USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1886-1892 > Part 4
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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),'
150 année 6 (30)
3. Sex, and whether single. Married, or Widowed,
4. Color, t
5. Age, .
Years, ... 7 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, . ManTheolo res 11. Name of Father, Zutphen /2010
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, .
1.0021
16
188
DATED at.
on ...
* 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.]
98 Opland
Ators
Mara
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 Deceased,* - ud Place of Death, -
Annie & Boylan
died at Withref Aug. 15 .-
1886,
or Cause of Death, - of Chalenge Infante Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
Residence of Certifying Physician ..
Date of Certificate, tres 15-c
1886
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 person-forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the person died, 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 Reg of Vital Statistics," passed April 23, 1878, provides that "no human body shall be buried, or removed from any city or towi proper Certificate has been given by the clerk or local registrar of statistics, to the Undertaker or Sexton, or person perform burial or removing the body. This certificate shall state that the facts required by chap. 21 of the General Statutes ha returned and recorded; and no clerk or local registrar shall give such certificate or burial permit until the Certificate of the C Death has been obtained, (from the Physician, if any, in attendance at the last sickness of the deceased), and placed in the hands 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 whe certificate of the attending Physician cannot, for good and sufficient reasons, be early enough obtained, the chairman of the local B Health, or any Physician employed by any city or town for such purpose, shall sign the Certificate of the Cause of Death, to the his knowledge and belief. In case of death by violence, the medical examiner shall furnish the certificate.
1
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, ·
2. Name, . (Maiden Name),
(legg 12/ 16" 1886 Chene Read
3. Sex, and whether single, Married, or Widowed,
1. Color, t .
5. Age,
X Years, ...
Months, ..
Days.
Disease or Cause of Death, 6. Duration of Sickness, ·
By whom certified,
7. Residence, .
Bratão 122022
8. Place of Death, .
P.S. Home ) Vintrop
9. Occupation,
10. Place of Birth,
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father,
Pentru 9 Har0
14. Birthplace of Mother,
15. Place of Interment, .
Signature of Undertaker or other person making the Return, .
cf
DATED at
Thithu
.. ..... ,
on
Eling 17
c.
18 FL
* If a Married Woman or Widow. + 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 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 o 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 deat to the best of his knowledge and belicf, 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 fo good and sufficient reasons be early enough obtaincd. In case of death by violence, the medical examiner attending shall furnish the requisite medical certificatc. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-five dollars.
PHYSICIAN'S CERTIFICATE.
Deco
eased,* -
dict at Sea Show Home Northrop, Mas. In. ..
188 4.
ce of Death,
use of Death, - \ of Harasimo Duration of Sickness
3 months
I certify that the above is true to the best of my knowledge and belief.
R. M. Suene
ence of Certifying Physician,
Date of Certificate, aug 16 188 6
ex 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 aft of such person, forthwith furnish for registration a certificate of the duration of the last sickness, the discase of which the and the date of his decease, as nearly as he can state the same. If a physician refuses or neglects to make such certif 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 or registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall facts required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or buria the certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the e placed in the hands of said clerk or registrar; and in cities and towns where there are boards of health, the certificate of (leath shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, of the board of health, or any physician employed by any city or town for such purpose, shall sign the certificate of the ca to the best of his knowledge and belief, if there has been no physician in attendance. He shall also sign such certificate, tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physici. good and sufficient reasons be early enough obtained. In case of death by violence, the medical examiner attending sha requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty
6
MA
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, (Maiden Name),*
@ Aug. 9,00 JeJames lo Didas
3. Sex, and whether single. Married, or Widowed,
Mali
ingly
4. Color, t ·
5. Age, .
15
Years, ....
6
Months,.
Days.
6. Disease or ( First or Primary
Cause of ‹ Secondary (if any)
Death, By whom certified
7. Residence,
8. Place of Death,
Great Ilead ! !
9. Occupation, .
10. Place of Birth, . Nutfuld Mais.
11. Name of Father,
12. Name of Mother, Sarah 8. Indurre
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, 11 11.
Signature of Undertaker or other person making the Return,
M.O. Brown
DATED at ..
on
Aug, 20
1886.
* 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.]
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.
1886
Boston, L 1 Chis Certifica, That James . Dodge day of Aug. 1886, aged 15 years,
died on the 9 6
months.
days.
CAUSE OF Typhoid Fever. Primary,
Duration
DEATH. Secondary,
Duration
Who formy the Pricing
4 Cop
*
Rockwell & Churchill, City Printers, 39 Arch Street, Boston.
0
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
auquel 20 ",886. Mary E Hodges
(Maiden Name),*
3. Sex, and whether single. Married, or Widowed,
Ifidon
9thite
4. Color, t
5. Age, .
47 Years, 2
... Months,. Days.
6. Disease or [ First or Primary
Cause of Secondary (if any)
Death, By whom certified
7. Residence,
8. Place of Death,
Jodoin Street
9. Occupation, . Otouxer Véefter 1
10. Place of Birth, .
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Exeter. Stordkan Dadlerij
Signature of Undertaker or other person making the Return,
Duvivier J troud
DATED at /16' , on
188
21
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.]
Lice each questiis not filled
1 ifeed tory her sister amanda a Magie- Japon Misen.
.
Viaturaja
0:
2 ..
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.
V
0
200 9-6
PHYSICIAN'S CERTIFICATE.
me of Deceased,* -
e and Place of Death,
ase or Cause of Death,
of
died at Winthrop, august- 19,
18&C. Duration of Sickness 6 hours
I certify that the above is true, to the best of my knowledge and belief.
and Residence of Certifying Physician,
you. E. Medearthy Withich Muss. Date of Certificate, defit ! 1886.
*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 shal 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 cle or registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall state that th facts required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial permit un the 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 case 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-five doll
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
milion Eustis
(Maiden Name),*
3. Sex, and whether single, Married, or Widowed,
Grader
4. Color, t
5. Age, .
Years, ... 5 Months, 26 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, Charles Ri Quel
12. Name of Mother, Sarah a. Evetis
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return,
JEG. 10
-
DATED at -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.]
2
Lere 01222022 11
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 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.
1
7
1
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred
d. aug 3
1. Date of Death.
Menge Clark
2. Name,
(Maiden Name),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t .
Male White
5. Age,
Year Monthy, 29
Days.
Disease or Cause of Death,
6 ..
Duration of Sickness,
By whom certified,
7. Residence, .
Berlin mars
4
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, .
1122212 Flegel) Lekt 10"
DATED at
on
31 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.]
John Clark
Calis Marie
11
1) Jeikuagde/20211 De 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 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.
wased,* - - re of Death, - use of Death, - of Depending
Lenge Clank . cd at Sea Shore Ham, Winthrop, Maro. Any 3/186. 6 VOSSO
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
neuro
once of Certifying Physician,
188 6
Date of Certificate, cate,
ex 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 of such person, forthwith furnish for registration a certificate of the duration of the last sickness, the disease of which the and the date of his decease, as nearly as he can state the same. If a physician refuscs or neglects to make such certifica 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 or registrar to the undertaker, sexton, or other person performing the burial or removing the body. Such certificate shall st facts required by this chapter have been returned and recorded; and no clerk or registrar shall give such certificate or burial the certificate of the cause of death has been obtained from the physician, if any, in attendance at the last sickness of the d placed in the hands of said clerk or registrar; and in citics and towns where there are boards of health, the certificate of death shall also be approved by such board before a permit to bury is given by the registrar or clerk. Upon application, t of the board of health, or any physician employed by any city or town for such purpose, shall sign the certificate of the ca to the best of his knowledge and belief, if there has been no physician in attendance. He shall also sign such certificate, u tion, in case of death by dangerous contagious disease, or in any other event when the certificate of the attending physician good and sufficient reasons be early enough obtained. In case of death by violence, the medical cxaminer attending shall requisite medical certificate. Any person violating the provisions of this section shall be punished by fine not exceeding twenty-
NUTURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
Dejest 1et 1886 - Simon & Sem
(Maiden Name),
3. Sex, and whether single, Married, or Widowed,
male
4. Color, t .
5. Age,
40 ... 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 Father.
12. Name of Mother,
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment, . 1
Signature of Undertaker by other person making the Return, -
activez
DATED at
on
* 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-
1
5
2.30. Friday
[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 deecased, 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- non, 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.
Simor ame of Deceased,* ate and Place of Death, - died at Withrich Sel 11 usease or Cause of Death, - of lypheed Yther Duration of Sickness
188
I certify that the above is true, to the best of my knowledge and belief.
me and Residence of Certifying Physician, He. S. Berclient Winthrop
Date of Certificate, ficate, Sef 12>c 1884.
*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 eities 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 ease 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."
NO
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Date of Deatlı,
2. Name.
(Maiden Name),
1 Female
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