USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 27
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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 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.
Coch. 8th
189
Name and age of deceased : Fiets Malconi
Age. 26 yrs 7 mos. dys
Date and place of death :. Och. 8th
US. Hospital
Disease or cause of death :
Depentity -
Duration of disease : *
I certify that the above is true, to the best of my knowledge and belief.
Name and residence
of physician. Francis
.. M. D ad ant Jungeon le sol
* 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.
7.
g
Boston, ..
UNDERTAKER'S RETURN .- Boston.
Date of death,
Get 8"
189 8
Name,
Victor Males Ki
Maiden name,* 02
Married, single, # widow Unknown
wife of
Color,
Age, 26 years, 6 mos( Ways. Residence,
H. Ifiglilands
Place of deathi (street and number 23 Sunnit-avenue
Place of birth, Russia Poland
Occupation,
Barber
Name of father,
Maiden name of mother,
Birthplace of father or Hun
Birthplace of mother,
Place of interment, t
Joly, leross lementary
(Malten)
* If a married woman or a widow.
t Give the name of the burial ground.
Signature of Undertaker :
Summer
Floyd
Sex, male
Oct8/091
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH
Winthrop Gel-15
189 8
Name of Deceased* Augustus Jainva Age. 72 Ye Cambridge, 6 Months. .Days.
Place and Date of Death; Died at Terrace ar
Street
Cel-15 -89
Disease, or Cause of Death Brights Disease complicated with Discare of Heart
Duration of Disease Six months probably longer
I certify that the above is true to the best of my knowledge and belief.
Signature of Physician Edward 7, Gage M. D.
Residence 131 Guest che Wanthal
*Or Sex of Infant (not named).
The office of Board of Health will be open for the granting of permits for burial as follows : Satur- days, 8 A. M. till 2 P. M .; Sundays and Holidays, 12 M. till I P. M .; Other Days, from 8 A. M. till 4 P. M.
BE VERY CAREFUL TO FILL ALL BLANKS IN INK
(OVER)
SECTION 5. Any person violating the provisions of either of the four preceding secuons snau forrent not exceeding hity dollars.
SECTION 6. No railroad corporation or other common carrier or person shall convey or cause to be conveyed, through or from any city or town in this Commonwealth, the remains of any person who has died of sinall-pox, scarlet fever, diphtheria or typhus fever, until such body has been so encased and prepared as to preclude any danger of communicating the disease to others by its transportation; and no city or town clerk, or clerk or agent of the board of health, shall give a permit for the removal of such body until he has received from the board of health of the city or from the selectmen of the town where the death occurred a certificate stating the cause of death, and that said body has been prepared in the manner set forth in this section, which certificate shall be delivered to the agent or person who receives the body. Any person violating the provisions of this section shall forfeit not exceed- ing twenty-five dollars.
SECTION 7. The boards of health of cities and towns shall, on or before the first day of May in each year, license a suitable number of undertakers who can read and write the English language, to take charge of the funeral rites preliminary to the inter- ment, removal or cremation of a human body. Such licenses shall be issued under such terms and npon such conditions as the board of health may prescribe, and may be revoked at any time by the board when such terms or conditions or any requirements of law relative thereto have been violated by the undertaker: provided, however, that an undertaker so licensed shall have the right to act thereunder in any city or town in the Commonwealth.
Acts of 1897, Chap. 444, Sect. 10.
A physician who has attended a person during his last illness shall forthwith, after the death of said person, furnish for reg- istration at the request of a duly licensed undertaker or other authorized person, or any member of the family of such deceased per- son, a certificate, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the decease of which he died, the duration of his last sickness, and the date of his decease; and a physician who has attended at the birth of a child dying immediately thereafter, or a physician or midwife who has attended at the birth of a child born dead, shall forthwith furnish for registration a certificate stating that to the best of his or her knowledge and belief such child either died immediately after birth or was born dead.
A physician or midwife who neglects or refuses to make the certificate required by this section or who makes a false state- ment therein shall forfeit not exceeding fifty dollars.
UNDERTAKER'S RETURN OF A DEATH
Date of Death
6cl-15-1898
Name of Deceased fur tino Sabble
(Maiden Name)*
(Husband's Name)
Sex male
Colort Thic
Condition, (Single, Married, or Widowed) Age, 72 Years, . C Months, ................ Days.
Occupation (if over 14 years old) Book Keeper
Signature of Undertaker, or other person making the Return.
Cambridge Det 15" 189 189
* If a Married Woman or a Widow. t (W) White; (B) Black; (M) Mulatto.
Occupation (if under 1 year old) of Father
Residence Winthrop mars
Place of Death Cenace ar. Menthis
Place of Birth
Plymouth Mars
Name of Father
Birthplace of Father Hengsten mar MAIDEN Name of Mother Lois Hubbard
Plymouthlutar
Birthplace of Mother
Arlington Mar
Place of Interment
Horace 2 Letech fuel. 401 Mars ar Cambridge fort Marx 1
auch ward, or agem, ot crew, facts required by law to be returned and recorded, which statement in every case of an original interment shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, or in licu thercof 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, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificatc as is required of the attending physician; and in case of death by violence the medical examiner only shall 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 forthwith countersign and transmit the same to the clerk of the city or town for registration. The person to whom the perinit is so given, and the physician who certifies to the cause of death, shall thereafter furnish for registration any other necessary information that can be obtained as to the deceased, or as to the manner or cause of the death, which the clerk or registrar may require.
SECTION 2. No undertaker or other person shall bury in a city or town a human body or the ashes thereof brought into this Commonwealth from without its limits until he shall have received a permit so to do from the board of licalth, other than the select- men, or its agent duly appointed to issue sach permits, or if there is no such board, from the clerk of the city or town in which the body is to be buried or the funeral rites are to be held: provided, however, that if there is a person duly appointed to have the carc of the cemetery or burial ground in which the interment is made, and there is a record kept of the names of all persons buried therein, or if there is a duly appointed superintendent of burials in such city or town who keeps a record of interments, said permit may be issued by such person having such care or by said superintendent of burials. Said permit may be granted upon delivery to said board, agent, clerk, superintendent or person having such care, as the case may be, of a certificate giving the name of the dc- ceased person, his age as nearly as can be ascertained, the cause of death, the name of the city or town where he last resided or from which the body was brought, or, if the death occurred at sea, the name of the vessel upon which it occurred, and any other facts re- quired for record which could be obtained with reasonable exertion. When such certificate is delivered to the board of health, or to its agent, or to the superintendent or person having such care, the board, agent, superintendent or person having such care shall forthwith countersign and transmit the same to the clerk of the city or town; and if the deceased person was at the time of his de- cease a resident of said city or town the clerk shall record the same in the books kept for recording deaths; but if the deceased was at the time of his death a resident of any other city or town within this Commonwealth said clerk shall forthwith forward to the clerk of such other city or town a certified copy of the certificate mentioned in this section.
SECTION 3. No person having the care of a cemetery or burial ground shall perinit a human body to be buried thercin or re- moved therefrom, or permit the ashes of a human body to be removed therefrom, until there has been delivered to him the permit for the burial or removal of said body or ashes, nor permit the ashes of a human body to be buried therein until there has been de- livered to him a certificate that the burial permit and the certificate of the medical examiner prerequisite to the cremating of said body have been duly presented.
SECTION 4. No undertaker shall bury the ashes of a human body which has been cremated until he has received from the person having the charge of the crematory a certificate that the burial permit and the certificate of the medical examiner prerequisite to the crcmating of said body have been duly presented.
No.
Commontocalth of Massachusetts.
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 hile
....
24
Years, 1 Months, 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, . Dreifach Rendre 11. Name of Father. Delphine 1 12. Name of Mother, (Malden Name), 13. Birthplace of Father, Daland
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker 1
miother person making the Return, .
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., 1896 .- 5,000.
-
[ Public Statutes, Chapter 32, as amended by _Acts of 1888, Chapter 306; Lets 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, forthiwith 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 flue 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 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 tury 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 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 giveu 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.
-14108-6 Friday 2 Pm
PHYSICIAN'S CERTIFICATE.
Stark Andrick
Age, 1 m 320
Name and Age of Deceased,* Date and Place of Death, t - died at quinteros
Cich 20
189 & .
Disease or Cause of Death, - (Primary and Secondary.) }
of
Hydrocephalus.
Duration of Sickness,
I certify that the above is true, to the best of my knowledge and belief
Signature and Residence of Certifying Physician,
Jer 20
189 %.
* Or Sex of Infant (not named). If stillborn so state. [ If child died immediately after birth so state.
# If a soldier or sailor who served in the War of the Rebellion.
Plate. Ed. May, 1893 .- 5,000.
..
Date of Certificate,
[Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 300 ; Acts of 1889, Chapter 224 ; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate starting, 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 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 hercinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, carly 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 certifleate 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 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.
No.
Commonwealth of Massachusetts.
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
5. Age, Disease or Cause of Death, (Primary and Secondary), +
6. Duration of Sickness, . (By whom certified,
7. Residence,
8. Ocenpation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker orother person making the Return, ..
DATED at Inuthof
, (11 Del 21
* If a Married Woman or Widow. { If & 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.
Dette 21 1895 Servera a Vouschaã
Years,
22heter 8 .Months, 4 Days.
In Meteres
UF w
[ 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 deccased, his agc, the discase 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 dyir immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furuish for registration a certificat stating to the best of his knowledge and belief the fact that such a child dicd after birth or was born dead. If a physician ne Iccts or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not excecdi fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give bo the primary and the sceondary or immediate cause of death as nearly as lic can state the same. If a physician refuscs or negle 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 in a city or town or remove therefrom a human body until 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 ci or town, from the city or town clerk. No such permit shall be issued until therc has been delivered to such board, or agent ( clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned an recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lier. thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending pliysicia' cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or an physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as i required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
6 - 5 - 20
PHYSICIAN'S CERTIFICATE.
1
ge and Age of Deceased,
Serveha a. Van Schaack
Age, 82-8-4
e and Place of Death, t died at. Winthrop (35. WashingtonQue Oct 21 189 8,
vase or Cause of Death, - "(Primary and Secondary.)} J 'ration of Sickness, -
of abdominal Carenomal
Cancer)
7
- 3 yrs
I certify that the hbove is true, to the best of my knowledge and belief.
gnature and Residence of Certifying Physician, .... B. H. Metcalf MA.
Date of Certificate, .. bet 24 1
189g
* 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 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 finc 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 tlic town in which he resides.
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