Town of Winthrop : Record of Deaths 1893-1896, Part 30

Author: Winthrop (Mass.)
Publication date: 1893
Publisher:
Number of Pages: 798

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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 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 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.

PHYSICIAN'S CERTIFICATE.

Name and Age of Deceased,*

William. P. Hillis 8.

Age, ST ys

Date and Place of Death, t - died at.

Mintto1. (Bowdown &V) aug> 189,5.

Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, -

of Peritonitis

I certify that the above is true, to the best of my knowledge and belief.

Signature and Residence of Certifying Physician,

Horace! Boule MS.

Date of Certificate,

189 5.

{ If a soldier or sailor who served in the War of the Rebellion.

* Or Sex of Infant (not named). If stillborn so state.

{ If child died immediately after birth so state.

Plate. Ed. May, 1893. - 5,000.

[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]

SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish' for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he (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 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 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 healthor 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.

Commonwealth of Massachusetts.

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),*

Charlotte SUR ul2

3. Sex, and whether single, Married, or Widowed,

marion

1. Color, ¡

Years, 10 Months, .Days.

5. Ago, .61 Disease or Cause of Death, (Primary and Secondary), ;

6. Duration of Sickness, . By whom certified,

7. Residence,

8. Occupation, .

9. Placerof Death, .

10. Place of Birth, .

11. Name of Father,

12. Name of Mother, (Maiden Name).

LiaRBradford L

13. Birthplace of Father,

11. Birthplace of Mother, .

15. Place of Interment,

Signature of Undertaker oesther person making the Return; .

DATED at

...

8 1

189.5

* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. 1

t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.

[Be very particular to fill all Blanks.] Mate. Ed. September, 1892 .- 5.000.

[ Public Statutes, Chapter 32, as amended by Acts of 1883, Chapter 305 ; Acts of 1889, Chapter 224.]

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 refuses to make a certificate, as aforesaid, 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.

PHYSICIAN'S CERTIFICATE.

Name and Age of Deceased,*

Charlotte Mr. Smith

Age, 61-10

Date and Place of Death, t - died at.

Printtro fo (Sargent b) Aug 7th,1895. Cancer of Bodait

Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness,

I certify that the above is true, to the best of my knowledge and belief.

Signature and Residence of Certifying Physician,.

Date of Certificate,

1895.

* Or Sex of Infant (not named). If stillborn so state.

t 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 Siatutes, 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 bary in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early 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 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 execed- ing fifty dollars.

PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.

Boston

189 ...

Name and age of deceased :

Hannah M. Her

Age

.yrs. .. mos .. .... dys

Date and place of death: Crest Ave, Wuithof, Mars

Disease or cause of death :

Disease of the heart, liver and kidneys

Duration of disease :* Four year

I certify that the above is true, to the best of my knowledge and belief.

Name and residence

Albert 18 Doman

of physician. Winthrop Centre Mars. M. D.

* It is very desirable to be informed of the duration of the disease.

UNDERTAKER'S RETURN .- Boston.

Date of death.

tug 8, 18915

Vage banale M Hennessy Garibaldi

Maiden name,*

Sex,

Married, single, or widow of wife of

Milliano

Color, or, HAge3 Years, mos., ~ days. Residence,/ S

3 Carlisle Dr. Rolfun

Place of death street and prest Philadelphia Ja. Occupation

Ivan Chop S

ward

Place of birth,

Name of father

Pietro

Maiden name of mother Querida Heavy

Birthplace of father, staly the

Birthplace of mother Benedict

Place of interment,

* If a married woman or a widow.

t Give the name of the burial ground.

Signature of Undertaker :

I. P. Cleary.

PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.

Boston, 9 189.6.^

Name and age of deceased :

Harry Rand Hooper

Age ............. yrs .............. mos. 14 dys.

Date and place of death :

Disease or cause of death :

(Tubercular)

Mencuento

with hambel dentition

Mwation of disease :*

Twenty-our

dons. ,

I certify that the above is true, to the best of my knowledge and belief. ..

Name and residence

M. D. . of physician. Edward 7, Sage

Comer Great one and Sturgis St Winthrop

It is very desirable to be inforn e informed of the duration of the disease.

RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.

1. Date of Death, .

august 14" 150g marshall

BirHarrie

2. Name,

(Maiden Name),

(Name of Husband),*

male

3. Sex, and whether single,

Married, or Widowed,

Malé

4. Color, t

5. Age,

Years,

Montlis,

2.2_Days.

Disease or Cause of Death, (Primary and Secondary), #

6. Duration of Sickness, . By whom certified, .

Die Flecal

7. Residence, .

8. Occupation, .

....

9. Place of Death, .

10. Place of Birth, .

11. Name of Father,

12. Name of Mother, · (Maiden Name),

13. Birthplace of Father, .

14. Birthplace of Mother, .

15. Place of Interment,

Signature of Undertaker or other person making the Return, .

Sum

Floyd

DATED at

, on

* 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. Nov. 1890-5,000.

...

Below Mare

Persona

Ve found deposition Rection

[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 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- nislied, 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 (Inly 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 issned 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 threc 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 de- livcred 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.

PHYSICIAN'S CERTIFICATE.

Name and Age of Deceased,*

Warshall B. Otani's

Age, 8mas 22 ds

Date and Place of Death,t - died at

Winthrop (Winthrop SI) aug17.189.5. Cholera Infantum

Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, -

of Three weeks

I certify that the above is true, to the best of my knowledge and belief.

Signature and Residence of Certifying Physician,

Date of Certificate, Cenas 18 1895.

* Or Sex of fufant (nut named). If stillborn so state.

¡ If child died immediately after birth so state. Plate. Ed. May, 1593. - 5,000.

{ 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 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 sneh permit shall be issued until there has been delivered to such board, or agent or elerk, 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 healthi 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 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 DEATH TO THE CITY REGISTRAR. Menthafe Mace

Date of Death,

1896

Name,

Harriet W. Smith

Color, H.

.Age,

5-1

Years,

Months,

Days,

Place of Death ? Winthrop

Mask WARD

Street and No. Residence, Centrul Falls Q. J. Sex,

Single, .. Married

Occupation,

Hite of

Birthplace,

Charlestown Willow Of

Name of Father,

Corepu di ++ mitt

Maiden Name of Mother,

Harriet

forfant

Birthplace of Father, Falem

Sabem

mass

Birthplace of Mother,

Cause of Primary, -

Death,

§ Secondary,

Place of Interment,

.Duration, .. .. Duration, In, Jonke Cem Everett

Date of Interment or Removal,

Sept 3 cl 1845

Undertaker or Informant,

Charles F. 1Bryant.

PHYSICIAN'S CERTIFICATE.

Name and Age of Deceased,*

Mariette Cinquenta Diritti

Age,

51-1-6

Date and Place of Death,t - died at. Goval avc, Winthrop Sep 200 895.

Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, - -

Mitral Dronfficiency (Heart Disease) of Four weeks

I certify that the above is true, to the best of my knowledge and belief.

Signature and Residence of Certifying Physician,

I horace & Soule MID

Date of Certificate,

Gebt 3rd

1895 .

* 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 died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a chikdl 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 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 lias received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town elerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in 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 eity 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 sneh 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.

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Town of Winthrop : Record of Deaths 1893-1896, Part 30

Author: Winthrop (Mass.) Publication date: 1893 Publisher: Number of Pages: 798

Author: Winthrop (Mass.)
Publication date: 1893
Publisher:
Number of Pages: 798