USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1902-1903 > Part 9
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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 certifice . its health (),
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,
Julia a Spaulding
Sex,
Color,
Mr.
Date of Death
Oct 5
1902;
Age,.
76 Years, 10.
Months, 14 Days.
Maiden Name,
{ If married, widowed }
or divorced
Julia ann Proctor
Husband's Name,
Seo.
Spaulding
Single, Married, Widowed or Divorced,
Married Occupation,
Housewife
*Residence
[ If out of town }
{ also state fully }
Chelmsford
"
Place of Birth,
* Place of Death,
Name of Father,
Jouash Proctor
Birthplace of Father,
Chelmsford
Maiden Name of Mother, Sybil Hodgman
Birthplace of Mother, Chelmsford
Place of Interment,
(give name of cemetery)
Dated at Chelmsford
Signature and
place of business
Och 51902
I
of Undertaker
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
Julia a Spaulding Age, 76 %, 10 M, 14D
Place and Date of Death,
Disease or Cause of Death, #
died at Chelmsford Det 4 - 1902 Typhoid fever
Duration of Sickness.
four weeks
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Varney M. D. of Certifying Physician.
north Chelfue ford
Date of Certificate
X
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.
Reca Oct-5
Forefathers Ceux Chelmsford
Walter Perhary
on
76
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 1. sect- ion I, to the board of health or to the clerk of the city or + in which the death occurred.
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,
Matilda Leclón
Sex,
71
Color,
Date of Death,
Och, 9
1902; Age, 62 Years,
8
Months,
7 Days.
Maiden Name,
{ If married, widowed }
Mateldã Portes
or divorced.
Husband's Name,
Cludiew Section
Single, Married, Widowed or Divorced,
Occupation,
House wife.
*Residence, { If out of town, )
Electretard, mare,
¿ also state fully.
Place of Birth,
Sh. Gobel W. B.
*Place of Death,
Chilisford, mais
Name and Birthplace of Father,
William Porter, St. John n.B.
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery)
Woodbine Ceny, Lowell, Mass.
Dated at
Chehusferd, Mars
Signature and
Walter Perhour
on
act. 9
1902.
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
matilda Section
Age, 828. 8 M. 7 D.
Place and Date of Death,
died at.
Chelmsford
act. at
1902:
Bronchitis
Duration,
10 amys .
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence §
of
Certifying Physician.
CET, 10 €/ 1902
Date of Certificate,
Ocl-10
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.
Agent of Board of Health.
decel Oct-10
77
M. D.
Disease or Cause
of Death, ¿
Secondary,
Climaza
Primary,
1
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 oceurs, 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 oeeurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the elerk of the eity or town in which the death oeeurred.
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 elerk of the city or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for negleet to comply with the requirements of seetions 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In ease the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate eausc of death as nearly as he ean 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 seetion 10, and return it, together with the faets required by section 1, to the board of health or to the clerk of the eity 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 certifieatc arc delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the elerk of the eity or town for registration.
SECTION 5. Penalty for violation not cxeeeding fifty dollars.
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,
John Quincy Battles
Sex.
.Color,
Date of Death,
Oct. 11,1902
190 }; Age,.
75 Years,
3
.. Months,
16 Days.
Maiden Name,
§ If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Married
.Occupation,
Farmer
*Residence, { If out of town, )
South Chelmsford.
Place of Birth,
new market
n. H.
*Place of Death,
Sc. Chelmsford
Name and Birthplace of Father,
Benjamin,
Dorchester mass
Maiden Name and Birthplace of Mother,
Charlotte Smith Dorchester
Place of Interment, (Give name of Cemetery), So Chelmsford 11ans
Dated at
Seth Chelmsford
Signature and
place of business
of Undertaker.
Daniel Puan
on
190 2
So Chelonsford May
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
John Quincy Battles
Age, 75 Y. 3 M. 16 D.
Place and Date of Death,
died at
do Chelmsford, Man.
Oct. 11.
1902-2
- Primary,
Disease or Cause of Death, } Secondary,
Myocarditis q
Duration,
Indefinite
Hukbritan
Duration,
1
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
5
M. D.
Date of Certificate,
Cet
11
190 2 .-
* 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.
Lica Del-11.1912.
78
¿ also state fully. 3.
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 funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS 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.
Rec
FORM C.
Commonwealth 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,
alicia Di walsh
Sex,
Color,
Date of Death
Oct 12
190 2 Age, .~ 7 Years,
Months,
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 (
North chehusford
Place of Birth, North chelmsford
* Place of Death,
Name of Father,
Jahre walsh
Birthplace of Father,
Juland
Maiden Name of Mother,
Budget Sheridan
Birthplace of Mother,
Place of Interment, (give name of cemetery)
Dated at
Louer
far Hike Dermott
oct 12
1902
of Undertaker
70 yorkand
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceasedt
alicia 2 Halsh
Age,
Y,
3 M / D.
Place and Date of Death,
died at
n. Chelmsford Oct. 12
1902
Disease or Cause of Death, #
Maraons.
Duration of Sickness.
2 months
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
Oct.12
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.
Rua Oel- 13
79
At Petuck
Signature and
place of business
I Chellaferd.
M. D.
LA COUNEDO
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 1. to the bagel .. . . .. k of the city or town in which the death occurred.
F
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,.
Alexander MC Connell
Sex, Ihale Color,
Date of Death
Oct: 5- 1902 Age, 45 Years, ~ Months,.
~ Days.
Maiden Name,
{ If married, widowed }
or divorced
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation, Carpenter
*Residence
( If out of town }
{ also state fully )
Nashua Road North Chelmsford
Place of Birth,
upper milla
N. B.
* Place of Death, -.
inket from Merrimack River North Chelmsford
Name of Father,
Charles. Mc Connell
Birthplace of Father,
upfer Milch N.B.
Maiden Name of Mother,
Elizbeth -Christic
NB
Birthplace of Mother,
Edson
Place of Interment, (give name of cemetery)
Signature and
C. A. Malloy
Dated
Lawell
Det 22
1902
on
place of business
Lawell
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased;
Place and Date of Death,
Disease or Cause of Death, #
Age, 45 %, ~ M, ~ D. died at intet from DurimacKRin Oct 5.902 Drowning.
Duration of Sickness.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
267 hermanth St.
Certifying Physician.
Date of Certificate.
Qet- 22.
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 FAPTULDUNGD 9
cf. 22
of Undertaker
80
No ..
RETURN OF THE DEATH
OF
at
Date,.
I
Filed,
1.
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 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 certificate setting forth the required facts.
SECTION II. In case the deceased was a soldicr 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.
1
81
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Date of Death, Och "13
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Full Name of Deceased, Fermer Edicon Thayer
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, + 4 Years, 9 Months, 13 Days. Occupation, ..
* Residence
{ If out of town, }
¿ also state fully. § Chebusford
Place of Death,
Place of Birth,
Vermont
Name and Birthplace of Father, Warren Thayer
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery)
Hach Pod Cenc;
Dated at.
chelunsford
Signature and
(ich. 14
190 2
place of business
of Undertaker.
3
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Homer E. Thayw
Age,
648.9 M. /3 D.
Place and Date of Death,
died at
Chelmsford Phos.
Oct. 13,
1902 .-
Disease or Cause of Death,
Primary,
Cerebral farmorhage.
Duration,
5 days-
Duration,
I certify that the above is true to the best of my knowledge and belief.
Arthur D. colonias
M. D.
Signature and Residence S of
Certifying Physician.
Chelmsford, Dass.
Date of Certificate,
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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Reed Delvis
Rec
FORM C.
Immediate,
No.
RETURN OF THE DEATH
OF
at
Date,
190
Filed,
1.90
[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 notiee thereof to be given to the board of health or to the town clerk.
SECTION 7. The commanding offieer 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 reecive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city, or town or remove therefrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- with countersign and transmit it to the clerk of the eity or town for registration. Penalty for violation not exceeding fifty dollars.
FORM C. RIC No.
Commonwealth of Massachusetts.
1
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,
Clef. 18
190 2.
Full Name of Deceased, Sarah P. Emerson
Maiden Name, Sarah Bram.
If a married or divorced woman or a widow give also
Name of Husband, Jos. B. Emerson.
Sex, + Color,
Single, Married, Widowed or Divorced,
Age,. 68 Years, ... 0 Months, 15 Days. Occupation,
* Residence
{ If out of town, }
{ also state fully. j . Chelmsford, Mas.
Place of Death,
Place of Birth,
Name and Birthplace of Father,
Henry Byon Chelmsford. Mars.
Maiden Name and Birthplace of Mother, Relief Spaulding Beverly Mass.
Place of Burial (Give name of Cemetery),
Forefathers Cen. Quelsfund, Maco.
Walter Perkau
on Ich. 19 190 2
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Sarah J. Emerson
Age,
68%.
M. .D.
Place and Date of Death,
died at
Chelmsford, Mass
Qcx 18
190 2.
Disease or Cause of Death, ;
Primary,
Immediate,
Exhaustion from same, Duration,
I certify that the above is true to the best of my knowledge and belief.
1
Signature and Residence S of Certifying Physician.
3
45 Harvard St. Lowell Mass,
Date of Certificate,
Oct 19
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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Rica Oct- 20
M. D.
Pneumonia
Duration,
several months
Dated :
Chelmsford, Mais!
Signature and
place of business
of Undertaker.
Chelmsford
No.
RETURN OF THE DEATH
OF
at
Datc,
190
Filed,
1.90
[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 offieer 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 funcral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city, or town or remove therefrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- with countersign and transmit it to the clerk of the city or town for registration. Penalty for violation not exceeding fifty dollars.
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