USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 26
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I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, Ant Campbell 6. Barton
Date of Certificate,
139
* Or Sex of Infant (not named). If stillborn so state.
{ If child died immediately after birth so state. Plate. E.l. 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; 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 clied, 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 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 ageut, or, if there is no board of health in sueli 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 hereinafter provided. If there is no attending physician, or if the certificate of the attending physician canuot 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, ageut 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 glven 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 execcd- ing fifty dollars.
RETURN OF DEATH TO THE CITY CLERK. CITY OF SALEM, MASS.
Date of Death,
left. 20
189 8
Name,
, Male child of Porchain Blaywere
Maiden Name,1
Sex, male ; Single, Married, Widow Color (if other than white)
Aged
years,
months,
days
Cause of death,
Premature Buch
Residence,3-No.
angle 31 Ruado
Street.
Place of death,-No.
11
Street.
Occupation,
Birthplace,
Wenitrof Toenter
Name of Father,
Lancharir Blaquière
Maiden Name of Mother,
Clara Déchiarire
Birthplace of Father,
Canada-
11
Birthplace of Mother,
To whom Married,
Attending Physician,
Date of Interment or Removal,
to Salem for Burial.
Jeft. 21
189 ៛
Place of
Ground, It. 2 21, Lot
Interment
Section,
3
Range g( Grave, 24
Undertaker (signature),
D. Bernier
It.
Salemi Plass.
OF The foregoing must be filled out and signed by the undertaker and returned to the city clerk, together with the physician's certificate of the cause of death duly approved by the board of health, before a burial permit can be issued.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
2. Name,
September 26"189 8 Lucille a. , Vangie
(Maiden Name) .*
(Name of Husband),
3. Sex, and whether single, Female
Married, or Widowed,
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. .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name), Delarey
13. Birthplace of Father. .
14. Birthplace of Mother, .
2
15. Place of Interment, (maldie) Signature of Undertaker mathew making the Return. . Summer Floyd
DATED at
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. Dec., 1596. - 5,000.
ghita
Years, 4 Months, 25 Days.
~ winthrop Mass
madison Mars
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 300 ; Acts of 1889, Chapter 224; Acts of 1893, 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 dylng 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 physiclan shall glve both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physleian 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 eity or town, from the eity or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if auy, as required by section three of this chapter, or in lieu thereof a certificate as 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 ease 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,*
Age, 4 mars 25 days
Date and Place of Death, t died at.
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, -
of
-
Lucille am Le Vangie. Minutters Mass. Seite 26 189 8. Cholera Infantuna. 7 days.
I certify that the above is true, to the best of my knowledge and belief.
O. E. Johnson Mg
Signature and Residence of Certifying Physician,
Date of Certificate,
Sept 26 1898
* Or Sex of Infant (not named). If stillborn so state.
{ If child died immediately after birth so state. Plate. Ed. May, 1893. - 5,000.
{ If a soldier or sailor who served in the War of the Rebellion.
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263. ]
SECTION 3. A physician who has attended a person during lus 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, 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 lie 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 bary 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 healthi In such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lien thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, If requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersigu and transmit the same to the clerk or registrar for registration. The person to whom the perunit 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 execcd- ing tifty 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,
4. Color, t
35 Years,
-
7 Months, 5 Days.
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 1 another porn-making the Return, . 1
DATED at
Muchas
, (11
Oct 6 18 9.8
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion. t If other than White. (M.) Mulatto. (1.) Indian. If of other Races, specify what.
{Be very particular to fill all Blanks.] Plate. Ed. Dec., 1896 .- 5,000.
Martha , Hanulton Pelvico
T
DetoTe 3- 1898
Quero Co
Rarhave
[ 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 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 clied, 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, 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 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 health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lien thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner sball, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of healthi or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the 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.
C
PHYSICIAN'S CERTIFICATE.
Vame and Age of Deceased,*
Martha ann Hamilton
Açe,
35-7-5
Date and Place of Death,t - died at. Winthrop (Beach Road) Oct 5 1898
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness,
of Queperal Seven days
-
I certify that the above is true, to the best of my knowledge and belief.
ignature and Residence of Certifying Physician, Horace &Sauer in. Dil men & Miss
Date of Certificate,
189 ·
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 18SS, Chapter 306 ; Acts of 1889, Chapter 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 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, 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 lie 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 health or its duly appointed agent, or, if there is no board of health In sueli 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 certifieate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good aud suffleient reasons, early enough for the purpose, the chairman of the board of healthi or any physician employed by a eity 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 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 healthi or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the 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, .
Detine 6" A
2. Name, .
(Maiden Name),* .
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color.i
5. Age, 86 Years, 4
Months,
(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 Heatherperam making the Return, .
DAATED at
, Oll 18
* 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. Dec., 1896. - 5,000.
D. metcalf
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; _ Irts of 1893, Chapter 20.
SECTION 3. A physiclan who has attended a person during his last illness shall, when requested, forthwith furnish for reg 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 dyin 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 exceedin fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give bot. the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or 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 vary 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 eity 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 liet 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 perinit is so given «hall 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.
Li
Ame and Age of Deceased,"
Susan adame allen
86-4 Age,
Erte and Place of Death, t - died at
of
Winthrop (Winthrop 2) Och 62 1808. Cystitis Carcinoma abdominalis, old age.
r Disease or Cause of Death, - (Primary und Secondary.)} Duration of Sickness, - 6 yrs I certify that the above is true, to the best of my knowledge and belief. B.It. Metcalf mil. winthrop it ₹
Signature and Residence of Certifying Physician,
Date of Certificate,
1898
* 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 Arts of 1888, Chapter 306; Arts of 1889, Chapter 224; Arts of 1893, Chapter 203.]
SECTION 3. A physician who has attended a persou during his last illuess shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born 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.
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