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