USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 15
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Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
'e of Deceased,*
Heute habeut Hemmet tu selfie
and Place of Death, -
died at Hi14/220tters fi
...... 1885,
ase or Cause of Death, - of . Serofice (CC
Duration of Sickness.
I certify that the above is true, to the best of my knowledge and belief.
and Residence of Certifying Physician 4. & Sc2. Scretc.
Date of Certificate, Aux( 1)
187'S-
* Or Sex of Infant (not named).
Any Physician having attended a person during his last illness, shall-when requested within fiftcen days after the decease of 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 Registr of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or town, u propcr 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 returncd and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the Cau 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 wher certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local Boa Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the be 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,
aug. 24, 1885. Charles Reilly
(Maiden Name),*
3. Sex, and whether single, Married, or Widowed.
4. Color, t .
Male white.
5. Age, Years,. O Months. o Days. Curricular Meningitis.
Disease or Cause of Death,
6
Duration of Sickness,
·
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 other person making the Return,
DATED at
on
aug. 24.
1885-
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto, (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ]
Dr. J.a. Pltu. 8 CherrySt. Boston.
Antrop, Muss. ,
England. Charles Reilly. Ellen Reilly. Leserne , England.
2)
[Public Statutes, Chap. 32, 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; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the 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, if there has been no physician in attendance. He shall also sign such certificate, upon applica- tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot for good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
PHYSICIAN'S CERTIFICATE.
me of Deceased,*
te and Place of Death, died at
ease or Cause of Death, -
Charles Reilly. Winetrop. Mass. Mcg. 24. 1882. Nutreular Meningstrim of Sick 18 Mayo.
I certify that the above is try, to the best of my knowledge and bearf. Dr. J. A. Potter, to Periu St Roxbury.
and Residence of Certifying Physician,
Date of Certificate, aug. 24. 1886%
*Or Bex of Infant (not named).
[ Extracts from Chapter 32 of the Public Statutes. ]
" 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. If a physician refuses or neglects to make such certificate, he shall forfeit ten dollars to the use of the town in which he resides."
" 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; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the 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, if there has been no physician in attendance. Ile shall also sign such certificate, upon applica: tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot fo good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish th requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
NYTUNN VI A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death.
2. Name,
aug. 25.1885. nellec Driscoll.
(Maiden Name),*
3. Scx, and whether single. Married, or Widowed,
Female_
4. Color, t .
white
5. Age. 6. ..... Years, 9 Months ... Days. Cholera Infantum
Disease or Cause of Death,
6 .. Duration of Sickness, ·
By whom certified,
14 Tay. L. f. Q. V alles.
7. Residence, .
8. Place of Death,
9. Occupation,
10. Place of Birth, /20ton.
11. Name of Father, 4
JamoThy Frisell.
12. Name of Mother, Driscoll. Both- Mass- 13. Birthplace of Father,
14. Birthplace of Mother,
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
DATED at
Winthrop.
on
Rug. 25.
188.5 .-
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
2 hawring
Winthrop. Luger
freland
Cambridge.
[Public Statutes, Chap. 32, 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; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the 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, if there has been no physician in attendance. He shall also sign such certificate, upon applica- tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot for good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
PHYSICIAN'S CERTIFICATE.
ame of Deceased,* -
Mellin Driscoll Winthrope. Mail. Aug. 25 188 3 .-
ute and Place of Death, - died at Cholera Infantenisation sease or Cause of Death, -
14 days.
ne and Residence of Certifying Physician, JA Votter Ho
erin S. Rochary.
Date of Certificate, lug. 26 188 3.
*Or Bex of Infant (not named).
[ Extracts from Chapter 32 of the Public Statutes. ]
" 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. If a physician refuses or neglects to make such certificate, he shall forfeit ten dollars to the use of the town in which he resides."
" SECr. 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 unti 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; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the 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, if there has been no physician in attendance. He shall also sign such certificate, upon applica- tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot for good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars."
NATURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death.
2. Name,
Ung. 26. 1885- TEwith Taylor. -
(Maiden Name).
3. Sex. and whether single, Married, or Widowed.
4. Color, t .
5. Age.
Female white.
0 Years, . . Months. o Days. Cholera Infantum.
Disease or Cause of Death,
6.
Duration of Sickness,
By whom certified,
7. Residence.
8. Place of Death,
9. Occupation,
10. Place of Birth,
11. Name of Father.
12. Name of Mother,
Ella B. Taylor
13. Birthplace of Father.
14. Birthplace of Mother. ·
15. Płace of Interment. .
Signature of Undertaker or other person making the Return,
DATED at
on
Lug. 21.
1886.
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ]
A.J. J. alter. Is Green It. Charleston. Winturk, Mas
[Public Statutes, Chap. 32, 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; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the 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, if there has been no physician in attendance. Ile shall also sign such certificate, upon applica- tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot for good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
PHYSICIAN'S CERTIFICATE.
ame of Deceased,* Edite
Taylor
ute and Place of Death, -
188 5-
sease or Cause of Death, -
of Cholera Infantunanon
2 works.
re and Residence of Certifying Physician,
f & Proti o assin H Rotary Mus.
Date of Certificate, aug. 2%. 1885 .-
-
+Or Sex of Infant (not named).
[Extracts from Chapter 32 of the Public Statutes. ]
" 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. If a physician refuses or neglects to make such certifiente, he shall forfeit ten dollars to the use of the town in which he resides."
" 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 unti 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; and in cities and towns where there are boards of health, the certificate of the cause of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the 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, if there has been no physician in attendance. He shall also sign such certificate, upon applic. tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot fo good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish th requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
To the Clerk or Registrar of the Town or City in which the Death occurred.
ame and Sex of Deceased,
Infant tandliter of bhas. R laswell of Worcester
ate and Place of Death, .
Maritturp Salt 1 1883 .-
....... Duration of,*
Cause
Death,
Duration of, Secondary, . Idemoline with at 7 months. Sived about I love. Died from infofor clave of the Eustachian
value of heart:
I certify that the above is a true Return, to the best of my recollection and belief.
re, Professional Title, and Residence, .
Dated at Shutting fat 1
1883
very particular to fill all Blanks.]
* Reckoned to the time of death.
isease,
First or Primary,
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 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
8
2. Name, (Maiden Name),
3. Sex, and whether single, Married. or Widowed,
....
4. Color, t .
5. Age,
Years.
3
Months,
..
Days.
Disease or Cause of Death,
6.
Duration of Sickness,
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,
DATED at 1
18
¥ If a Married Woman or Widow. t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what-
[ Be very particular to fill all Blanks.]
[Public Statutes, Chap. 32, 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 registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall state that the far required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial permit until t certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the deceased, a placed in the hands of said clerk or registrar; and in cities and towns where there are boards of health, the certificate of the cause death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairn of the board of health, or any physician employed by any city or town for such purpose, shall sign the certificate of the cause of de to the best of his knowledge and belief, if there has been no physician in attendance. Ile shall also sign such certificate, upon appl tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot good and sufficient reasons be early enough obtained. In ease of death by violence, the medical examiner attending shall furnish requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty dollars.
PHYSICIAN'S CERTIFICATE.
fame of Deceased,* -
ite and Place of Death, let. pil
died at
Eleneger Burrill Winthrop felh & Lenralgia Heu 7 Duration of Sickness 1885
sease or Cause of Death, - of
ish n&T.
I certify that the above is true, to the best of my knowledge and belief.
re and Residence of Certifying Physician,
Date of Certificate, Cet 3 1885.
*Or Sex of Infant (not named).
[ Extracts from Chapter 32 of the Public Statutes.]
" 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. If a physician refuses or neglects to make such certificate, he shall forfeit ten dollars to the use of the town in which he resides."
" 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; and in cities and towns where there are boards of health, the certificate of the cause of «leath shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairman of the 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, if there has been no physician in attendance. Ile shall also sign such certificate, upon applic. tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot for good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.'
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),* .
frederick
3. Sex, and whether single, Married, or Widowed.
71
4. Color. t .
5. Age, Years,.
Months, Days.
Disease or Cause of Death,
6 Duration of Sickness, · By whom certified,
7. Residence, .
8. Place of Death,
9. Occupation, .
10. Place of Birth,
11. Name of Fatlier.
...
12. Name of Mother,
13. Birthplace of Father,
14. Birthplace of Mother,
15. Place of Interment. . ·
Signature of Undertaker ar other person making the Return,' ..
DATED at .... on
18
* If a Married Woman or Widow.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ]
1
[Public Statutes, Chap. 32, 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 o registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall state that the fact required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial permit until th certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the deceased, an placed in the hands of said clerk or registrar; and in cities and towns where there are boards of health, the certificate of the cause death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, the chairma of the board of health, or any physician employed by any city or town for such purpose, shall sign the certificate of the cause of dent to the best of his knowledge and belief, if there has been no physician in attendance. Ile shall also sign such certificate, upon applica tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician cannot fo good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending shall furnish th requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-fi dollars.
PHYSICIAN'S CERTIFICATE.
le of Deceased,* - - thech/s
, and Place of Death,
ase or Cause of Death,
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