USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 28
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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,
L. g ....
1804
5. Age,
25 Years,
8
Months,
23 Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . (By whom certified, .
Frenchand
7. Residenec, .
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Eliza 8, Rue
12. Name of Mother, (Maiden Name),
4.
13. Birthplace of Father, .
14. Birthplace of Mother,
15. Place of Interment,
Signature of Undertaker sendher-peram making the Return, .
Lord
DATED at
, on
18
* If a Married Woman or Widow. f Hl 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.
Selber 1"188.
4. Color, j
Dr Johnson
Lepe Candy
[Public Juntates, Chapter 32, as amended by Acts of 1988, Chapter 300 ; Acts of 1889, 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, à 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, fortliwith 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 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.
1
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Ida romina
Age, 25 8 23
Date and Place of Death,t - died at.
Disease or Cause of Death, - (Primary und Secondary.) } Duration of Sickness,
of
Irinaterap Maso July , 1895. Extra Utérine Pregnancy about four wuchs
I certify that the above is true, to the best of my knowledgeand belief.
Signature and Residence of Certifying Physician,
Date of Certificate, July 3
189 5.
* 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.
1 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 dicd, the duration of his last siekness, 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 execcding fifty dollars. In case the deceased was a sollier 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 sainc. 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 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 violenec 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 scetion shall be punished by a finc not exceed- ing fifty dollars.
1
No.
Commontucatth 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),*
male
Married White
36
Years,
.Months, ..
Days.
Med of Fa. Stanis
7. Residence, .
8. Occupation, .
9. Place of Death, .
Laborer Stillede Minitrop, Marchalest Sewer Queland
10. Place of Birth, .
11. Name of Father, .
michael
12. Name of Mother, . . (Maiden Name),
Ireland)
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker other person making the Return, .
6 ummer Floyd)
DATED at
Stinttrop
July 1et 189/5
* 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.] I'late." Ed. May, 1805. - 5,000.
July 1" 1895 John Doyle
3. Sex, and whether single, Married, or Widowed,
1. Color,i
5. Age,
Disease or Cause of Death, (Primary and Secondary), # 6. {Duration of Sickness, . By whom certified, .
Waltham Mass
Preland
Calvary Quemelin Waltham
[Public Statutes, Chapter 32, as amended by Acts of ISS8, 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, liis 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, fortliwith 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 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.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Whittierof
July 1. 1895
of Deceased,*
f Deceased,
John Doyle aged. 40
360(r) Relevi)
ind Place of Death,
years, months, days, died at Winthrop July 12 1895
se or Cause of Death
tion of Sickness,
of Internal inquiries und possible suffocation in sewer Trench The Duration of Sickness was
I certify that the above is true, to the best of my knowledge and belief.
Través Alanis
ud Residence of Cerligging Physician, . ..
BOrex of Infant (not named).
Extract from Section 1 of Chapter 306 of the Legislative Acts of 1888.
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 refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
NO.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, . 2. Name, .
ulry 13 "1895 Sally ahm Floyd
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, į
5. Ago, 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,
atlantic Street Chelsea Mass Samuel Floyd Hannah Bunkee Chelsea mais Chelsea quais Winthrop Cemetery Summer Floyd
Signature of Undertaker
the Return, .
DATED at Winthrop
uly 13" 1895
+ 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 linces, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1893 .- 5,000.
Phillipe Payson Floyd temalle married White
78
Years,.
7
Months, J.
Days.
I Willard Com Winthrop Mass
[ 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 lit - 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 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 neglects to make sueli 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 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 healtli 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 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 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.
Vame and Age of Deceased,*
Sally Como
+ land
5 de
Age,
Date and Place of Death, t - died at. Winthrop, hace.
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, -
of
July 13, 1892. Cornicione macmia couto Cirrhosis gained about sit monthe.
I certify that the above is true, to the best of my knowledge and belief.
ignature and Residence of Certifying Physician, Willand Can, Cento Doslow, Jueves.
Date of Certificate,
1893.
Or Sex of Infant (not named). If stillborn so state. { If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
# Ifa soldier or sailor who served in the War of the Rebellion.
1
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.] SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides. SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if 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 snch 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, .
July 15-1895 Abby die restric
2. Name,
(Maiden Name), *
(Name of Husband),*
William H. Mais Tic terriale.
3. Sex, and whether single, Married, or Widowed,
married
hité
4. Color, į
5. Age,
64 Years,
3
...... Months,
Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . (By whom certified, .
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Motlier, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker Mapavan making the Return,.
Summer Floyd
DATED at Winthrop
ney 16" 1895
* 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.
Afeffery 6 Day
1
Stries Creve ,
VILLE.
thenthan
[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 rey tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which (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 dyilly 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 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 je 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 give shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as tli 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.
=0
migame and Age of Deceased,*
abby Quetin
Age,
64 yra3-1
Date and Place of Death,t - died at
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, - -
of
berebral hemorrhage (spojlery) One Treek
I certify that the above is true, to the best of my knowledge and belief. -
Feature and Residence of Certifying Physician, .
...
Date of Certificate,
Atr Sex of Ilutant (not named). If stillborn so state. ¡ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
gul, 17th
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