician.


267 herwith st-


Date of Certificate.


Sefit 27-


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,


TRADE? 14 C TUMOR COUNCIL 0


j If married, widowed }


L


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 oceurred.


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 scctions 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 eertificate setting forth the required faets.


SECTION II. In case the deccased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate monde in cognedoing with casting on and podium it tomathartwith the facts required by sect- ion I, to the board of health


Je city


74


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,


Franck Mc Manus


Sex, ..


Color,


Date of Death.


Sept 30


190 2 Age, 45 Years,-


.Months,


Days.


Maiden Name,


{ If married, widowed }


or divorced


1


Husband's Name,


Single, Married, Widowed or Divorced,


Occupation,


f -6 ayers co


*Residence


( If out of town }


¿ also state fully §


Place of Birth,


Ireland


* Place of Death,


Chelmsford centre


Name of Father,


Nutnoune


Birthplace of Father,


Ireland


1


Maiden Name of Mother,


Unknown


Birthplace of Mother,


Ireland


Place of Interment, (give name of cemetery)


St Patrick Source


Dated at


Signature and


Das Hille Dennott


place of business


on


Sept 30


1902


of Undertaker


70 Gorkane Ht


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceasedt


Frank Mcmanus, Age,


.. Y,


M,


D


Place and Date of Death,


died at


Chelmsford, Mans,


I


Toute dilatation of heat result


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


Auchin V. Scoloria


M. D.


of


Certifying Physician.


Date of Certificate


Defit- 30


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 Canse.


TRADES ||+BEN COUNCIL 9


L


No.


RETURN OF THE DEATH


OF


at


Date,


I


Filed,


1.


1


$24


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.


75


Commonwealth of Massachusetts.


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,


Mary Jane Odall


Sex,. Color,


Date of Death,


Apt 28


1902


Age,. 69 Years,


Months, .Days.


Maiden Name, married, w or divorced.


Mary


Jam


Marshall


Husband's Name,


Single, Married, Widowed or Divorced,. Occupation,


*Residence,


{ If out of town, {


¿ also state fully. §


Place of Birth, Duress U.P.


*Place of Death,


Name of Father,


Birthplace of Father, 11


Maiden name of Mother,


Birthplace of Mother, /


Place of Interment, (Give name of Cemetery),


Snow Country Setting Massa


Dated at


9% Chilensford


Signature and


Sift 29 1920


place of business


of Undertaker.


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Mary Jane O. Dule Age, 678.7 M


D.


Place and Date of Death, }


Disease or Cause of Death, §


died at


Marth Chelmsford Safe. 28


15.2.2


Catanhal Einen minia


Duration of sickness,


one work


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence of


JE Varney


M. D.


Certifying Physician.


n. Chelmsford


Date of Certificate,


Sell. 29-


1880.2


Give also street and number, if any. t Or sex of infant not named. If still-born, 80 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.


Reach Schl 29


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 thercof to the board of health or to the clerk of the city or town in which the death occurred. (See section 6.)




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