USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 22
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Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
16" 1894
2. Name,
(Maiden Name),* .
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color,t
3. Age,
Years,
Months,
Days
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
7. Residenec, · .
8. Occupation, . .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father, "helia)
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
13. Place of Interment,
Signature of Undertaker another person making
the Return
DATED at
Ministrofo
, on
Nov 1/2 189.4
* 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, spceify what.
[Be very particular to fill all Blanks. ] Plate. Ed. May, 1893 .- 5,000.
5 Horas
An alt+370
Millian B. Imitt Edith.
Roud
[ 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 regi tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which 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 dyir immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificat 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 exceedi fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, 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 neglec 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 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 ci 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 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 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 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 whoin 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 deatlı, as t clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exced ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Verlie Finish
Age, , 5 Haus
Date and Place of Death, t - died at ..
Winthrop0 (Revere Rivel) Nov.16/1894.
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, - -
of Premature infant ... Died a few hours after birth. .....
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
Albert Do. Dorman, M. D.
Date of Certificate, ate, Nov. 18Th
1894.
* Or Sex of lufant (not nanied). If stillborn so state.
[ If child died immediately after birth so state.
If a soldier or sailor who served in the War of the Rebellion
Plate. Ed. May, 1893. - 5,000.
[ 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 ean 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 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 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 facts 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 lien 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, carly 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 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 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.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston a/r 24 th 189 54
Name and age of deceased :.. Mary D. Muchas
Age 83 yrs. 8 mos .. .. dys.
Date and place of death : Nov. 24 th, 1894, Barttelt Road Writtenonthe Coulis
Disease or cause of death :
Duration of disease :* Three necles
I certify that the above is true, to the best of my knowledge and belief.
Name and residence of physician. fruittuer 2%.
Autori 111/a22. M. D
* It is very desirable to be informed of the duration of the disease.
ficala 125
UNDERTAKER'S RETURN .- Boston.
Date of death,
Nov, 24 1994 Name, Mary Sophia Muchow
Maiden name,*
mary e Barrett.
Sex, FF
Married, single, or widow of Peter Truckau wife of
Color, W, Age, 83 years, 8 mos., days. Residence, Bartlett Road, Weiltirar
Place of death (street and) , Bartlett Road, Winthrop Centre
Place of birth, Chambly Canada. Occupation, ..
Name of father, John Barrett.
Maiden name of mother,
Soplica Twott
Birthplace of father,
, Spain
Birthplace of mother, ..
France
Place of interment,t
"Italy Grass" walden
* If a married woman or a widow. t Give the name of the burial ground.
Signature of Undertaker :
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
,24"1894
2. Name,
(Maiden Name),
·
(Name of Husband),*
3. Sex, and whether single,
Married, or Widowed,
male
4
4. Color, t
5. Age,
3
Years, ..
11
Months,
Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Siekness, . By whom certified, ·
21
Plicil
7. Residence,
.
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
.......
oun
13. Birthplace of Father, ·
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . -
/
DATED at
on
1
18
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion. -
t If other thau White. (M.) Mulatto, (I.) Indian. If of other Races, specify what,
[Be very particular to fill all Blanks.] Plate. Ed. Nov. 1890-5,000.
12. Name of Mother,
(Maiden Name).
novelle own
[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 Public 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, and the date of his decease. If a physician neglects or refuscs 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 has 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 lien 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 samc 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 exceeding fifty dollars. [Approved May 4, 1888
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Raymond A. Daniels
Age, 3-11-4
Date and Place of Death,t - died at. Montant Shirley ET Mor 29' 1894.
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, - 1
of .. Laryngeal Diffituria
Fine day
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, Albert 13. Domman A.S.
Date of Certificate, Nr. 30 Th
189 8
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 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 deccase; 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 fiue notexceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall givc botli 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 healthi 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 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.
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,
Disease or Cause of Death, (Primary and Secondary), #
U. 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,
Summer Floyd
DATED at
Dan13
189.5
* li a Married Woman or Widow. { If a Soldier who served ia the War of the liebelilou.
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.
-
Perkins At Winthrop
Minthaof Beach
Monthrah Beach Hamilton Re Danclass Angelina Faylar P. S. Island
P. S. Berland Winthrop dass
Signature of Undertaker or other person making the Return,
Jan 12 1895 Henry Reay Douglas
16
... Years, Months, 1 2 Days.
weeks
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter :
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for 1. tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of whic died, the duration of his last siekness, 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 certifi stating to the best of his knowledge and belief the fact that such a child died after birthi oriwas born dead. If a physician leets or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exeet fifty dollars. In case the deceased ¿vas 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 ean 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 whieli he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body unt 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 elerk. No such permit shall be issued until there has been delivered to such board, or agel clerk, as the ease may be, a satisfactory written statement containing the faets 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 phys cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or physician employed by a city or town for the purpose shall, upon request of said board, agent or elerk, make such certifieate required of the attending physician ; and in ease of death by violence the medical examiner shall, if requested, make the s: When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall fc with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so g shall thereafter furnish for registration any other information as to the deceased or to the manner and eause of the deatlı, as elerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fine not exe ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Henry Ray Douglass
Age, 9 mas. 12 days
Date and Place of Death,t - died at Winthro Mars, Jan.
19Th 1895.
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, -
-
Tubercular Meningitis
of thorch two weeks
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,.
Albert 19. Soman M.D.
Date of Certificate, Jan. 15th
1895 .
Pr Sex of Infant (not named). If stillborn so state.
[ Ii child died immediately after birth so state.
# If a soldier or sailor who served in the War of the Rebellion.
Plate. Ed. May, 1893. - 5,000.
[ 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 hls 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 death. 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 sueli 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 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 fortli- 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,
.
(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 Siekness, . 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 or other person-making the Return, .
1
DATED at , on
7,4
18 9
* 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.
23/195
Millian Ort, necheren
Sicela
incite
67 Years, A Months, Am Days. -
Chathar SIM . .
Contai
[ 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 regi: tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which h 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 dyir immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificat 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 exceediz fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give bot !. the primary and the secondary or immediate eanse 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.
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