USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 10
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9 wake
Pneumonia 19 Duration of, be lay 2.
age 69 years, 9 months and It days
I tertify that The above is a true Return, to the best of my recollection and belief.
ame, Professional Title, and Residence,.
M.E. MElexthy M.D. Y Thoof Mass.
Dated at.
.............. 18 7 4.
Be very particular to fill all Blanks.]
* Reckoned to the time of death.
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the discase of which the person died, and the date of his decease, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859. ]
The attending Physician is requested to make out his Certificate as promptly as possible, for the information and use of the Undertaker, or other person making return of the ease to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTH.
No
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
- 188×
2. Name, (Maiden Name),'
6
3. Sex. and whether single, Married, or Widowed.
4. Color, t
5. Age, 12 Years,- Months, .... Days.
6. Disease or First or Primary
Cause of { Secondary (if any)
Death, [ By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birthı, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, . c·
15. Place of Interment, .
Signature of Undertaker or other person making the Return,
DATED at .. .... ,
1
L
188
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
.....
1 F
Cr
1
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITHI GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blauk forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
To the Clerk or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deceased,
Date and Place of Death, . . Disease, First or Primary, or Cause of Death, Secondary, .
Eletatiane here'scerede Duration of,*
14,10
Duration of,
1
I certify that the above is a true Return, to the best of my recollection and belief.
Vame, Professional Title, and Residence,
Dated at.
3e very particular to fill all Blanks.]
* Reckoned to the time of death.
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the dreease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decrase, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859. ]
The attending Physician is requested to make out his Certificate as promptly as possible, for the information and use of the Undertaker, or other person making return of the case to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTII.
Commonwealth of Massachusetts.
No. .. ..
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),
3. Sex, and whether single. Married, or Widowed.
4. Color, t
5. Age,
5 ........ Years ...... 5 2 Months, .... Days.
6. Disease or First or Primary
Cause of Secondary (if any)
Death, [ By whom certified
/
111/11/
8. Place of Death, 1 /11/11/11.
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother,
pi
tard
13. Birthplace of Father, .
14. Birthplace of Mother, .'
15. Place of Interment,
Signature of Undertaker or other person making the Return,
(
on ..
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
188/
DATED at .. J
1
C 1
C
7. Residence, 1 1. 1 /14. 1
1
V
June >
The Undertaker, or other informaut, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT. 1
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
1
Date and Place of Death, - died at. 1
.z. C 1874,
Disease or Cause of Death, - of
7 of horner Duration of Sickness.
A
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Date of Certificate,
187 .
* O: Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
waniu vi Etlassachusetts.
No ......
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),*
3. Sex. and whether single. Married, or Widowed.
L
/
4. Color, t
5. Age,
65 Years, 6 Months, Days.
6. Disease or First or Primary
Canse of { Secondary (if any)
Deatlı, [ By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Sanddorn It. It
11. Name of Father,
annuel
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker another person making the Return,
- Denver Fax(
-
DATED at.
1. 11/ 16
on
188
* If a Married Woman or Widow.
f If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
"
e
1
/
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITHI GIVE NOTICE thereof-or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
C
. 121th 1884
This Certifies, That Mannuel Ingalls died on the I bu day of freue 1884,aged 65. years,
6 months, days.
CAUSE OF) Primary K. K. Accident Duration
DEATII. Secondary Letsmal HarmonlaDuration )
(Francia (A.Havia 1 Physician.
Boston,
Printing Department, Deer Island, Boston Harbor.
No.O
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),'
June 19 " 1884 George & Hewitt
3. Sex. and whether single. Married, or Widowed.
4. Color, t
5. Age, 50 Years ... 3 Months, ..... 1
......
Days.
6. Disease or First or Primary
Cause of { Secondary (if any)
Death, By whom certified 1
. .
7. Residence,
8. Place of Death,
9. Occupation, .
10. Plaec of Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return; .
11212222
7
DATED at ...
on ..
Service 2.5
188
1
C 12422
C
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, > pecify what. [Be very particular to fill all Blanks.]
June 19: 84 217
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death -to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death, oceurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
To the Clerk or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deceased,
Date and Place of Death, .
Anttivoli Para, Inne 14, 1984.
Disease, or Cause of Death,
First or Primary,
Duration of,*
Secondary, . Plethisis Pulmonalis
Duration of,
2 . HERV1 .
I certify that the above is a true Return, to the best of my recollection and belief.
Name, Professional Title, and Residence,
Dated at Strutture Sica 2 June 2℃)
18 84.
[Be very particular to fill all Blanks.]
* Reckoned to the time of death.
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859. ]
The attending Physician is requested to make out his Certifieate as promptly as possible, for the information and use of the Undertaker, or other person making return of the case to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTII.
No.
Commonwealth of fHassachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
(Maiden Name),*
3. Sex. and whether single, Married. or Widowed,
?
4. Color, t .
5. Age, 5- Years, ... 9 Months, Days.
Disease or Cause of Death,
6 .. Duration of Sickness.
By whom certified,
7. Residence, .
001/16. Jucat Fond
S. Place of Death,
9. Occupation,
10. Place of Birth.
11. Name of Father. .
.....
12. Name of Mother, .
13. Birthplace of Father,
14. Birthplace of Mother,
15. Place of Interment. .
Signature of Undertaker or other person making the Return, .
DATED at
on
18
* If a Married Woman or Widow. { If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[ Be very particular to fill all Blanks.]
1
0
/
The Undertaker, or other informant, is requested to report the facts -together with the Physician's Certificate of the Causes of Death - to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred, (or the deceased resided.) having first been obtained, the person having charge of such Interment inst FORTHWITH GIVE NOTICE thereof- or report these facts - to said Clerk. Penalty for neglect, twenty dollars.
Blank forms of Returns may be obtained from the Town Clerk.
une 2/ 8
PHYSICIAN'S CERTIFICATE.
Name of Deceased,* -
Date and Place of Death, -
Dienet i at Great Head Phone: 22 nd 84
Disease or Cause of Death, -
of Tubercular Incuingitis Duration of Sickness .. 2. 11x 122
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician, .
1111
Date of Certificate, 22 188 .
*Or Sex of Infant (not named).
[Extracts from Chapter 32 of the Public Statutes, ISS2. ]
" SECT. 3 .- A Physician who has attended a person during his last illness, shall, when requested within fifteen days after the decease of such person, forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same."
"SECT. 5 .- No human body shall be buried, or removed from any city or town, until a proper certificate has been given, by the clerk or registrar, to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall state that the facts required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial permit until the certificate of the cause of death has been obtained from the Physician, if any, in attendance at the last sickness of the deceased, and placed in the hands of said clerk or registrar."
[If there has been no physician in attendance, or in case of death by dangerous contagious discase, or in any other event when the certificate of the attending physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the Board of Health, or any physician employed by any city or town for such purpose, shall, upon application, sign the certificate of the cause of death, to the best of his knowledge and belief. In case of death by violence, the medical examiner attending shall furnish the requisite certificate. ]
No ...
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
15-52.
2. Name,
(Maiden Name),'
Receta of Caseta alle
3. Sex, and whether single. Married, or Widowed,
4. Color, t
5. Age, .
Years, ... Months, ..... 5 Days.
6. Disease or First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
Falls
12. Name of Mother, .
13. Birthplace of Father, .
14. Birthplace of Mother, .
...
15. Place of Interment, Ly
Signature of Undertaker or other person making the Return,
DATED at ...
T
.. , on
6 .... 1884
* If a Married Woman or Widow.
If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
..
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Glerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof-or report these facts -to said Clerk. Penalty for negleet, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
No ....
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
/
C
3. Sex, and whether single. Married, or Widowed,
4. Color, t
While
68
.Years, ....
Months, .
,28
Days.
5. Agc, .
6. Disease or First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence, etremont 81. Minithiol 8. Place of Death, tremens Si rench opp
9. Occupation, . Farmer
10. Place of Birth, .
11. Name of Father, E benezer Dounviel
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker another person- making the Return,
Minitrofo Naco
22 des Flinttvoje Jann berrele
- Summer at loud
DATED at .......
.. ,
on
July 1 2 18
* If a Married Woman or Widow.
t If other than white. (A.) African; (MI.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
July-2-1881
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE THE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITHI GIVE NOTICE thereof - or report these facts - to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
/ 7
что тся 1 381,71
PHYSICIAN'S CERTIFICATE.
.
Name of Deceased,*
Date and Place of Death,
died de . ....... ....
1,
187 4.
1
Disease or Cause of Death, - of
Duration of Sickness
. .....
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician 6.5.
Date of Certificate, 1 12
187
· Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and the date of his decease, as nearly as he can state the same .- [Extract from Chapter 21 of the General Statutes, 1859.]
Without repealing the foregoing requirements of the General Statutes, the recent " Act to provide for the more Accurate Registration of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, until a proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing the burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes have been returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cause of Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of said clerk or local registrar."
If there has been no Physician in attendance, or in case of death by dangerous contagious disease, or in any other event where the certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board of Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the best of his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
No. 10
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
Julie 20 "1884
2. Name,
(Maiden Name),*
/
3. Sex, and whether single. Married, or Widowed,
C
11/ 110
4. Color, t
5. Age, .
.Years, ..
5
Mouths,
Days.
6. Disease or [ First or Primary
Cause of? Secondary (if any)
Death, By whom certified
7. Residence, .
8. Place of Death,
9. Occupation, .
10. Place of Birth, . (Seilen 122022 C
11. Name of Father,
12. Name of Mother, .
8 Siela, (d)
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
1.1
1, 004 - 122 /
Jenni" Site Forele
Signature of Undertaker or other person making the Return,
(1)
DATED at .. /////2010, on.
188 (/.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
Que
1.11
88. Home thirty
Villian O Connor V
guy 20 84
The Undertaker, or other informant, is requested to report the facts-together with the Ithysician's Certificate of the Causes of Death~to the Town Clerk, BEFORE THIE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTIIWITH GIVE NOTICE thereof- or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
To the Clerk or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deceased,
nelly O'Comma
female
Date and Place of Death, .
Sea Sture hour. Minttuop Mart.
July 20 5 1884.
Disease, Cause
First or Primary,
marasmus.
Duration of,*
3ms.
/ Death,
Secondary, .
multiple abscesser.
Duration of, Duas
I certify that the above is a true Return, to the best of my recollection and belief.
ame, Professional Title, and Residence,
Sau T. William IND Rabmy, Buton
Dated at.
Winthrop Mass
1884.
Be very particular to fill all Blanks.]
* Reckoned to the time of death.
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of such person-forthwith furnish for registration a certificate of the duration of the last sickness, the discase of which the person died, and the date of his decease, as nearly as he can state the same .- [EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859. ]
The attending Physician is requested to make out his Certificate as promptly as possible, for the information and use of the Undertaker, or other person making return of the case to the Town Clerk.
Physicians may obtain BLANK CERTIFICATES from the Town Clerk or Registrar.
Copies of the STATISTICAL NOSOLOGY, adopted for the purposes of Registration, may be obtained on application to the SECRETARY OF THE COMMONWEALTH.
Fill out in ink.
When married erase "single" and "widow"; when widowed, erase "single" and "married."
RETURN OF DEATH TO THE CITY REGISTRAR. CITY HALL, BOSTON.
Date of Death, August, 2
1854
Name,
Nephew IV. Boylan
Color.t W.
Age.
years
Months
14. days
Place of death
Auchwitz WARD
Street and No.
Residence,
Sex,
//11 , Single,
Married.
Occupation,
Wife of
Birthplace*
Widow of
Name of Father,
Name of Mother,
Birthplace of Father,
Birthplace of Mother, *
Cause of
) Primary,
Duration,
Death Secondary,
.Duration,
Place of Interment,
Houty Grapes Malere
Date of Interment or Removal,
Undertaker or Informant,
Anyother D. Rely
*Insert Town and State.
tState whether white or black.
1111 22
1
1
Printing Department, Decr Island, Boston Harbor.
2
Besten, Giethoorn My. 2 1884 This Certifies, That Nephew A. Mayhave. died on the 2 day of Areg. 1881, aged reais,
1 months Gdays.
CAUSE OF ) Primary,
+ Duration
DEATH.
Secondary,
Duration
Physician.
No ..
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),*
.
Resihard Reid
3. Sex, and whether single. Married, or Widowed,
4. Color, t .
5. Age,.
2 .Years, ..... Months, .. Days.
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, |By whom certified
7. Residence,
6 have my Place
...
8. Place of Death,
Sea Shore Home
9. Occupation, .
10. Place of Birth, . Martin
11. Name of Father,
James
12. Name of Mother, Joanna
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return,
James
Lotte
DATED at. , on 187
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
relanel
Calvary
The Undertaker, or other informant, is requested to report the faets-together with the Physician's Certificate of the Causes of Death-to the Town Clerk, BEFORE TIIE INTERMENT.
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