USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 12
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SECTION 5. No undertaker, sexton or other person shall bary 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 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 samc. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with conntersign 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 tlie 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.
.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
telling 14 " 1844 loturiled. F. Beers
2. Name,
(Maiden Name),? · (Name of Husband),*
(
3. Sex, and whether single, Married, or Widowed,
invaried
ithité
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
Typhoid Pneumonia 5 Days 1
I'M thron muss
7. Residence, . ·
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Charles Clinton Jeers
Nennetta Grace Beers
Derly Low
herby. Com
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker of allergeron making the Return, .
DATED at
1
February 14 181.4
* If a Married Woman or Widow. fifa 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.] Plate. Ed. May, 1893 .- 5,000.
55
.. ... Years, ..
2 Months, 15 Days.
v. {Duration of Sickness, . By whom certified, .
Pleasant Stred
Derberg, Como. @
12. Name of Mother, . (Maiden Name),
13. Birthplace of Father, ·
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 26.
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regu tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which dicd, the duration of his last sickness, and the date of his decease; aud a physician who has attended at a birth of a child dyi immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certifica stating to the best of his knowledge and belicf the fact that such a child dicd after birth or was born dead. If a physician ne lccts or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceedi fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebelliou, the physician shall give bo the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negledas to make such certificate lie 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 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 cl or towu, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned a recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in li thereof a certificate as herciuafter provided. If there is no attending physician, or if the certificate of the attending physic: cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or ale physician employed by a city or towu for the purpose shall, upon request of said board, agent or clerk, make such certificate as required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the sar When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall for with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so giv shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as 1 clerk or registrar may require. Any persou violating any of the provisions of this section shall be punished by a fine not exce iug fifty dollars.
PHYSICIAN'S CERTIFICATE.
me and Age of Deceased,*
Charles i Bare
te and Place of Death,t - died at.
ease or Cause of Death, - (Primary and Secondary.)} aration of Sickness, -
-
Age, 55-2-18 1. Minitrop (Pleasant PV.) Feb 14" 1894. of Pneumonitis - Heart failure
4 Days.
I certify that the above is true, to the best of my knowledge and belief.
Mature and Residence of Certifying Physician,
Albert B. Woman
M.D.
Nuitturn, massi
Date of Certificate, Fieber 66,
189 4.
Sex of Infant (not named). If stillborn so state. { If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
Į If a soldier or sailor who served in the War of the Rebellion.
A
[ Public 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 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 finc 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 lie 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 as is required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When snch satisfactory statement and certificate are delivered to the board of healthi 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
andrew full &
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t
5. Age,
Disease or Cause of Death, (Primary and Seeondary), ;
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, .
14. Birthplace of Mother, .
90
15. Place of Interment, ·
Signature of Undertaker ar ther pemer making the Return,
DATED at #2
, on
flere 18 189.4
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1893 .- 5,000.
68 .Years, ... 9 Months, 7 Days.
2. Farò (24x-6)
Jonneed VI-
[ Public 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 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 dicd after birth or was born dead. If a physician neg. lects or refuses to make a certificate as aforesaid, or makes a false statement thercin, 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 certificatc 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 o 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 liet thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of thic attending physician cannot be obtained, for good and sufficient reasons, carly enough for the purpose, the chairman of the board of health or an physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as i 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 ant 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 give shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as th 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,*
Andrew 7. Fr.
Age, 68-9-1
1
Date and Place of Death, t - died at. Winthrop Mass. Feb 17-1894. 2- Diabetes 2d Gangrene Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, - - of Three hears Marc
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, Boston
S. a.
Davis, Man.
Date of Certificate,
Feb. 19th
189 46.
{ If a soldier or sailor who served in the War of th : Rebellion.
Or Sex of Infant (not named). If stillborn so state.
[ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
[Public 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 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 lie 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 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 canse 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.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
.
2. Name,
.
20.0000 1
(Maiden Name), ·
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . (by whom certified, ·
1
That role 923000
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, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return,.
DATED at
1
., on
on Ma 13
* If a Married Woman or Widow. "{ If a Soldier who served in the. War of the Rebellion.
If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. {Re very particular to fill all Blanks.] Plate. Ed. May, 1893. - 5,000.
1
21000
-
FOR /201024
C
7
7
Years,
7
Months,
12
Days.
N
2 -
2.681
27-1-831
[Public Statutes, Chapter 32. as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 26
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for resf. tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of whiche died, the duration of his last sickness, and the date of his deceasc; and a physician who has attended at a birth of a child dy g immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certifica 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 ne. lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceed g fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give by the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglet 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.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until 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 ( or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned : recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in ] thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physic cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or :y physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the sait. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall for- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so gi shall thereafter furnish for registration any other information as to the deceased or to the manner and canse of the death, as clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exccl- ing fifty dollars.
1_
PHYSICIAN'S CERTIFICATE.
ame and Age of Deceased,* ate and Place of Death, t - died at.
Durch Newman Minitrop Centre Rt
Age,
77-7-12
mch 12180 4.
isease or Cause of Death, - (Primary and Secondary.)} uration of Sickness, -
of
I certify that the above is true, to the best of my knowledge and belief.
nature and Residence of Certifying Physician,
Date of Certificate, March
1 189 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.
[Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 300; Acts of 1889, Chapter 224 ; Acts of 1893, Chapter 203.]
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 the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early cnough 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 vivience 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 deccased 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.
No.
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, ¡
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . (By whom certified,
7. Residence,
8. Occupation, . .
9. Place of Death, . Street,
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, ·
11. Birthplace of Mother, .
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