USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 14
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PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
France Winnie tokcroft Nintendo Winthrop Street, Mich 21" 1804.
Age, 48-7-9
Date and Place of Death,t - died at.
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, -
of Heart failure following
Preuzima 1
Twenty- six days
I certify that the above is true, to the Rest of my knowledge and belief.
Signature and Residence of Certifying Physician,
13 Van papers742
Date of Certificate,
Chelsea march 23, 189+x
* 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 lias 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 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 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 OF THE CAUSE OF DEATH.
Boston ,.
Mar.
21 cm 189
4
Name and age of deceased : .
Age ..... yrs. .mos. dys.
Date and place of death :
Found in water lenültrop Mar. 19her
Disease or cause of death : Sule Bom
..
Duration of disease :*
I certify that the above is truex to the best of my knowledge and belief.
Name and residence
of physician.
Urana. C A Harris
M. D. Med. Syauir
* It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting of permits for burial, as follows: - Saturdays, 9 A. M. till 2 P. M .; Sundays, 10 A. M. till 12 M .; Holidays, from 10 A. M. till 12 M .; other days, from 9 A. M. till 5 P. M.
¿
; is
me. ·rtli-
.
UNDERTAKER'S RETURN .- Boston.
Date of death,
TDch 21 " 1894
189.4- Name,
me,
Llileton Infant Sex, male
Maiden name,*
Married, single, or widow of
wife of
Color, W/ Age, (. years,
.mos., ... days. Residence,
Place of death ( street and ) ), number 1
Found in mater af Minttu vard
Place of birth,
Occupation,
Name of father,
Maiden name of mother,
irthplace of father,
Birthplace of mother, bemeleny
Place of interment,t
* If a married woman or a widow.
t Give the name of the burial ground.
Summer Floyd
Date of Certificate quel 22 "1894
Signature of Undertaker :
No.
Vommonwealth of &dlassnehuseits.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
binles Pharaohs fixe 2d
(Maiden Name), .
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Truelle
4. Color,t
5. Age, Years, ~ ~ Months, Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
Stranqueel plein
H'N Pinle
7. Residence, Thinktan
8. Occupation, .
9. Place of Death, .
Trasbringdir Chienne
10. Place of Birth,
11. Name of Father,
Clarence H. Pire
hathanne E. Claix
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
DATED at
A
, On Incl 50: 18/4
' If a Married Woman or Widow. { If a Soldier who served in the War of the Rebelhou. { 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.
12. Name of Mother, (Maiden Name),
Theland
Floyd
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Cha
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of dicd, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a ch immediately thereafter, or at the birth of a stillborn child, shall, when requested, fortliwith furnish for registration a cr stating to the best of his kuowledge and belief the fact that such a child died after birth or was born dead. If a physin lects or refuses to make a certificate as aforesaid, or makes a false statement thereiu, lie shall be punished by a fine not er fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall , the primary and the secondary or immediate cause of death as uearly as he can state the same. If a physician refuses or to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he residc 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 or town, from the city or town clerk. No such permit shall be issued uutil there has been delivered to such board, or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be reture recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, o! thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending pr 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 certific: required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make th When such satisfactory statement and certificate are delivered to the board of health orto its agent, the board or agent sha with conntersign 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 death. 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.
same and Age of Deceased,*
Thomash vete 2d
Age, 1 Hour
rø and Place of Death,t -
died at.
or Cause of Death, - (Primary and Secondary.)} L'uration of Sickness, -
of
r trajo (Washington (ve) March 30,8g 4. Strangulation
r 1 1
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 31
1894.
!
Sex of Infant (not namned). 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.
[ 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 lie 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 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 bury in a city or town or remove therefrom a human body until hie 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 sueh 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 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.
communwtiY ul gmassachusetts.
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 Ilusband) ,*
3. Sex, and whether single, Married, or Widowed,
1. Color,t
3. Age, 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. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker weather person making the Return.
DATED at
Ofere 2" 1894 Charlotte Chalencon Walthers Prouvée
03"18'4 10 June.
52 Years, 10
Months, ..
2 Days.
Thantheufo 2110
Julian Queel Practical @
mary real
Halicar 2.4.
-
3
18
.
* 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. ] l'late. 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 deathi 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 hu 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 cit: 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 an recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lie thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physicia cannot be obtained, for good and sufficient reasons, early enough for the purpose, tlic chairman of the board of health or a). 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 sam When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall fort 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 person violating any of the provisions of this section shall be punished by a fine not excee ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
ame and Age of Deceased,* ute and Place of Death, t.
COhurcolt 6 Mattheus
Age, 52-10-2
sease or Cause of Death, - (Primary and Secondary.) } ration of Sickness, - -
died at.
of
Pinturap (Putnam &t) apue 2 1894. Ulcer of Stomach Four weeks
I certify that the above is true, to the best of my knowledge and belief.
ature and Residence of Certifying Physician,
Harace I jinde 2 11 W/ 01
Sex of Infant (not named). If stillborn so state.
Date of Certificate,
189 4.
[ 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 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- leets 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 negleets to make such certificate he shall forfeit to the treasurer the sun 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 eity 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 elerk, 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 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.
No.
Commonwealth ot Strassachusetts.
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, 1
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, .
10. Place of Birth, .
Montow Mark
Oliver Dormeau
autu
12. Name of Mother, · (Maiden Name),
13. Birthplace of Father,. .
11. Birthplace of Mother, .
15. Place of Interment,
Force ster Ila, (tofu cennet
Signature of Undertaker chp other person making the Return, .
Summer Floyd
-
Il States of un.
Marea 0
DATED at
, Ol
Maril 3
189.4
* If a Married Woman or Widow. f Hf a Soldier who served in the War of the Rebellion. # If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] I'lale. Ed. May, 1893 .- 5,000.
aforil 2" Lathrop Dorma
189-1-
Male, "Married
Travied While
7 9 Years, 6 Months, ...... Days. Interstitial rights fine frans A.S.V. Dorman Ilf.h.
Retired Merchant
Arcticop Socut It Mars
11. Name of Father,
[ 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 canse 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 sumn 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 o clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned an recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in liel thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physicia cannot be obtained, for good and sufficient reasons, early 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 and certificate are delivered to the board of health or to its agent, the board or agent shall fortl 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 canse of the death, as tl clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceer ing fifty dollars.
1
PHYSICIAN'S CERTIFICATE.
be
Latte of Normand
Age 7 9
6.20
ng Tame and Age of Deceased,* ate, ling! hoth'ate and Place of Death,t - lects, til hesease or Cause of Death, - (Primary und Secondary.)}
died at
J
189 2%.
Bitte interstitial cheze
officer.
ent or ed and vation of Sickness, -
-
hrsiciare or any cate as ig
he same iture and Residence of Certifying Physician,
Accueil It. Norman Mentrots/1000
all forthi
so giren ith, as the ot exceed
Date of Certificate, april 2 1892 .
Sex of Infant (not nained). 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.
of Nive grans
I certify that the above is true, to the best of my knowledge and belief.
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