USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 36
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13. Birthplace of Father,
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
1 ١
Summer Floyd
DATED at
, On
- * 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.] Piate. Ed. Dec., 1596. - 5,000,
1
Male
Dr Fa Hanis Winthrop Mais
Of Rece Kler Printrop al Irelles
England England Nontrop amely
[ 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 regls- 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, 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 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 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 healthi or any physician employed by a city or town for the purpose shall, npon 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 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.
albert Delle
Name and Age of Deceased,*
Date and Place of Death,t - died at
Age, / yr 11 hrs-1d Winthrop (Pesce St) June 28" .899, of heerdewhat does
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, - -
I certify that the above is true, to the best of my knowledge and belief. Y Signature and Residence of Certifying Physician,
Date of Certificate,
June 30
.. 1899 .:
* 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. December, 1896. - 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 kuowledge and belief the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforcsaid, or makes a false statement therein, 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 sun 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 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 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. Wlien 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 deathi, 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,
adoram os mith female (r) married mité
1. Color, t
5. Age, 36 Years, 6 Months, 17 Days.
Disease or Cause of Death, (Primary and Secondary), # 1
6. Duration of Sickness, . By whom certified,
7. Residence, Winthrop mars
8. Occupation, . Marshall Street
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
Hava Perlia Joseph ni Kempen Many M. Hammond Nova Sentía
12. Name of Mother, . (Maiden Name),
·
13. Birthplace of Father, .
Nova Scotia
11. Birthplace of Mother, .
15. Place of Interment,
Winthrop Comeles Single trae For Summer Floyd
Signature of Undertaker or other person making the Return, .
DATED at
Winthrop
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. (1.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. Dec., 1896. - 5,000.
uly 1 "1899 Edith M Smith.
[ 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 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 child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate, stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physleian neg- lects or refuses to make a certificate as aforesaid, or makes a false statement 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 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 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.
Name and Age of Deceased,*
Educa Mr. Smith
Date and Place of Death, t - died at
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, - -
of
Age, , 36 yrs Gine 19d. Winthrop (Marshall St) July 1" 1899, Chronic Interstitial hephritis not known
I certify that the above is true, to the best of my knowledge and belief.
St.
son for Princeton
ignature and Residence of Certifying Physician,
Date of Certificate, ....
Cama 30
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 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 lis 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 rchellion, 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 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 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 inay 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, .
uly 2" 1599 alexandre Harrington
2. Name,
(Maiden Name) .*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Odarrington Female Married white
4. Color, ¡
5. Age,
39 Years,C Months, Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness. . (By whom certified,
7. Residence, Winthrop Mars 8. Occupation, . Trident avenueO, pray 9. Place of Death, . Pt deland alexander MC innis Eliza mo Sims Op 6. ORland
10. Place of Birth, .
11. Name of Father,
12. Name of Mother. . (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
E. Upland
15. Place of Interment, E, Oppland
Signature of Undertaker another person making the Return, . -
Summer Floyd
DATED at
July 3" 1
9.9
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion.
1 lf 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.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts 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 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 ncg- leets 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 case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall glvc 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 certifieate he shall forfeit to the treasurer the sun 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 eertificate 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 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 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 death, as the clerk or registrar may require. Any person violating any of the provisions of this section shail be punished by a fine not exceed- ing fifty dollars.
Seedate
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Alexanderig Harrington
39.
Date and Place of Death, t -
22 Tudent the
Age, July 2 Wirthof 18 .189 ៛. ,
died at Buinchilis Pneumonia, Buchilis
Disease or Cause of Death, - of
(Primary and Secondary.) } Duration of Sickness,
Three weeks and one half.
I certify that the above is true, to the best of my knowledge and belief.
Edward F. Eage M. D.
Signature and Residence of Certifying Physician, Leini Black . Winther a Beach Date of Certificate,
celare. July 3 1899.
* Or Sex of Infant (not named). If stillborn so state.
t If child died immediately after birth so state. Plate. Ed. December, 1996. - 5,000.
t If a soldier or sailor who served in the War of the Rebellion.
[Public Statutes, Chapter 32, as amended by Arts of ISSS, Chapter 300 ; Arts of ISS9, 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 discase 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 canse of death as nearly as he can state the same. If a physician refuses or neglects to make such certifieate 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 violenee 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.
July 2nd 1899
Name and age of deceased :. Thomas Grilem trilem Francia Age. 1 yrs. 11 mos. 26 dys. July 2nd 189- ISay awas an Die throp Highlands. Date and place of death :. Central Recursosbaja following
Disease or cause of death :
Duration of disease. * .
levis hours
I certify that the above is true, to the best of my knowledge and belief.
Name and residence of physician. 18 Lagamin An. WinthropHighlands, E. G. Druword,.
* It is very desirable to be informed of the duration of the disease. When more than one cause of death is mentioned state the duration of each.
UNDERTAKER'S RETURN .- Boston.
Date of death, July 2
189 Name, ....
Horas Filson Francis
Maiden name,*
Sex, 2L
Married, single, or widow of
Color, W
wife of Age, / years, // mos. 26 days. Residence, 7 Sagamore It treet and), ? Sagamme a Place of death (
.Ward
Place of birth, E. Boston Occupation,.
Name of father, Plcamas Maiden name of mother, Cattierien a Bagau Birthplace of mother, 8. Bas low
Birthplace of father,
Place of interment, t.
"Holy Cross" Malden-
* If a married woman or a widow. t Give the name of the burialground.
vhost Name.
Undertaker.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City of Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name, Found ahow ar Sex, Color.
Date of Death,
1899; Age, ~ Years, Months, 5 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation,
*Residence, ¿ If out of town, } ( also state fully. )
Place of Birth,
*Place of Death,
Name of Father, Birthplace of Father, Maiden name of Mother, Birthplace of Mother,
Place of Interment, (Give name of Cemetery),.
OF THE DEATH
OF
.......
189
189
quire that every houscholder in whose house a death occurs, the any of his kindred, or the person in charge of an institution ir such a death, give notice thereof to the board of health or to ec section 6.)
the death of any person under his charge to the board of healthi t which his vessel first arrives after such death. (See section 7.) sections 6 and 7, five dollars. (See section 8.)
illness shall forthwith after the death of said person, upon quired facts. (Sec section 10.)
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