USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 12
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RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
Och 28 " 1885 Altro Reicher
(Maiden Name),*
3. Sex, and whether single. Married, or Widowed.
7
Titule
4. Color, t
5. Age, .
.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 Birth, .
11. Name of Father,
12. Name of Mother, .
13. Birthplace of Father, . 922.2x 2
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, , .
DATED at 11/11/2010 ., on
March 21, 1885.
* 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.]
/
()
..
C ( -
) .. .
·5
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 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 FORTHWITH GIVE NOTICE thereof - or report these faets - to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Vame of Deceased,*
1
6
Date and Place of Death, -
died at
1875
Disease or Cause of Death, - of ........ fent any of ADuration of Sickness ist heves
I certify that the above is true, to the best of my knowledge and belief.
ame and Residence of Certifying Physician
He & firele'
2.
20%
Date of Certificate, ...
March 25
187.3.
* 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),
apice 25 " "1845 Kate He
3. Sex, and whether single. Married, or Widowed.
4
4. Color, t
5. Age,
.. Years, ..
8
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 Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
121
+ bluestar maso
Signature of Undertaker or other person making the Return, .
DATED at .... Trulima
on OU/2: 27
.1883.
/
.
1
6 -
0. 15.
* 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.]
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 FORTHIWITHI 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.
Katie Holmes
(female) age 8 months.
Tame and Sex of Deceased, .
Date and Place of Death, . . isease, First or Primary, 1 Cause
Bronchitis
Duration of,*
4 clays
Death, Secondary, . ·
Bronchial Pneumonie
Duration of,
24 hours
I certify that the above is a true Return, to the best of my recollection and belief.
Geo. EM Earthy AUD Marctil Mann.
me, Professional Title, and Residence,
Dated at Un Thirty, quan 2
1885-
very particular to fill all Blanks.]
* Reckoned to the time of death.
Winthrop, Dass
Any Physician having attended n 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, 1850. ]
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 TIIE COMMONWEALTII.
--
No. 5
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
1
2. Name,
2
(Maiden Name),
3. Sex, and whether single. Married, or Widowed,
4. Color, t
5. Age, ·
27 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 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, L
DATED at .. Minthip
, 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.]
.........
. 205 . 4.
10
C
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.
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 most 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.
ime of Deceased,*
Jepre Bursite
1
Date and Place of Death, 1 died at
.
1885.
Disease or Cause of Death, - of
: Liter 4.1 .. .. Duration of Sickness .. Che pecar
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
N
Date of Certificate, c. 1
1855.
* 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
May 19 "1885 Melissa & Floral
(Maiden Name),*
3. Sex, and whether single. Married, or Widowed,
Female
While
1
4. Color, t
34 Years, ~ Months, ~ Days.
6. Disease or [ First or Primary Cause of Secondary (if any) Death, By whom certified
7. Residence, .
8. Place of Death,
mani Er Hemma Plats
9. Occupation, .
10. Place of Birth, .
11. Name of Father, James Pl 12. Name of Mother, margaret A Plant
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return,
S Sumaner Flere
DATED at.
,
on
Jan 20 1883 .-
* 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.]
5. Age,
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 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.
VIVE ..
RETURN OF A DEATH. To the Clerk of the Town in which the Death
wywhich the Death occurred. S
1. Date of Death,
.
I reunião Denas Lo
2. Name,
(Maiden Name),*
3. Sex, and whether single. Married, or Widowed,
male
4. Color, t .
5. Age, .
.Years,
Months, .
Days.
6. Disease or First or Primary
Syptheria
Cause of Secondary (if any)
Death, [ By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
2
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, .
S
DATED at.
,
on
LL 11 188 3.ª
.
* If a Married Woman or Widow.
t If other thau white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
.....
.2.1.4111 1
...
9h
1110
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 TIIE 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 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 Clerks or Registrar of the Town or City in which the Death occurred.
Name and Sex of Deceased,
Clarence Treinar
(anale)
Date and Place of Death, . .
Disease,
First or Primary,
¥ Cause Death, Secondary, .
July 3, 1883-
Diphttiena
Duration of,*
1 week
Duration of,
I certify that the above is a true Return, to the best of my recollection and belief.
me, Professional Tille, and Residence,
Geo. E. MiCarthyde 2 Amittrich Press.
Dated at ...
4
1883 .-
very particular to fill all Blanks.]
* Reckoned to the time of death.
d
Any Physician having attended a person during his last illness, shail-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 di-case 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
July 12 th 1885.
1. Date of Death,
2. Name,
(Maiden Name),
Flaruut
Gilbert Phillips Widow
3. Sex, and whether single. Married, or Widowed.
Hemals
4. Color, t .
63 Years,
Months,
Days.
5. Age, .
6. Disease or [ First or Primary Cause of { Secondary (if any)
Death,
By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
inthe Plottager.
Dawn
10. Place of Birth, . Boston Mai.
11. Name of Father, John L. Phillip Hall 12. Name of Mother,
Bastou Man.
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Cambridge
Signature of Undertaker or other person making the Return, .
Dr.S. Drowns
DATED at
,
on
July 13 th
188
* If a Married Woman or Widow.
+ If other than white. (.) 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 TIIE 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 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.
Huithurto, Preston,
July 13 & 1885.
This Certifies, That Harriet Gilbert died on the 12th day of July 1885, aged 63 years, months, days.
CAUSE OF
Primary,
Kleumatism
Duration
DEATH.
Secondary,
Heart Disease
Duration
See. @ Alibarth /x
Physician.
Rockwell & Churchill, City Printers, 39 Arch Street, Boston.
No ...
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
July 18 "1885 O'bancha Y aller Dana
3. Sex, and whether single. Married, or Widowed,
Female
4. Color, t
5. Age, .
4
.Years, ...
8
Months, ............
Days.
6. Disease or [ First or Primary
Dysotheria
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, a, alle
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
Thine
, on Inl, 18 1883.
* 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.]
4. Er Una Sheet
arabella H. Dilan
Floral
Box I'm Carry
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.
L
A Na
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Laura
...
Date and Place of Death,
died at .
.7
12
Disease or Cause of Death, - of
Blood Lockedin Duration of Sickness.
I certify that the above is true, to the best of my knowledge and belief.
me and Residence of Certifying Physician
ertificate, feel, 22
1885
* 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.
C
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
July 22 "1885 Mar Gs. Snc Naught
3. Sex, and whether single. Married, or Widowed.
Female
4. Color, t
5. Age, .
Years, ...
5
Months Days.
6. Disease or First or Primary
Cholera
Cause of Secondary (if any)
Deatlı, By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
Rend Stul
Juhn Ine Utan; hr
12. Name of Mother, annie Pane. Sayhr
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return,
Simmar
Ferra
DATED at ..
Thathis
on
.. 188 2
* 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.]
AnniTing maso
Read Street
11. Name of Father,
0221 /3
puede 23 dias at 11 a su
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 persou 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.
me of Deceased,* -
Mary J. e Naught
te and Place of Death, -
died at Winthrop Arct, 2h 18ES,
case or Cause of Death, - of telwfera Infacen Duration of Sickness.
I certify that the above is true, to the best of my knowledge and belief.
and Residence of Certifying Physician
Wewhich
Date of Certificate,
* Or Sex of Infant (not named).
1
Any Physician having attended a person during his last illness, shall-when requested within fifteen days after the decease of su person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, and 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 Registra of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, un proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person performing 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 Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands of 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 certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Board 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 his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
---
No ..
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),*
July 22 1.885. Halter B. Morris
3. Sex, and whether single. Married, or Widowed,
White
4. Color, t
5. Age, .
15 Years, 4
Months,.
Days.
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence, Muchof Man 8. Place of Death, Shirley J
9. Occupation, . Machines/ Filtration / clara
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, Farah
13. Birthplace of Father, . Mais
14. Birthplace of Mother, .
15. Place of Interment,
I hring field / blau
Signature of Undertaker or other person making the Return,
Dr. G. Brown
DATED at.
on
July 220, 1887.
* 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.]
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.
P 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.
Winthrop Preston, July 20. 1885.
This Certifies, That Walter B. Morris
died on the 22 0 day of July 1885, aged 75 years,
days.
4 months,
DEATH. Secondary, apoplexy Duration 3 days
CAUSE OF Primary,
Duration
S.H Dungice, Physician
Rockwell & Churchill, City Printers, 39 Arch Street, Boston.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
Timothy M. Carthy Dale Only 22"1883-1
(Maiden Name),*
3. Sex, and whether single, Married, or Widowed,
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