USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 35
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[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 30G ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illuess shall, wheu 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, 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 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 sun of ten dollars for the use of the town in which he resides.
SECTION 5. No uudertaker, 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 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 auy, 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 eannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or 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 section shall be punished by a fine not exceed- ing fifty dollars.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
Edward IL Hame
2. Name, ( Maiden Name), * (Name of Husband) ,
3. Sex, and whether single, Married, or Widowed,
male Married
1. Color,t
Years,
9
Months,
4
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,
14. Birthplace of Mother,
15. Place of Interment,
En human F 1
Signature of Undertaker vr other person making the Return, .
DATED at
aiziet 36 Clubewaren
infarct e
189.9
* 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. May, 1893 .- 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 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 uearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement coutaining 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 aud sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician enployed 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 death, as the clerk or registrar may require. Any person violating any of the provisions of this seetion shall be punished by a fiue not exceed- ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
Edward Lo Hanlow.
Age, 5-1-8-4
Vame and Age of Deceased,*
Date and Place of Death,t - \ died at
Hunterop mars Jane
4 1899, Myocarditis (Disease of heart
Disease or Cause of Death, - I.(Primary and Secondary.)} Elation of Sickness, -
of muscle)
I certify that the above is true, to the best of knowledge and beliff. & Johnson. MX
ignature and Residence of Certifying Physician,
Date of Certificate,
" 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 ISSS, 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 clicd, 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 cause of death as nearly as he ean 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 healthi 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 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 healthi 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 requestcd, make the same. When sueh satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the deathi, 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.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
A
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name, 6
Sex,
Color,
Date of Death,
15
189 9; Age, ~Years, 2
Months, 17 Days.
Maiden Name, { If married, widowed ) or divorcech
.....
Husband's Name,
Single, Married, Widowed or Divorced, . Occupation,
* Residence,
( If out of town, }
10.
also state fully. j . Place of Birth, 100 16
*Place of Death,
Name of Father,
Birthplace of Father,
Maiden name of Mother,
Birthplace of Mother,
Jena Mr Tralee
Place of Interment, (Give name of Cemetery),
No.
OF THE DEATH
189
189
1897 require that every householder in whose house a death occurs, the eath of any of his kindred, or the person in charge of an institution in date of such a death, give notice thercof to the board of health or to red. (See section 6.)
ptice of the death of any person under his charge to the board of health wealth at which his vessel first arrives after such death. (See section 7.) ents of sections 6 and 7, five dollars. (See section 8.)
his last illness shall forthwith after the death of said person, upon th the required facts. (See section 10.) section 11.)
Preliminary to the interment of a human body shall obtain the physician's turn it, together with the facts required by section 1, to the board of death oeeurred.
PHYSICIAN'S CERTIFICATE.
ame and Age of Deceased,*
Christina M. Leahy
Age, 2'Mos -17 ds
ate and Place of Death, t - died at.
Minitrop. (108 9 huiles 21) June 10" 1899,
isease or Cause of Death, - (Primary and Secondary.)} uration of Sickness, -
of . we've ilas CI
I certify that the above is true, to the best of my knowledge and belief.
nature and Residence of Certifying Physician, ...
Date of Certificate,
189 7 .
Or Sex of Infant (not named). li 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 furnishi 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 bot! 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 linman 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 hercinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth- with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed- ing fifty dollars.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
June 16ch. -
9 189
Name and age of deceased :
Age 64 yrs. mos. dys.
Dute and place of death :
Disease or cause of death :
Organic Ouvriers M Frank
Duration of disease :*
I certify that the above is true, to the best of my knowledge and belief.
Name and residence )
of physician.
1.
M. D.
* 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.
08.91 39.60
316 05%
ath occ
UNDERTAKER'S RETURN .- Boston.
Date of death,
June 16
1899 Name, Berge It. Kippen
Maiden name,*
. Sex, Share
Married, single, or widow of
marked wife of
Color, 27 Age, 6 years, Amos., days. Residence,.
Pris-Chiley
Place of death street and ) number
att Chance
ward
Place of birth,
England
Occupation,
Name of father,
Itilliana
Maiden name of mother. anna de
Birthplace of father,
Birthplace of mother,
Place of interment,? milliof Comedy
* If a married woman or a widow.
+ Give the name of the burial ground.
Signature of Undertaker :
Summer Flord. Undertaken
3 P.m. 3 Carriage
dea
-
RETURN OF A DEATH.
To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
Jeme 19"1899 Henry It's floyd
2. Name,
(Maiden Name),*
(Name of Ilusband) ,
3. Sex, and whether single, Married, or Widowed,
Malo
manuel
Milé
4. Color, t
5. Age,
62 Years, .. 7 Months, 19 Days.
Disease or Cause of Death, (Primary and Secondary ), # 6. Duration of Sickness, . By whom certified,
7. Residence,
Hantrop mass
Contractor
8. Occupation, . 9. Place of Death, . Winstrol? (Shuts RI) Chelsea Mass David Floyd Sally e. Jentes hun
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name). 13. Birthplace of Father, . Chelsea mass 14. Birthplace of Mother, . Chelsea Mass Hinttrop Develey 15. Place of Interment, Summer Floyd
Signature of Undertaker winther person making the Return, .
DATED at
Düntrop
, (11
delunes 19 189.8
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [ Be very particular to fill all Blanks.1 Plate. Ed. Dec., 1896 .- 5,000
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 300 ; Arts of 1889, Chapter 224 ; Arts of 1898, 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- 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 eause of death as nearly as he ean 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 3. 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 ease may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a 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 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 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,*
Date and Place of Death,t - died at
Henry Glia Floyd 16. Vily 97 Intestinal Laen
Age, 62
1899,
Disease or Cause of Death, - (Primary and Secondary.) Duration of Sickness, - -
of
1ex-1?
I certify that the above is true, to the best of my knowledge and belief.
.1 C.f 211220 x matura i h
Signature and Residence of Certifying Physician,
Date of Certificate,
1899%.
* 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 Sets of ISSS, Chapter 300 ; Arts of ISS3, Chapter 224; Arts of 1838, 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 furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the 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 conr ersign 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.
X
Commonlocalth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
2. Name,
une 28" 1899 albert Wells
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single,
Married, or Widowed,
4. Color, t
White
Years.
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, .
11. Name of Father.
12. Name of Mother, (Maiden Name),
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