USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 38
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No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, . .
Much 29"1896
2. Name, .
(Maiden Name),* ·
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
male
4. Color, i
5. Age,
Ycars, ..
Months,
Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
H & Smile
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, .
-
Floyd
DATED at
2
, on
Sich 29
184.5
* 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. Dec., 1895 .- 5,000.
·11
Adult Ningar
...
[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 aud belicf, 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, ne shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served iu 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 statc the same. If a physician refuses or ueglects to make such certificate he shall forfeit to the treasurer the sumn 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 humau 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 towu clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in licu thereof a certificate as hereiuafter 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 iu case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement aud 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 furuish 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, .
alene 5.1826
2. Name,
.
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age. 32 Years, 3 Months, .. 8 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 Mother, (Malden Name).
Vusau B. grass 22
13. Birthplace of Father,
1.1. Birthplace of Mother, .
"
Cemeter!
15. Place of Interment,
Signature of Undertaker wr Ather permet making the Return, .
Ferido
DATED at
, on.
aferie
7 18
* 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. Jan. 1935 .- 5,000.
12
г Свг. - р
....
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 26
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for re 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 dy immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certific stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician: lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceed fifty dollars. In case the deceased ¡vas a soldier or a sailor who served in the war of therebellion, the physician shall give the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negl 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 unti 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 suchi or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agen clerk, as the case may bc, a satisfactory written statement containing the facts 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 clerk, make such certificate required of the attending physician; and in case of death by violence the medical examiner shall, if requested, makc the s When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall f with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, a clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a finc not ex ing fifty dollars.
i
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,* Date and Place of Death,t - died at.
Lizzie & Thom.
Age, 32-3-8.
Winthrop (Pleasant Sr) aserie 5 " 1896, Eclampsia (Rajard Convulsive Motivo)
of Disease or Cause of Death, - (Primary und 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,
* Or Sex of Infant (not named). If stillborn so state.
¡ If child died immediately after birth so state. Plate. Ed. October, 1895 .- 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 certifieate 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 siekness, and the date of his deeease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn eliild, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a ehild died after birth or was born dead. If a physician neg- leets or refuses to make a certifieate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give botlı the primary and the secondary or immediate eause 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 whieli he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a eity or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the eity or town clerk. No such permit shall be issued nntil there has been delivered to such board, or agent or elerk, as the ease may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by 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, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or elerk, make sueli certificate as is required of the attending physician ; and in ease of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certifieate are delivered to the board of healthi or to its agent, the board or agent shall forth- with conntersign 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 seetion 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), #
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 or other person making the Return, .
DATLD at Sincity
alice Ky
2000
35 Years, Months, www ...... Days.
....
Sulland 512 Lenge 96
-
, (11
Clue q 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 other Races, specify what.
[Bo very particular to fill all Blanks.] Plate. Ed. Jan. 1895 - 5,000.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, 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, fortliwith 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 deeease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician 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 ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give 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 sneh 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 elerk. No such permit shall be issued until there has been delivered to sueh board, or agent o elerk, as the ease may be, a satisfactory written statement containing the facts required by this chapter to be returned an recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lie . thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physicia cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or an physician employed by a eity or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as i., 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,*
Alice G. Legg
Date and Place of Death, t - died at.
Age, 35 jer Withno (Beach Road) Cfr. 9th ,80€ Tuberculose ... About 18 months
Disease or Cause of Death, - of (Primary and Secondary.) } 8 Duration of Sickness, -
7
I certify that the above is true, to the best of my knowledge and belief. Albert 13. Dorman M.
Signature and Residence of Certifying Physician,
Date of Certificate,
April 12th
1896.
* Or Sex of Infant (not named). If stillborn so state.
t If child died immediately after birth so state. Plate. Ed. October, 1895 .- 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, 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 execeding fifty dollars. In ease the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negleets 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 eity 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 ease may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu 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 saine. 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,
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,
Signature of Undertaker ** making the Return. . Hind
COISAS
DATED at
apul 12 1896
* If a Married Woman or Widow. { If a Soklier who served in the War of the Rebellion.
tlf 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.
azul 12 1896 Douglas
male Married Huile
76 Years, ~Months, Days.
Muere
[ Public Statutes, Chapter 32, as amended by Acts of 18SS, Chapter 306 ; Acts of 1889, Chapter 224 ; Acts of 1833, 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 deccascd, his age, the disease of which he died, 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, fortliwith furnish for registration a certificate, statiug 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 pliysician 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 lie 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 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 attcuding physiciau, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, thic 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 samc. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the dcatli, as the clerk or registrar may require. Any personviolating 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,*
Eduard Diniglas Winthrop (Putnam Sr/a/v 12 1896,
Age, 76 yrs
Date and Place of Deathi, t - died at.
of
Heart Disease,
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, ..
Maracest Boule M.D.
Date of Certificate,
Abril 1425
189 4
* Or Sex of Infant (not named). If stillborn so state.
[ If child died immediately after birth so state. Plate. Ed. October, 1895. - 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, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child dicd 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 physiciau; 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 requirc. 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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