USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 31
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PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Je 121
11et et -
Boston,
Name and age of deceased :.
Age 1
yrs. 2
25
mos. dys.
Date and place of death: Dept. 4ª 1895- almonte Ocean Spray
Disease or cause of death :
acute meningitis
Duration of discase :*
10 days
I certify that the above is true, to the best of my knowledge and belief.
Name and residence ) Ef Cummings.
M. D.
of physician.
68 winthrop ar Ggeachmonth
* It is very desirable to be informed of the duration of the disease.
1895 ....
0
UNDERTAKER'S RETURN .- Boston.
1
Date of death,
Yepi.
4ª
189.5
Name,.
Maiden name, *.
Sex, 22rule
Married, single, or widow of wife of
Color, UhAge, 1 years, 2 mos., 15 days.
Residence, almond fr. Ocean Spray
Place of death ( street and
d),
number
Occupation, ..
Name of father,
Maiden name of mother, Helen Campbell
Birthplace of father, Nahane Una 20 Birthplace of mother,
Dr John N.13.
Place of interment,f
Nahant In120
* If a married woman or a widow. t Give the name of the burial ground.
Signature of Undertaker :
NE JONES & S. NEERTAL'ERS, AAGE ST . BOSTON 1
1- Vim 7
ward
Place of birth, Frank &. -
.....
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Splancher 12 1895 thestr Enfant
(Maiden Name),
(Name of Husband) , *
3. Sex, and whether single, Married, or Widowed,
1. Color,t
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, .
11. Birthplace of Mother, .
15. Place of Interment,
Sunn
Floyd
Signature of Undertaker
Mammuking
the Return, f
DATED at
word . .
on De- 12 " 1895
. 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 ollier Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. September, 1892 .- 5,000.
Frewall
While
Years, Months, Days.
ساريمن ١/
Read Ulice
11
Faul Purlin
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 305; Acts of 1539, 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.
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.
No.
Commontocatth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, . .
DejeTember 13.1895 Stilllow Entant
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 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,
Cottage Odile 2 anthrop (Cottage Odice) Elmer & Dawson Seesie In Coburn Longmantry dora Clarksburg Street- Va Winthrop Cemetery
Signature of Undertaker -
the Return. .
DATED at Minitrop
, ()11 Sept 14. 189.6
* 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. Jan. 1895 - 5,000.
Female
While
........
Stylelow Year's, .. Months, Days.
Dr a B Dorman
Summer Floyd
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263. ]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of 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 arc delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
No.
Commonwealth of Massachusetts. 1640000
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,
Mariel
1. Color, t
5. Age, Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
7. Residenee,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
England
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 wwother person making the Return, .
-
...
DATED at
, on
.
.18 .
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
1 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.
He 1 15"188.50 John moule
male
53 Years, ..... Months, Days.
Street
[Public Statutes, Chapter 32. as amended by Acts of 1888, Chapter 806; Adts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illuess 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 dcad. If a physician nog- 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 thic 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 sueh city or town, from the city or town clerk. No sueh permit shall be issned 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 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 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.
Name and Age of Deceased,*
Date and Place of Death,t - died at.
John moyle Age, 53 Yrs Virtuals (Beach Road) Rejet 15 1895 Probably of Cerebral Enlations
Disease or Cause of Death, (Primary and Secondary.)} Duration of Sickness,
Signature and Residence of Certifying Physician,
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.
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 liis 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 rebelliou, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negleets to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body umtil 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 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.
Commontocalth of Elassachusetts.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Naine,
(Maiden Name), *
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
1. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), f
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, .
11. Birthplace of Mother,
15. Place of Interment,
Signature of Undertaker punprewen making the Return, .
DATED at
With
Pohtembin 18th 1895 Horace Whitney
Male Widower
white
93 Years,
4
Months,
23
Days.
Old age
Boston
gentleman Winthrop mass. Westminster mare. Joel Whitney Alegal Weaknins ten mars. wedtrus tin mais. Boston,
Sept 15 th 1891
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, specify what. [Be very particular to fill all Blanks. ] 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 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 dyin immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certifica- stating to the best of his knowledge and belief the fact that such a child dicd after birth or was born dcad. If a physician no lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not excecdi fifty dollars. In case 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 cause of death as nearly as he can state the same. If a physician refuses or neglect- 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 auy, as required by section three of this chapter, or in lieu thereof a certificate as hercinafter 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 healthi 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 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 exceed- ing fifty dollars.
r
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Horace Whitney
Age, 93 Mp Jabl 18-
Date and Place of Death, t - died at.
Haphop. Quais.
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, - -
of Old acal
I certify that the above is true, to the bestof my knowledge and belief.
Date of Certificate,
Lepr 19
Boston muss 180/5.
* Or Sex of Infant (not named). If stillborn so state.
{ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
# Ifa soldier or sailor who served in the War of the Rebellion.
Signature and Residence of Certifying Physician, ..
Leth Flushwaite, 444 hunsave
[Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 300 ; Acts of 1889, Chapter 224; Acts of 1993, Chapter 203. ]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there 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 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 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.
No.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
1. 30, 1895.
anna @ Rues
2. Name,
(Maiden Name),
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, i
5. Ago, Disease or Cause of Death, (Primary and Seeondary), ;
6. Duration of Sickness, . (By whom certified,
7. Residence,
8. Occupation, .
9. Place of Deathı, .
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 www making
Rummer
the Retury, .
DATED at
Dept 30. 18 9/5
* lia Married Woman or Widow. f Hi a Soldier who served in the War of the Rebelhiva.
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.
Cor. Smiley + Und bull 8to
Wanttest
Valentine -11eller! Elizabeth Walkter
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