USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 8
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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 oeeurred (or the deceased resided) having first been obtained, the person having charge of such Interment mint 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,* - - -
lasquerique Ale Dingeeste
Date and Place of Death, - died at ...
1863,
Disease or Cause of Death, -
of Ulch Aye Duration of Sickness
.... .... ..
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
11
Date of Certificate, Avec 4 187
* 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. 11
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),'
Ang 7,883, David Belcher.
3. Sex, and whether single. Married, or Widowed.
4. Color, t
5. Agc, .
6. Disease or [ First or Primary Cause of { Secondary (if any)
Death, | By whom certified
7. Residence,
8. Place of Death,
9. Occupat.on, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, hope Town Cemetery
Signature of Undertaker Seother person making
Bummer floyd
the Return,
DATED at ..
-2018 ... , on
188 3.
* 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.]
Male Married
While
73 Years, 9
Mouths,
....
Days.
1
Carpenter Monthof, formerly Chelsea Joseph Belcher. Holtan 4 Belcher
CAunttrop formerly Chelsea Muitole formerly 6 heleed
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.
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,
David Beliben , Mode 1
Date and Place of Death, .
acevient 7.1883 Hintherate Heals
Disease, sr Cause of Death,
First or Primary,
Duration of * 11 clays
Secondary, .
Duration of,
I certify that the above is a true Return, to the best of my recollection and belief.
Vame, Professional Title, and Residence,
Dated at
1383.
:
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-forthicith 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 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.
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,
allan Ferguson.
male Chili act. 1 year
Date and Place of Death, . .
aug 15 83 Sea Shore Home, Winthrop
Discase, or Cause
First or Primary,
Pneumonia
Duration of,*
24 hours
of Death, Secondary, .
aprova + asturias
Duration of,
I certify that the above is a true Return, to the best of my recollection and belief.
Vame, Professional Title, and Residence,
EduAT Himling M.P. 298 wash " Su, Ruby Bulun
Dated at ..
Winthrop aug. 15
1383.
[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 di-case of which the person died, and the date of his decense, 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.
No ...
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),
Churchitã
16
Chevalita Jani
3. Sex. and whether single. Married, or Widowed.
manière
4. Color, t
5. Age,
6. Disease or First or Primary
38 Years, -.
Months, ......
.....
Days.
Perlinitio
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
new Juk
8. Place of Death,
9. Occupation, . new Jak
10. Place of Birthi, .
Unknum James of Jans
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, . 18
14. Birthplace of Mother, .
15. Place of Interment,
munti
auchun
Signature of Undertaker or other person making the Return, .
DATED at
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.]
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.
No ....
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
august 16. 1883
(
2. Name,
(Maiden Name),
3. Sex, and whether single. Married, or Widowed,
1
4. Color, t .
5. Age,
38
Years, ....
Months, .........
Days.
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
New York
8. Place of Death,
Winthrop Mass
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, . 11
14. Birthplace of Mother, . 11
15. Place of Interment, Into autre
Signature of Undertaker or other person making the Return, .
Berg & Smith
€
DATED at
, מס 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.]
a
2
The Undertaker, or other informant, is requested to report the facts-together with the Physician's Certificate of the Causes of Death-to tlie 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.
(
jamin F. Smith Undertaker 51 Tremont St
PHYSICIAN'S CERTIFICATE.
Boston Mass Name of Deceased,*
Chevalita de dooring
- -
Date and Place of Death, - died at
ang. 16' 1883.
Disease or Cause of Death, - of Recete l'interich Duration of Sickness.
Facecurry
I certify that the above is true, to the best of my knowledge and belief.
Vame and Residence of Certifying Physician.
Date of Certificate, Cen Gast. 15" 1883.
* 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.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
August 21-1883 Paul Mansfield
3. Sex, and whether single, Married, or Widowed,
male Single
4. Color, t .
2-
0
Years,.+
9
¿Months, ..
Days.
6. Disease or First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
Boston Mais
8. Place of Death,
C
Dolphin Ove Winthrop has
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
Doston mas Ex Summer Mansfield maria 6
12. Name of Mother,
Dorchester Mars
13. Birthplace of Father, .
14. Birthplace of Mother, .
Cambridge Mass
15. Place of Interment,
Signature of Undertaker or other person making the Return,
Benji Fi Chwith
DATED at. 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.]
-
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 intermcht taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased residcd) 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.
Jug 21. 53.
n F. Smith
lertaker remont St
PHYSICIAN'S CERTIFICATE.
on Mass
Paul Mansfield
e of Deceased,*
and Place of Death,
aug. 212m Ocean Spray Winthrop 4 1883, died at
se or Cause of Death, -
of Meningitis ... Dur Duration of Sickness. 15 days
I certify that the above is true, to the best of my knowledge and belief.
d Residence of Certifying Physician
Samuel ADemain Via
Date of Certificate, . . aug. 22' 188 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 s 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 1 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 Boar. Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the bef his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
No. 12
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
august 25 "1883 ambrose a Sukketury
(Maiden Name),*
3. Sex, and whether single. Married, or Widowed,
Male
4. Color, t
3
Years/
Months,
Days.
5. Age, .
6. Disease or First or Primary
Dipltarna
3
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Minttrofe mare George F Vermehrung
11. Name of Father,
12. Name of Mother, . WinThropo 72 varR) 13. Birthplace of Father, . 14. Birthplace of Mother, . Each localon mars Winthropo Tom hendlery
15. Place of Interment,
Signature of Undertaker another person making the Return,
Sumner Flojo
DATED at .. 0:
,
on ..
Chugirl 25 183.
* 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.]
D'argent &1-> Ifit Leverant SI- Largent 21- fit Re arunt 21 -
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.
I hereby certify that that ambrose a. Tewksbury, aged years, did at Winthrop on the 25 th of august 1883.
Cause of death; Diphtheria. Duration of disease; One week.
Ch. Brooks, In. D.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
auquel 26 "1883 Many Driscoll.
3. Sex, and whether single. Married, or Widowed.
Female
(Hhuilé
4. Color, t
5. Age,
.............. Ycars, ....
Mouths,
Days.
6. Disease or [ First or Primary
Cause of { Secondary (if any)
Death, By whom certified
7. Residence,
location
mazs
..
88 Home Minitrope
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 Returnsy
S
on
Aluguel 26 188. 3.
* 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.]
Oholend an Fartura
Halland Greland)
(Jerne/@mail Deferiti
Summer Floyd
DATED at ...
(Maiden Name),'
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.
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, or Cause of Death,
First or Primary,
-
Secondary, .
many dicall Female chili act. y unos Sea Shore Homme Winthrop aug 2 6 1883 Choling Infantum Duration of,"
Exhaustion Duration of,
I certify that the above is a true Return, to the best of my recollection and belief.
Name, Professional Title, and Residence,
Echo. T. william
Restring, Buton
Dated at.
Winthrop aug. 26th
1883.
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 deeease 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, 1839. ]
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,
2. Name, (Maiden Name),'
@yer 11 " 1883 Eba G. Belcher
3. Sex, and whether single. Married, or Widowed,
etemale
Hhété
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, . Minttrofe St Ninthrole 11. Name of Father, M Quetin Welcher flora, a Belcher
12. Name of Mother, .
Winthrop mare
13. Birthplace of Father, . ... 14. Birthplace of Mother, . Hillsborough Of It Winthrop Jon Cemetery
15. Place of Interment,
Signature of Undertaker or other person making the Return,
Summer Floyd)
62
DATED at ..
on
De las 15
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.]
Winthrop 81
..
Hinthvala.et
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.
Jeff 11-11
€
PHYSICIAN'S CERTIFICATE.
Vame of Deceased,*
Gra G. Belcher
Date and Place of Death,
died at .. Mindhrof Seft, 11 1885,
Disease or Cause of Death, - of
Ifile
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
me and Residence of Certifying Physician
A. I. foule
/
Date of Certificate,
Soft 15
1877
· 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 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. 15
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.
étemale
4. Color, t
5. Age, .
2 .... Years, ..... 4 Months, .... 3 Days.
6. Disease or [First or Primary
Cause of ? Secondary (if any)
Deatlı, By whom certified
7. Residence,
2 quince Spree-, 1
0
8. Place of Death,
9. Occupation, .
10. Place of Birth, . Bast Boston Mark
11. Name of Father, Thomas Q. dolmetor .
12. Name of Mother, Jane good raw Brunswick
13. Birthplace of Father, .
Prince Edwarde d'ex and 1
..........
14. Birthplace of Mother, .
15. Place of Interment,
Printnos com Cemetery in ..
single graves
Signature of Undertaker or other person making
the Return
winner Floyd
01
DATED at // itrop on Jekat 1505 1883.
* If a Married Woman or Widow.
t If other than white. (1.) African; (M.) Mulatto; (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
Del21/4",883 Henrietta E Bohnetón
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.
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