USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 10
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PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
July 30ce
1897
Name and age of deceased :
Elisabeth A HarRon
Age .. 81 .yrs. 2 mos !. 13 days.
Date and place of death: Sula 3rd 1897
Winthrop Mass
Disease or cause of death : Peritonitis following herphilits
Intersusception of bowels
Duration of disease : *
7 in days
I certify that the above is true, to the best of my knowledge and belief.
Name and residence ) Horace & Soulé of physician.
M. D.
109 Winstwoth St. Winthrop Mass.
* It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting of permits for burial, as follows : ~ Saturdays, 9 A. M. till 2 P. M .; Sundays, 10 A. M. till 12 M .; Holidays, from 10 A. M. till 12 M .; other days, from 9 A. M. till 5 P. M.
UNDERTAKER'S RETURN .- Boston.
Date of death,
July
3 20 1897 Name,
Elizabeth a, Hanem Elizabeth W. Hanson
Maiden name,*
......
Sex,.
Married, single, or widow of 81 2
13
{mos., 13 days. Residence, cipline Chance
Place of death street and), leplume # Wenttrab
ward
Place of birth, Beveik 0/ 2
Name of father, tuncel Falls Maiden name of mother,
Occupation, Hanah Surles
Birthplace of father, to Know
Birthplace of mother,
Place of interment,t
Lynn
Dine grace
Tem
* If a married woman or a widow.
t Give the name of the burial ground.
Signature of Undertaker :
y V Bagan/-
wife of Fredrick 6 Handen
Color, ONT Age Ry .. years.
.....
C
No.
Commonwealth of stlassachusetts.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
2. Name,
July 9" 1894 Dane brose
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Thomas , brose (Female married While-
4. Color, j
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, .
Everman Sheet -
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,
Minitrop Cemetery -
Signature of Undertaker Or THhier wwwan making the Return, .
Summer Floyd
DATED at Minituap
, On July 10" 189.7
* 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., 1896. - 5,000.
3 5 Years, / Months, 16 Days.
Mais
[ 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 furulsh for regi -- 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 physleian neg- lects or refuses to make a certificate as aforesaid, or makes a false statement thereiu, 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 ncarly 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 clerk. No such permit shall be issued until there has been delivered to such board, or agent or elcrk, 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 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 statemeut 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 deatlı, 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.
June CONOR
Name and Age of Deceased,*
Date and Place of Death,t -
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, -
of
Age, 55 ye-/ms-16de ferie Virtual (Herman street) July 9/2180%, Lienidany cancer .) Leg! Fleurs + mediactini Iwanty me, rolls
I certify that the above is true, to the best of my knowledge and belief.
28 amatoriali E.B
ignature and Residence of Certifying Physician,
Date of Certificate,
1897
* Or Sex of Infant (not named). If stillborn so state.
{ If child died immediately after birth so state. Plate. Ed. December, 1896. - 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 1989, 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 deccased, his age, the disease of which he lied, the duration of his last siekness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, ne 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 nogleets 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 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 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 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 seetion shall be punished by a fine not exceed- ing fifty dollars.
No ..
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
2. Name,
(Maiden Name),* (Name of Ilusband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Agc, 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 Birthi, .
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 prove making the Return, .
July 19the 1894 Marjorie 4.1
temale
Ihité
Years, .. 10 Months, 2 Days.
Dr & Flage
...
40 Terrace Ave
winthrope Barton
John A. Thomas
Margaret Thompson
NEW York
Manut Auburn
Summer Floyd
DATED at
Hinttrop
on
July 19" 189.
* 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.
[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 ehild 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 faet 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 solcher 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 negleets 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 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 elerk. No such permit shall be issucd 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 ease of death by violence the medical examiner shall, if requested, make the samc. When such satisfactory statement and certifieate are delivered to the board of health or to its agent, the board or agent sliall 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 exeeed- ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
Le m do
Name and Age of Deceased,*
Marjorie a. Thompson
Age, 1-10-2
Date and Place of Death, t - died at
of
Winthrop (40 Terrace are) only 19" 180g, Provelitis followed 4 Milemingitis Two days
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, 07Tage
Date of Certificate,
1897.
* Or Sex of Infant (not il:qued). If stillborn so state.
{ If chill died immediately after birth so state. Plate. Ed. December. 1896 .- 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 ; Arts of 1889, Chapter 224 ; Arts of 1833, 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 deccased, his age, the disease of which he died, the duration of his last sickness, aud 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 ncg- lects or refuses to make a certificate as aforesaid, or makes a false statement thereiu, he shall be punlslied 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 iu a city or town or remove therefrom a human body until he has received a permit so to do from the board of healthi 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 therc 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 licalth 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 canse of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Shutter July 20 189
>
Disease or cause of death :
mos. - dys. -34 Bral St . Thistherap of Showark. Six nu months.
Duration of disease : *
I certify that the abore ix true, to the best of my knowledge and belief.
Name and residence
V. D.
of physician.
* It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A. M. till 2 P.M .; Sundays, 10 A. M. till 12 M., Holidays, from 10 A.M. till 12 M .; other days, from 9 A.M. till 5 P.M.
Vame and age of deceased : Date and place of death :
Rachel Stea July 19,1897 Career
Age 59 yrs. -
4
٠
UNDERTAKER'S RETURN .-- Boston.
Date of death, July 19 Rachel Murphy 189 %
mme, Name,
Rachel Shea_
Maiden name, *.
Sex,
7 .-
Mawiel single, or widow of flow of Geremiale Shea Color, While Age: 59 years, - mos- days. Residence, 3 4 9 Deal So Muchof
Place of death ( street and number
ward
Place of birth,
Occupation.
Name of father, Auchace Murphy Maiden name of mother,
Nova cullerano
Birthplace of father, ; Irland
Birthplace of mother,
Place of interment, t
.....
* If a married woman or a widow. t Give the game of the burial ground.
Signature of Undertaker :
Johntums
-
July 19
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
July 25 189
Boston,
Name and age of deceased :
Date and place of death :
Disease or cause of death :
25-189). Intins" Cholera Infante
4 days
Duration of disease : *
I certify that the above is true, to the best of my knowledge and belief.
Name and residence of physician.
Maso
* It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A.M. till 2 P.M .; Sundays. 10 A. M. till 12 M .; Holidays, from 10 A.M. till 12 M .; other days, from 9 A.M. till 5 P.M.
Julia A junedesrongeurs.
7 mos. 22 lys.
July
7
2681
tobeers
UNDERTAKER'S RETURN. Boston.
Date of death, July 25th 180)
Name, Felia H. Gunderson Sex, Female
Maiden name,*
Married. single, or widow of
wife of
Color, WhAge, - years.
2days. Residence. idence. 18% Winthrop 0
Place of death ( street and 18% Winthrop ward number
Place of birth,
Cash Boston Occupation Night Metchancen
Name of father,
Maiden name of mother,
Birthplace of father, Norway Birthplace of mother.
Place of interment, t Holy
Macchine
* If a married woman or a widow. t Give the name of the burial ground.
Signature of Undertaker : M. J. Kelly
RETURN
...
No.
.......
Con. calty of jonssargasents.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
Smile 3/1/897 Dorothy Porling
2. Name, (Maiden Name),* (Name of Husband), *
3. Sex, and whether single, Married, or Widowed,
Female 0
4. Color, t
5. Age,
Years,
8
Months,
7
..
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,
2 2
Ele Flamp
12. Name of Mother, (Maiden Name), Tracho Enlas
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, ·
Summer Florid
DATED at Minttriops, on
21".
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.] l'late. Ed. Dec., 1895 .- 5,000.
In Denen Dermele, .......
Signature of Undertaker erotherperson making the Return,
[ 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 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 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 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,*
Dorothy Collins
8 MAR 0/ de Age,
Date and Place of Death, t - died at.
121" 189 > of - , 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,
July 31 189>
* 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 died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforcsaid, 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 lie shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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