USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 21
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PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Millicent Louise anderson
Date and Place of Death, t - died at.
Age, 11 yre 3 MAR 18 Winthrop (Shintopost) June 11 1808 Shock, from fracture of pelvis ...
Disease or Cause of Death, -
----- (Primary and Secondary.) } Duration of Sickness, -
of . and internal injuries. (accidents) - I certify that the above is true, to the best of my knowledge andbelief!
Signature and Residence of Certifying Physician,
Date of Certificate,
June 12 1898
* Or Sex of Infant (not named). If stillborn so state.
If child died immediately after birth so state. Plate. Ed. December. 1806 .- 5,000.
{ If a soldier or sailor who served in the War of the Rebellion.
[Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 300; Arts of 1889, Chapter 224 ; Arts of 1993, 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 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 lie 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 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 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, thic chairman of the board of health or any physician employed by a city or town for the purpose sliall, 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 fortli- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
RETURN OF 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 Husband) ,*
3. Sex, and whether single, Married, or Widowed,
Tharnial
4. Color, t
5. Age, Years,
Months, 13 Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified, 9h -1.
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father, (C 13
12. Name of Mother, (Maiden Name),
13. Birthplace of Father,
11. Birthplace of Mother, .
15. Place of Interment,
..... ........ Smell
Signature of Undertaker other person making the Return,
1
DATED at
June 25 18 98
-
, (11
* 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., 1996. - 5,000.
25-1591
WALLER
manu Welche alberi le Mit. .
....
...
-
Le-manu 15-91-1
[ Public Statutes, Chapter 32, as umentled 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 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 deceasc; and a physician who has attended at a birth of a ehlld 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- jeets 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 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 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 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 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 clerk, make such eertificate 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 givel shall thereafter furnish for registration any other information as to the deecased 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 scetion shall be punished by a fine not exceed- ing fifty dollars.
Juneal !..
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,* Manie Florence Hyman
Date and Place of Death,t - died at.
Age, 30-5-17 Winthrop (Shirley Street) June 25". 808. ubercularis. I
Disease or Cause of Death, - (Primary and Secondary.)} - Duration of Sickness,
of 10 months
I certify that the above is true, to the best of my knowledge and belief.
Enature and Residence of Certifying Physician,
Date of Certificate, June 26,
1898.
Or Sex of Infant (not named). If stillborn so state. t If child died immediately after birth so state#If a soldier or sailor who served in the War of the Rebellion. Plate. Ed. December, 1896. - 5,000.
[Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 300; Arts of 1889, Chapter 221 ; Arts 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 statiug, 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- Iccts 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 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, sextou 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 physiciau, 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 auy 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 violeuce 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 forthì- with countersign and trausmit the same to the clerk or registrar for registration. The person to whom the perinit is so given shall thereafter furnish for registration any other information as to the deceased or to the inanncr and cause of the death, as thie 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.
Jura 30
189 8
Name and age of deceased : Gathering
Boston,
Toucher
Age 37 yrs. fursmos. .dys.
Date and place of death :
Jums, 291898 31/ German & Hruthrop
Disease or cause of death: Thatwas Sulmonalis
Duration of disease : *
6 months
I certify that the above is true, to the best of my knowledge and belief.
Name and residence
of physician.
hmmm . M. D.
228 Paratenga 26
* 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., except during the months of June, July, August and September, when the office will be closed on Saturdays at 12 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.
189
Name,.
Katherine laucher.
Maiden name,
Katherine Oneil
Sex Female
of Jotun Toucher wife of
Married, single, or widow of
Color, ...
years,
mos., .... ...... days.
Residence 3/ 2. Her, none
Place of death (street and) number
ward
Place of birth
Occupations Hauteurde.
Name of father, James ( Heell Maiden name of mother,
Catherine Golfen).
Birthplace of fathers
Birthplace of mother Ireland.
Place of interment,t Sole traso
Cequeteres Malden.
* If a married woman or a widow.
t Give the name of the burial ground.
Jerome Jerome
Undertaker.
Age,02
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 Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, i
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . (By whom certified,
7. Residence, Michael Dass
8. Occupation, .
Plech
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Charliey
12. Name of Mother, (Maiden Name),
13. Birthplace of Father. .
11. Birthplace of Mother, .
15. Place of Interment, ·
Signature of Undertaker 1 Run
Fund
To making
the Returng .
DATED at
* 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., 1996 .- 5,000.
Erauch
Del
Finale IArdue
69
Years,
6
Months,
TO
Days.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; _ lets of 1889, Chapter 224; _ lets of 1893, Chapter 203.]
SECTION 3. A physielan 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 belicf, the name of the dceeased, his age, the disease of which he died, the duration of his last siekness, 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 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 execeding 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 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 inry in a city or town or remove therefrom a human body until he lias received a permit so to dlo 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 sueh 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 eertificate 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 clerk, make such eertificate 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 eertifleate are delivered to the board of health or to its agent, the board or agent shall fortli- with eountersign 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 canse 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 exceed- ing fifty dollars.
1
Globe Herect
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Mire Fancy Etherington
Age, 69-6-10
Date and Place of Death, t - died at. 31. Altanie Street, Hintway July 91180 8.
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness,
of Carea of Duodenum Three months I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
Stephan R. Dacia Atlantic It. I
Date of Certificate,
1898.
* Or Sex of Infant (not named). Jf stillborn so state.
t If child died immediately after birth so state. Plate. Ed. December. 1896 .- 5,000.
f If a soldier or sailor who served in the War of the Rebellion.
.
[Public Statutes, Chapter 32, as amended by _Acts of 18SS, Chapter 300 ; Arts 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 furuish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- leets or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until 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 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 orto its agent, the board or agent 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.
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 Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
64
19
65 Years, Months, Days.
Shopley
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,
14 Albion St., Roxbury, Chass. Salesman minthaof A.S. Wish Johnson Clark Julia Ann Or.S.
Hilmot Liderhood, Eng Oito Hope Completa
Signature of Undertaker + other person making the Return, .
1
Summer Hloud'
DATED at Winthrop
Que
1,
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. | Be very particular to fill all Blanks. 1 Plate. Ed. Dec., 1896 .- 5,000
13
Inky. 1.
1898 Henry Clark
Male.
Married
5. Age, Disease or Cause of Death, (Primary and Secondary), +
..
3. Causer
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chopter 224; Arts 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 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, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birthi or was born dead. If a physician neg- Icets or refuses to make a certificate as aforesaid, or makes a false statement therein, nc 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 rebelllon, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the sanc. 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 bnry 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 clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the easc 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 saine. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forthi- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not execed- ing fifty dollars.
Hanual Striden A. P.M. /ps 57 Bailey Rien
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
David Henry Clark
Date and Place of Death, t - died at Winthrop July 13."
Age,
65 yrs 1898
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, - -
of
I certify that the above is true, to the best of my knowledge and belief.
Elalimon LuA.
Signature and Residence of Certifying Physician,
Date of Certificate,
July - 180$
* Or Sex of Infant (not named). If stillborn so state.
{ If chill died immediately after birth so state. Plate. Ed. December, 1896. - 5,000.
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