USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1853-1885 > Part 9
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In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must FORTHWITH GIVE NOTICE thereof -or report these facts -to said Clerk. Penalty for neglect, twenty dollars.
Blank forms for Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,* - Henrietta
Henrietta E. fonction?
Date and Place of Death,
died at Hi thereof fel 1 14,
Disease or Cause of Death, -
1875 of I fhtleritie Gerely Duration of Sickness
W
.... ..
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
He
foulé Michsehr
* Or Sex of Infant (not named).
Date of Certificate, ertificate, tel + f
187
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),
DieA 28 " , 883 Arthur L. Belcher
3. Sex, and whether single. Married, or Widowed,
4. Color, t
male while
Years ..... 2 Mouths, .. 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, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, 6mma /Spichler
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker other person making the Return,? .
1 Summer 1 Floyd
DATED at the Chicote
on
il 21ch
188 3.
* If a Married Woman or Widowy
t If other than white. (A.) African; (M.) Mulatto; (1.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
with Cu
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 FORTHIWITH GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for negleet, 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,
arthur D. Welcher
Date and Place of Death, .
Sept 281883 Wintherch.
Disease, sr Cause of Death,
First or Primary,
Cholera Infactura
Duration of,*
Secondary, . ·
Juanition
Duration of, 17 class
I certify that the above is a true Return, to the best of my recollection and belief.
Vame, Professional Title, and Residence,
Dated at Wine Marche Sefit 29the 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 disease of which the person died, and the date of his decease, as nearly as he can state the same .- [ EXTRACT FROM CHAPTER 21 OF THE GENERAL STATUTES, 1859.]
The attending Physician is requested to make out his Certifieate as promptly as possible, for the information and use of the Undertaker, or other person making return of the 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.
Pleasant Street mary L. Smith Employed as servant, in the & Baht, It 13. border.
2
1. Date of Death, 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. 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, .
LA 15. Place of Interment,
60 England England Hetfield Mask
Signature of Undertaker another person making the Return,
Summer Of loyd
DATED at. Minitrope ... ,
on ... Dec 18"1883 To
* 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.]
¿for more of smith see margin at left-
Dec 18 "1883 mary & Smith
Cemale (Unmarried)
While.
23 Years, .....
Months, ..
...
Days.
Diptheria
Pleasant St. Monitoro iPleasant St, Minitrope House Servant Hetfield Frase
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 dceeased 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.
Printing Department, Deer Island, Boston Harbor.
Boston, Dec. 18th 1883 Mars De Smith
This Certifies, That
died on the 18 Th day of Dec. 1883, aged 23 years, months, days.
Difturia
CAUSE OF) Primary, DEATII. Secondary, Paralysis Duration
Duration /2 days
Physician.
E. B. Robinson
NO.F. V.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),
Hinmary 2y",88% Sarah Belcher
3. Sex, and whether single. Married, or Widowed.
Female
While
4. Color, t
5. Age, .
6. Disease or First or Primary
Cause of { Secondary (if any)
Death, {By whom certified
7. Residence,
main Street Minuti0
8. Place of Death,
9. Occupation, .
Main Street >tinet
10. Place of Birth, . Main Street Unitario 11. Name of Father, Salut Delelien annie Welcher 12. Name of Mother, JockKRoll Onva Scalia
13. Birthplace of Father, .
14. Birthplace of Mother, .
Offence 6 Amvan de land 1
15. Place of Interment, Minttrofe vom Cemetery
Signature of Undertaker
or other person making @univer cloud
the Return,
DATED at ....
, on January 2898 4.
* 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.]
nfant
Months, . .Q ..... Days.
The Tuder @her, or other informant, is requested to report the facts-together with the Physician's Certificate of the C ises of Death -to the Town Clerk, BEFORE THE INTERMENT.
In ease of n inmer nt taking place, without the Certificate of Registry of the Clerk of the Town in which the Death oc urred (or the deceased resided) having first been obtained, the person having charge of such In rir Ant must FORTHWITH GIVE NOTICE thereof - or report these facts -to said Clerk. Penalty for negle , Anty dollars.
Blank fornuft- Returns of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,* -
Date and Place of Death, - died atfaz2. 21
ffier Barn
Duration of Sickness
Disease or Cause of Death, - of
I certify that the above is true, to the best of my knowledge and belief.
N
Name and Residence of Certifying Physician
Date of Certificate, .n
ate, fen 28
187
4
* Or Sex of Infant (not named).
12 cce Cc
thereh 187 4
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 performning 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 «liscase, 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. 1
www vi massachusetts.
,
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),*
February 28",8817 Abigail Jealfield abbrail CAndrews
3. Sex, and whether single. Married, or Widowed.
éFemale
4. Color, ¡
5. Age,
6. Disease or [ First or Primary
Cause of { Secondary (if any)
Death, 1 By whom certified
-
@tremont St, Winthrop Fremont St. Minthraje
7. Residence, ·
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
60 Desex mars Even andrewa
11. Name of Father,
12. Name of Mother, Susannah andrews
13. Birthplace of Father, .
14. Birthplace of Mother, . Geset Mare Kewich Dass 15. Place of Interment,
Signature of Undertaker on other person making the Return,
Summer Glaude
DATED at.( ............ 1 Winthrop
188
* If a Married Woman or Widow.
t If other than white. (A.) African; (M.) Mulatto; (I ) Indian. H of other Races, specify what. [Be very particular to fill all Blanks.]
While
63 Years, Months -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 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,* -
Date and Place of Death, - died at U 2 Ahref, Fick 28 1894
Disease or Cause of Death, -
of Lulars ment of Heart Duration of Sickness
1
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician
Date of Certificate, bet 29
1884.
* 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 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 rcturned 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. 2
in vi zmassachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Namc,
(Maiden Name),
quel2 21.1884 Jessie Q. Chercher
3. Sex, and whether single. Married, or Widowed.
Female
4. Color, t
. 5. Age,
Years, 14/
Mouths, .
Days.
6. Disease or First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence, ·
8. Place of Death,
9. Occupation, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, ), x " fil -
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, rituof, Jon (4,2 lorry
Signature of Undertaker or other person making the Return,
DATED at.
rith2+10 ,
on Tuch "22" 18/1
* 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.]
Minitrope. 1
Schreef
JE sland
1
Corte 21 . 84
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,
2. Name,
(Maiden Name),' HIill
3. Sex, and whether single. Married, or Widowed.
4. Color, t
5. Age,
Years,
... Y .. Months, 1 Days.
6. Discase 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,
DATED at
, on 1 187
* 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.]
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 THIE INTERMENT.
In case of an interment taking place, without the Certificate of Registry of the Clerk of the Town in which the Death occurred (or the deceased resided) having first been obtained, the person having charge of such Interment must 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,* -
Date and Place of Death, -
died at 11 Abrufe three 93
187
4,
Disease or Cause of Death, - of
Duration of Sickness.
I certify that the above is true, to the best of my knowledge and belief.
ame and Residence of Certifying Physician He f. foule N
Date of Certificate, . April 10c 187,4
* 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. 3
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),
Steril >". 88+ Francie Of /Excluir
3. Sex, and whether single. Married, or Widowed.
C mare
4. Color, t
52 Years
8
Mouths,
Days.
6. Discase or First or Primary
Cause of Secondary (if any)
Death, By whom certified 2. Pincho e Di Vinstivo o 1 .
8. Place of Death,
9. Occupation, . Mille Derer
10. Place of Birth, .
11. Name of Father, Sanmel E leter 2 at
12. Name of Mother, ....
13. Birthplace of Father, . ·
Ti-122 -
14. Birthplace of Mother, .
15. Place of Interment, A Coin Que erv 1 - Minstios
Signature of Undertaker or other pers person making the Return,
1 1
Donner + condu
UpM.T
DATED at ................
X 1
.. , on LEVie 8
188 1
* If a Married Woman or Widow.
t If othor than white. (A.) African; (M.) Mulatto; (I ) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.]
5. Age, .
7. Residence, .
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 Returus of Deaths may be obtained from the Town Clerk.
PHYSICIAN'S CERTIFICATE.
Name of Deceased,*
Date and Place of Death,
died at It's Ihren, April 1)
Disease or Cause of Death, - of teffening of Brain Duration of Sickness. 2 0% 1h
I certify that the above is true, to the best of my knowledge and belief.
ame and Residence of Certifying Physician Ho, f. to a' Mct Hl : thisof
Date of Certificate, April 1
187 7
* 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.
No. 2/
wwwwvuwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
U
1. Date of Death,
2. Name,
.
3. Sex, and whether single. Married, or Widowed,
4. Color, t
5. Age, .
.... Years, ..... Months, . ... Days.
6. Discase or ( First or Primary
Cause of { Secondary (if any)
Death, By whom certified
7. Residence, 11
8. Place of Death,
1 th nx
)
9. Occupation, .
10. Place of Birth, . 10rxfine.
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Per Therok 11 tvr
Signature of Undertaker or other person making the Return,
1
DATED at
,
on
gruany 200
188
1!
* 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.]
(Maiden Name),*
sivile
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 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 FORTIWITH 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.
me and Sex of Deceased, . Date and Place of Death, . ·
Mrs. Jane B. Morze.
May Int. 1884.
Monthsof Mars.
Disease, - First or Primary,
r Cause
Death,
Secondary, . ·
Pusemia
Duration of,*
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