USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 11
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SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he · has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and . recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in licu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
Vo.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Apaula 24/692
2. Name, .
(Maiden Name),*
(Name of Husband),
3. Sex, and whether single, Married, or Widowed,
1. Color, t
5. Age, 2 Years, Montlis, Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
.
7. Residence,
.
8. Occupation, .
9. Place of Death, .
10. Place of Birth, . 11
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father,
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker other person making the Return, . .
€
DATED at
, OIL 18
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
f If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] l'late. Ed. September, 1892 .- 5,000.
1
₱
[ Public Statutes, Chapter 32, as amended by .1cts of 1853, Chapter 305; Acts of 1839, Chapter 224.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, liis age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate ås is required of thc attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall fortewith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars.
0/01
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Ruth Emma Wyman
Açe, 2)The $ de
Date and Place of Death,t -
died at Winthrop Charles Street) Dee 24 1893;
Disease or Cause of Death, - (Primary and Secondary.) Duration of Sickness,
of Peritonitis
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, Gorace y Joale MMY Dicultivas U ....
Date of Certificate,
189 7 .
Or Sex of Infant (not named). If stillborn so state.
¡ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
# If a soldier or sailor who served in the War of the Rebellion .
yblic Statutes, Chapter 32. as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he (lied, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child clied after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he ean state the same. If a physician refnses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk., No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the ease may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a eity or town' for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health orto its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any, person violating any of the provisions of this section shall be punished by a fine not creeed- ing fifty dollars.
To the Clerk of the Town in which the Deat
occurred.
1. Date of Death, .
2. Name,
8,00
(Maiden Name), *
(Name of Husband) ,
3. Sex, and whether single, Married, or Widowed,
1. Color, t
5. Age,
.Years, ......
Months,
9 Days.
Disease or Cause of Death, (Primary and Secondary), # 1
6. Duration of Sickness, . By whom certified, ·
7. Residence, .
8. Occupation, . .
9. Place of Death, . .
10. Place of Birth, . .
11. Name of Father, .
12. Name of Mother, · (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker W ather premen making the Return, .
-
1
DATED at
, on
18
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
! It other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Bo very particular to fill all Blanks. ] Plate. Ed. May, 1895 .- 5,000.
r
·
lo ficios
Chefer
×
!
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 300 ; Acts of 1889, Chapter 224; Acts of 1893, Chapte
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disc died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a cer stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physici lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not ex fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall gi the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or n to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides. SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in su or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or a clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be return recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending pl. cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certifica required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent slial with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is s shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the deatlı. clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Sally T. Gland
Age,
79 -4-19
Date and Place of Death, t - died at.
Prothrop Locust Sweet Dee 28 1895
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, -
of Interencent of the Heart Um year
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
Date of Certificate, Leczyc
189º
* Or Sex of Infant (not named). If stillborn so state.
t If child died immediately after birth so state. Plate. Ed. May) 1893. - 5,000.
{ If a soldier or sailor who served in the War of the Rebellion .
Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 300 ; Acts of 1889, Chapter 221; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deecased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and aphysician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when reghested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negleets to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall buffy in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health In such city or town, from the city or town elerk. No such permit shall be issued until there has been delivered to sueh board, or agent or clerk, as the ease may be, a satisfactory written statein nt containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no at rolling physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enou. 4 for the purpose, the chairman of the board of health or any physician employed by a eity or town for the purpose shall upor faquest of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by vie dice the medical examiner shall, if requested, make the same, When snch satisfactory statement and certificate are delly "e l t he bo ird of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar
Ar registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the leeeased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Ofrederia Wentworth
Age, 142-29do
Date and Place of Death, t -
Winthrop( WoodsideQue) Jan 6" 1804. died at
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, -
of
utricular Merciunités
Eforturidays
I certify that the above true, to the best of my knowledge and belief. N.a Mornson 80 Princeton &1-8 2
Signature and Residence of Certifying Physician, .......
Date of Certificate, Jan 8 1894
* Or Sex of Infant (not nan:ed). If stillborn so state.
[ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
# If a soldier or sailor who served in the War of the Rebelhon.
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. . If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if 'he certificate of the attending physician cannot be obtained, for good and suficient reasons, early enough for the purpose, the cha' man of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall fortli- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the perinit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
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),
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t
5. Age, Years, 2 Months 8 Days.
Disease or Cause of Death, (Primary and Secondary), }
6. Duration of Sickness, . By whom certified, ·
7. Residence, .
8. Occupation, . · ·
9. Place of Death, .
10. Place of Birth, . Minhmp (Film Che)
11. Name of Father,
12. Name of Mother, . (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
4
Ferrero
-
L
DATED at , on
18
blic Statutes, Chapter 32, as amended by Acts of 1888, Chapter 300 ; Acts of 1880, Chapter 221; Acts of 1893, Chapter2
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish fore ion, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of w.c I, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child icdiately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a cer ing to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physici: s or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exce. dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall giyb primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or nole hake such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides. SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body uilil . received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in sur cit own, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agit 01 k, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and rded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or i licu eof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending phy cian not be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health cany sician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificates is tired of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the me en such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall firth- i countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so 1 thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, a the k or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exted- fifty dollars.
ven
PHYSICIAN'S CERTIFICATE.
, and Age of Deceased,*
and Place of Death, t - died at. . . El avenue, forming 16th
Age, .
18911.
sase or Cause of Death, - (Primary and Secondary.)} aration of Sickness, -
of Labio Mesentérica
2 20 8 do
I certify that the above is true, to the best of my knowledge and belief.
Horace & Souli M
gnature and Residence of Certifying Physician, ....
Date of Certificate,
Jan 174
189 4.
Or Sex of Infant (not named). If stillborn so state.
If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
If a soldier or sailor who served in the War of the Rebellion.
i Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263. ]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- Iccts or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate canse of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he sliall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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