USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 39
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SECTION 5. No nndertaker, 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 snch 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 licu 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 cnough 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.
UNDERTAKER'S RETURN .- Boston.
Date of death, Oct 6
189.9 Name, ... Edward Cafe 1
Maiden name,
Sex, MY.
Married, single, or widow of wife of Color, M. Age, 73 years, 5 mos., 3 days. Residence, 30 Need It
Place of death (8 number 1),30 reade It Willnot
Ward
Place of birth, Canada Occupation, Haberer
Name of father, David Ma Maiden name of mother,. Jouir Gerald
Birthplace of father, Canada
Birthplace of mother, Canada
Place of interment, f "Holy Cross" Malden
* If a married woman or a widow. t Give the name of the burial ground.
Thes. J. Lane
Undertaker.
1
دم صم
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Oct 189
Name and age of deceased:
Waterand Ein
Date and place of death :
Det 6.18969
Disease or cause of death :.. 1 LAAchuna 1
a of Stomach.
<
Duration of disease: *
Que lilerea 7
I certify that the above is true, to the best of my knowledge and belief.
Name and residence of physician.
€,
---
* 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.
The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A.M. till 1 P.M., except during the months of June, July, August and September, when the office will be closed on Saturdays at 12 M. ; Sundays, 10 A. M. till 12 M. ; Holidays, from 10 A.M. till 12 M .; other days, from 9 A. M. till 5 P.M.
-
Age. 73 13 mos. 3 ays. Is Read UB Fretten
.....
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
4 189
Name and age of deceased:
6 Boston Edward En Age.
1 3 yrs. 130
yrs .
mos. Says,
Date and place of death :
Det 6.18969
To Read
Disease or cause of death : Diciona of Alomach.
Duration of disease : *
Que til leje a 7 e .
I certify that the above is true, to the best of any knowledge and belief.
Name and residence of physician. (Detant Freeway Ox and SIND2 2
1
* 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.
The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A.M. till [ P.M., except during the months of June, July, August and September, when the office will be closed on Saturdays at 12 M. ; Sundays, 10 A. M. till 12 M. ; Holidays, from 10 A.M. till 12 M .; other days, from 9 A.M. till 5 P.M.
٢
UNDERTAKER'S RETURN .- Boston.
Date of death, Oct 6
189 9 Name, ..
Edward Caja 1
Maiden name, *.
Sex,
Married, single, or widow of
wife of
Color, W. Age, 73 years, 5 mos., 3 days. Residence, 30 Need It
Place of death (street and number 1,30 Teade It Willerop
Ward
Place of birth, Canada Occupation, .. Haberer
Name of father, David Maiden name of mother,
Jouir Gerald
Birthplace of father,« Canada
Birthplace of mother,
her, Canada
Place of interment, t
Holy
Grass".
Malden
* If a married woman or a widow.
t Give the name of the burial ground.
has. I. Lane
Undertaker.
5.
....
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
Detile 9"1899
1. Date of Death, .
2. Name,
(Maiden Name) ,
1
(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. 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 or other person making the Return, .
1 ١
DATED at Det 9
14901
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., 1590. - 5,000.
3 & Years, Months, 9 Days.
Englad
[Public Statutes, Chapter 32, as amended by _Acts of ISS8, Chapter 306 ; Acts of ISS9, 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 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 arc 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.
Vame and Age of Deceased,*
3/ge-11sure 9 Ase,
Date and Place of Death,t
Disease or Cause of Death, - (Primary und Secondary.)}
Duration of Sickness, -
- died at Finitoof October 9" 1899 Riosgia resulting from Septic Recomboris origination of in lift whenel Software view, Secondway DEgripelas followed by RD. Robor Paeonia and a general Pyormia about nine days. - Howhard condition.
I certify that the above is true, to the best of my knowledge and belief.
ignature and Residence of Certifying Physician, Frank A Lillan. 15 Princeton str Enn Boots Date of Certificate, Oct 2 10 . 1899.
Or Sex of Infant (not named). If stillborn so state.
t 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 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 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, 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 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 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.
Isapatie Thounitario
Pyarmina fram
universidade- euro a
9
OFFICE HOURS: I to 3 and 7 to 8 P. M. Sundays, 12.30 to 1.30 P. M.
Premiery
FRANK H. TILTON, M. D. 15 Princeton Street. CONNECTED BY TELEPHONE.
RETURN OF A DEATH. To the Clerk of the 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 Siekness, . 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, . 4
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker wother person making the Return, .
1
, on
Des 12
189.2
* 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 whal. [Be very particular to fill all Blanks.] Plate. Ed. May, 189S. - 5,000.
J. M. Strach Female
Married, White
ZA Years, 2 Months,- 1.8 Days. General Paresis Caramma 4
T
Winthrop 0
E das courts Me Sallodge
Illaryfibras
Winthrop, Cemetery
Summer Floyd
DATED at Minttrop
Oct 11 ut 18 99 Mary P. Strach
Dodge
[ Public Statutes, Chapter 32, as umentled by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith 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, forthiwith furnish for registration a certificate, stating to the best of his knowledge and belief the faet 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 ease 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 deatli, as the clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fiue not exceed- ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
= ame and Age of Deceased,* mary Patront died at3 Pleasant St Unitirob ate and Place of Death,t -
Age, 74-2- oct 11h
hus 189 4 ,
icease or Cause of Death, - * (Primary and Secondary.)} uration of Sickness, - -
of General, Paresis, Carcinoma abdominal 9 minutos
I certify that the above is true, to the best of my knowledge and belief. Bin hits Metcalf M.N.
nature and Residence of Certifying Physician,
Date of Certificate, art. 1.h
1894
)r 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 300 ; Arts of 1889, Chapter 221 ; Acts of 1993, 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- 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 lie 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 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 fortlı- 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 inanner 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, .
Och 144 th bases M Alvoul ....
2. Name, ·
(Maiden Name),* ·
(Name of Husband),
3. Sex, and whether single, Married, or Widowed,
Male
Married
4. Color, t
5. Age, 75 Years, 4 Months, Days.
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,
Signature of Undertaker other person making the Return, .
-
Dummer Floyd)
DATED at
Minitrop
, on ..
Oct 15"
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.] Plate. Ed. May, 1893. - 5,000.
Chewits 1.
[ Public Statutes, Chapter 32. as amended by Acts of ISSS, Chapter 306; Acts of 1889, Chapter 294; 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 hls 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 inakes 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 élerk, 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 arc 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.
me and Age of Deceased,*
F
te and Place of Death, T died at .. . dat os lov Ast et /4h
Age, 75-4- 189 ,
sease or Cause of Death, - (Primary and Secondary.)}
of Cerebral
Lage
ration of Sickness,
I certify that the above is true, to the best of my knowledge and belief.
nature and Residence of Certifying Physician .......
12
Date of Certificate, $14
189
·
r Sex of Infant (not named). If stillborn so state. f 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 kuowledge 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 physiclan 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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