USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1893-1896 > Part 39
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No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
aferie 13 " 1896
2. Name,
Catherine
Mason
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Female
4. Color, t White
5. Age, Disease or Cause of Death, (Primary and Secondary), #
63 Years,
wwwMonths, Days.
6. Duration of Sickness, . By whom certified,
7. Residenec,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Namc of Father,
12. Name of Mother, (Malden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return,
Stile
Verdens Undrom
DATED at
2
, on
april 13
18%0
* 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. Jan. 1895 .- 5,000.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.1
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 ehild 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 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 certifieate as is required of the attending physician ; and in case of death by violenee the medical examiner shall, if requested, make the same. When sueh 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 eause 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.
Sareining NO.1
-
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Catharine L. Mason
63 yrs
Date and Place of Death,t - died at
Age, Winthrop (Shirly R.) aparece 13"1806, Caricer
Disease or Cause of Death, - of .. (Primary and Secondary.);
Duration of Sickness, 1
of diver- About one year
I certify that the above is true, to the best of my knowledge and belief.
Samson DA.
Signature and Residence of Certifying Physician,
Date of Certificate, av 15 189 6.
· 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 (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, 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- 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 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 eause of death as nearly as he ean state the same. If a physician refuses or neglects to make sneh certifieate 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 sneh eity 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 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 certifieate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician eannot 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 such 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 sueh satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with conntersign 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 eause of the death, as the elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exeeed- 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),*
Smile
3. Sex, and whether single, Married, or Widowed,
1. Color, t
Muito
5. Age, 72 Years, 10 ... Months,
5 Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, . . 2. ...
10. Place of Birth, .
11. Name of Father, .
12. Name of Mother, .
.... (Malden Name),
13. Birthplace of Father, .
1.4. Birthplace of Mother, .
15. Place of Interment, 1
... ...
Signature of Undertaker of other 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.
tlf other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Jan. 1895 -5,000.
,
april 25 "1896
[ 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 agc, 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 ehild, 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 eause 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 until hc 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 elerk. No such permit shall be issned 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 threc of this ehapter, 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 ease 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 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,
1. Color, t
5. Age, 7.
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 of other person making the Return, .
....
, On 18
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion.
tlf other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. Jan. 1505 - 5,000.
--
DATED at
april 25 "1896
Mucha
Muito
Years, Months, Days.
[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 kuowledge and belief, the name of the deceased, his age, the discasc of which h died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child 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 lie 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 lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician caunot 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 ageut shall forth- with couutersign 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,*
JohnC. Me Lovan
Age, 722.10 m. 5d.
Date and Place of Death, t - died at WinThe Mass, C/M. 25th 1800,
Disease or Cause of Death, - of (Primary and Secondary.)} Duration of Sickness, - -
banca 18 mos.
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
Ribal 13. Donnan GUID Chairman Band of Health Date of Certificate,
189¢
* 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 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- 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 canse 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.
No.
Foumonternity of Massachusetts.
RETURN OF A DEATH. C 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,
Tale mamed
4. Color, t
5. Age, Years,
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, .
14. Birthplace of Mother, .
15. Place of Interment, ·
Elizabeth Dnialas deland 4 deland anthropo Gemelli
Signature of Undertaker weather 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.
$ If other than Wlute. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. Jan 1995 .- 5,000.
Months,
17
Days.
Dr Price
[ 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 h died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child 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 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.
2Carriagea
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Date and Place of Death, + - died at.
lit in ther ap
Daughter Mac, 21
Age, 27 1,4
189€, (cadeaus À rease)
Disease or Cause of Death, - of.
' Primary and Secondary.) }
Duration of Sickness, -
-
I certify that the above is true, to the best of my knowledge and belief.
Totale will X
nature and Residence of Certifying Physician,
Date of Certificate,
189
* Or Sex of Infant (not named). If stillborn so state.
t If child died immediately after birth so state. Plate. E.d. October, 1995 .- 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 lie (lied, the duration of his last sickness, and the date of his deceasc; 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 furnisli 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 neg- lects or refuses to make a certificate as aforesaid, or makes a false statement thercin, lie 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 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 snch certificate lic 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 human body until he has received a permit so to clo 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 attendiug physician, if auy, 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 cxaminer 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.
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