USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 18
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PHYSICIAN'S CERTIFICATE.
38-11-5 -
"ame and Age of Deceased,*
Date and Place of Death, t -
Siecase or Cause of Death, - { Primary and Secondary.)} Duration of Sickness, - 1
of
Mycia!
-
Dastutis chenne
Saugpul ky
Three years.
I certify that the above is true, to the best of my knowledge and belief.
EBotón
Signature and Residence of Certifying Physician,
Date of Certificate,
189
* Or 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.
1894.
-
1
Camille
Age,
Lat Winthrop July 23.
[ 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 (lied, the duration of his last sickness, and the date of his deeease; 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 ehild died after birth or was born dead. If a physician neg- lects or refuses to make a certifleate 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 eause of death as nearly as he ean 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 eity 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 sneh city or town, from the eity 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 faets required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by seetion three of this chapter, or in licu thereof a certifieate 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 elerk, make sueli certifieate as is required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When sueli satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with eountersign and transmit the same to the elerk 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 eause 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,
(Maiden Name),*
.
(Name of Husband),
3. Sex, and whether single, Married, or Widowed,
married
1. Color,t
5. Age,
74 Years,
1
Months,.
J Days.
Disease or Cause of Death, (Primary and Secondary), #
La Harman
7. Residence,
.
1
Real Estate
8. Occupation, .
9. Place of Death, .
Buchanan Cheel
10. Place of Birth, .
Williameling (mass) Milliano
11. Name of Father,
Farah Hunt Chiang
12. Name of Mother, · (Maiden Name),
Williamsburg makes
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. l'lace of Interment,
11
Signature of Undertaker weather werven making the Return,
Dumper
Floyd
DATED at Bientrop, on
uly 20.189.4
* 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.
[Bo very particular to fill all Blanks.] Plate. Ed. May, 1893 .- 5,000.
6. {Duration of Sickness, . By whom certified, .
prale
[Public Statutes, Chapter 32, as amended by Acts of 1888, 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 regi‹ tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which li (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 dy ?- immediately thereafter, or at the birth of a stillborn child, shall, when requested, fortliwith furnish for registration a certifi 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 lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceed fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give } the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neg . 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 thercfrom 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 C. 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 physici. cannot be obtained, for good and sufficient reasons, early enough for the purpose, the 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 sar 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 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.
e and Age of Deceased,*
Fand Place of Death, t -
Joseph & Snow died at.
74-1-5 Age,
Minttuate (Buchanan el al) 89 4).
Hease or Cause of Death, - Ff (Primary and Secondary.) } ration of Sickness, -
of . Cyclo- nephritis
Diease
of Kidneys
Probably Some months. Satteusted him 5 days
: [
I certify that the above is true, to the best of my knowledge and belief.
Ahilure and Residence of Certifying Physician, ..
Albert B. Dornan, M. D.
Winthrop Mach.
Date of Certificate,
July 31
189 .
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 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 buy 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 duy 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 licreinafter provided. If there is no atter ding 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 vio,ence the medical examiner shall, if requested, make the same. When snch 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.
Leng 2 1894
1. Date of Death, .
2. Name,
.
Grotte Cuan Lec
0
(Maiden Name),* .
(Name of Husband),*
3. Sex, and whether single,
Married, or Widowed,
phil
4. Color, t
5. Age,
Sears
7
Months,
Days.
Disease or Cause of Death, (Primary and Secondary), #
In Anace of Loule
/
7. Residenee,
8. Occupation, . .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Harn Stewart Le
Sarah Ella Crasin
12. Name of Mother, . (Maiden Name), Wilford Maine
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
.. ..
Floyd
DATED at
Minttuals
, on 189.4
* 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.] Plate. Ed. Nov. 1890-5,000.
Petilburg N.H.
Winthrop, Ammeter Summer-
27
6. Duration of Sickness, . (By whom certified, ·
[ACTS OF 1888, CHAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Publie Statutes, requiring attending physicians to furnish for registration certain facts relating to deceased persons, is amended so as to read as follows :- 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, his age, the disease of which he died, the duration of his last sickness, aud the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be pun- ished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur- nished, is amended so as to read as follows : - 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 lias been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment 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 de- livered to the board of health or to its agent, the board or agent shall forthwith 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. [Approved May 4, 1888.
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, i
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, .
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 at other person making the Return, ..
- Venner Hard
DATED at
, On
Queprale 5" 1894
* li 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.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1893 .- 5,000.
August 44, 1894 Mary Leary ...... Mary Lawless Cornelius Leary. Fremale- Charrier widowed white 7 Years .... Months, ... Days.
Cholera Mortis DN& Ht Durgun Dorchester, mass
Hanshrop, Shark Ireland.
Romas Lawless Dillon mary xaile
Ireland
Ireland,
Calvary Cemetery
[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, forthiwith 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 notcxeeeding 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 eause 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 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 thercof 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 tlie attending physician ; and in ease of death by violence the medical examiner shall, if requested, make the same. Wlien such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with eountersign 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 elerk 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.
ne and Age of Deceased,* e and Place of Death, t - died at.
Mary Leary wruttrots aug 3 189 4.
71-5 Age,
case or Cause of Death, - (Primary and Secondary.) } ration of Sickness,
of ..
Cholera Morbus Que wick with relapse
I certify that the above is true, to the best of my knowledge and belief.
S. A. Drivgino VA.
ature and Residence of Certifying Physician,
Date of Certificate,
4
189 4.
Sex of Infant (not namco). 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 he died, the duration of his last siekness, and the date of his deeease; 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 ncg- 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 eity or town or remove thercfrom 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 elerk, 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 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 punislicd by a fine not exceed- ing fifty dollars.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
.
(Maiden Name),*
Calderwood
a I Multico
Female
Married Philé
56
cars, ...
4
Years,
Months,
22 Days.
5. Age,
Disease or Cause of Death, (Primary and Secondary), ;
6. ¿ Duration of Sickness, . (By whom certified, .
Faittrop mais
7. Residence, .
8. Occupation, .
9. Place of Death, . .
10. Place of Birth, . .
11. Name of Father, ·
Unvertuville Central(me) Jour Cúdia
12. Name of Mother, (Maiden Name), 13. Birthplace of Father, . Quierenville Centre me 11. Birthplace of Mother, . Beaumont me, Hyde Park Cemetery
15. Place of Interment,
Signature of Undertaker wother person making the Return, .
Summer etlojd
DATED at
the ilTop
, Ou
aug 16" 189.4
* 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.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1893 .- 5,000.
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
1. Color, t
Ouguale 15"1894
111 thnot Street
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 300 ; Acts of 1880, Chapter 224 ; Acts of 1993, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certifieate 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 siekness, and the date of his deecase; 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 ehild died after birth or was born dead. If a physician neg- leets or refuses to make a certifieate 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 eause of death as nearly as lie ean state the saine. If a physician refuses or negleets to make such certificate lie shall forfeit to the treasurer the sun of ten dollars for the use of the town in which he resides.
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