USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 3
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In case of an inferment 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,*
Jezal 120112
Date and Place of Death, -
died at Winter thril 6 1 of Conser tion of Lung, Duration of Sickness. Fine day)
18$1,
Disease or Cause of Death, -
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Date of Certificate, ..
April 3
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 deccase 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.
1
Commonwealth of Massachusetts. No. 2
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
While
32 Years,
X
Months,
Days.
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, By whom certifi d
7. Residence,
8. Place of Death,
9. Occupation, .
Prick- maxon
10. Place of Birth, . Treston mars
11. Name of Father, Eli E.Premia,
12. Name of Mother, Demás,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, 1
Signature of Undertaker or other person makin! the Return,
Summer Phone
DATED at.
Mintturopa
on
april 28
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.]
eApril, 24 " 1881, Charges! Bernis
Inale
married
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 FORTHIWITHI GIVE NOTICE thercof -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,* -
George Remis
Date and Place of Death, died at
1881.
;isease or Cause of Death, - \ of
Typhoid fever
Duration of Sickness.
I certify that the above is true, to the best of my knowledge and belief.
-
Name and Residence of Certifying Physician H. t. foule .A.A Hibathirty 124/11/12
Date of Certificate, April Li
1895%.
* 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
June 5th, 1881 Julia W. Lawton
3. Sex, and whether single, Married, or Widowed,
4. Color, t
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, .
10. Place of Birth, . Salón mare
11. Name of Father,
H, WO CHtillie
12. Name of Mother, Sophia P. Willie Mareachvedl
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Balon massachusets Micros autumn Cemetery Summer Floyd
Signature of Undertaker or other person making
the Return,
DATED at. Mini trope
,
On ...
June 6th
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.]
éFemale (married)
White
55 Years,
X
Months,
X
Days.
Main St Winthrop
Main St' Shinthrop
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 thercof- 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.
158/
Lauter
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Julia YV Lavatona
Date and Place of Death, - died at
1891,
Disease or Cause of Death, - of Heart
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Date of Certificate, Cuore 6 188/.
* 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.
Commonwealth of Iti ..... r wetts.
No. 4
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),*
une y " 1881 Daniel Di Waren.
3. Sex, and whether single. Married, or Widowed.
male ( married
4. Color, t
5. Age, .
6. Disease or [ First of 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,
Somerville mars Deand Pray Winthrop Carpenter Rochester r. H. Millian Hansen Sudan Waren farminglenty farmington OV XX Hradlawn Cemetery
Signature of Undertaker wother person- making the Return,
Summer floyd
DATED at
ochrop, on June 8ª 18%.
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. ĮBe very particular to fill all Blanks.]
678
Years, ..
2
Months, /2 Days.
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 FORTIIWITHI 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,*
Date and Place of Death, -
Disease or Cause of Death, - of
Daniel S. Hanen tic ad Ninthrojo Dixcare of Heart Duration Duration of Sickness ... Cocan Speray Aune 181
I certify that the above is true, to the best of my knowledge and belief.
7. B. Jule . th. D.
Name and Residence of Certifying Physician . .
Concord Mars
Date of Certificate, 18,8%.
* 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.
Commonwealth of Massachusetts.
No. J
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Deatlı,
2. Name, (Maiden Name),
3. Sex, and whether single. Married, or Widowed.
4. Color, t
5. Age, .
6. Disease or [ First or Primary
Cause of { Secondary (if any)
Death, By whom certified
7. Residenee,
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
. f.
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return,
!
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.]
3.1 Years,
Months,
Days.
L
2/
V
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 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.
C
Name of Deceased,* -
{
Date and Place of Death, - died at . ..
1.
187 /,
Disease or Cause of Death, -
of
UfnanDiation of Sickness.
.
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Date of Certificate,
P
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 deccase 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 carly 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),
C Horas A. Satef
3. Sex, and whether single. Married, or Widowed.
Male
Ma cd
4. Color, t
5. Age, .
32 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,
-
1
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.]
Pulch
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 FORTIIWITHI 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,*
Date and Place of Death, - | died at
187%,
Disease or Cause of Death, - of
1
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Date of Certificate, . cate, 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 deccase 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.]
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 o' his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
Boston, July 13€ 1881 George A. Patch
This Certifies, That, it
died on the.
day of July 1881, agod 3.5 years, nicais,
months,
days.
,
CAUSE OF ) Primary, Valvular diseaseoperarioheart. DEATH. Secondaryy .. Both lings ingran with blood
as shown by autopay- Sw. Stedman. Physician. A Mio Examina
134 .841
Commonwealth of Massachusetts.
No. 7
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name, .
(Maiden Name),*
July 26th 1881, andra fighthice
3. Sex, and whether single, Married, or Widowed,
éfemale
4. Color, t
5. Age,
6. Disease or First or Primary
Cholera Infantum
Cause of Secondary (if any)
Death, ¿ By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Beton make 11. Name of Father, Frank Lighthe 12. Name of Mother, Priacht Lahthrice
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, ·
Simperrary defever in Jour Receiving Tomb
Summer Floyd
DATED at ..
Signature of Undertaker other person making the Return, Winthrop
,
on
July 2%
188%.
* 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.]
Years, ..
X
Months, 21
Days.
Boston mare
Sea Shore Home Minitrope
Sligo Fretand Seigo Ireland
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.
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 persou 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.
18/02 4mb
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
anna
Lighthill
Date and Place of Death, - died at Winthrop, Maza
July 24, 1881,
Disease or Cause of Death, - of.
Cholera Infantum Duration of Sickness. 9 days
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician George W. Goodell, M.D. Resident Plays, at Sie Store
Homme
Date of Certificate, July 26, .. 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 deccase 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 Statutcs 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.
8
Commonwealth of Massachusetts.
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.
female While-
4. Color, f
Years
4
Months,
.
2 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, .
Dansbridgeport maes Northrop Point Shirley Mas
10. Place of Birth, . Cambridge port mass
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