USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 41
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RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
December 5" 1899 Avenue Henry Dowell
2. Name,
(Maiden Name),*
(Name of Husband) ,*
3. Sex, and whether single,
Married, or Widowed,
4. Color, t
5. Age,
Years, 6 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, .
Cambridge Cancelar
DATED at , on 181. 23
* 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.
Malo
garnier Teile
no 17. dammi Plan
Mars Real
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 20
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for res. 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 deceasc; and a physician who has attended at a birth of a child .dying immediately thercafter, 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, thic 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, t Place and Date of Death, } died at
Disease or Cause of Death, §
John H. Dowell Age, 6%. CAND. Winthrop (Armin Rl) Dec 6" 1899 approplety
Duration of sickness,
Tivents for
~ hours
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
Winthrop Mass M. D.
Date of Certificate,
Dec. 8 M
189 9.
Give also street and number, if any.
+ Or sex of infant not named. If still-born, so state. # If child died immediately after birth, so state. § If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
RE
at
Date,
Filed,
The provisions of chapter 444 of the oldest person next of kin present at the time whieli a death occurs, shall, within five days the clerk of the eity or town in which the de The commanding officer of a vessel sh: or to the clerk of the city or town within the Penalty for negleet to comply with the A physician who has attended a pers request, furnish for registration a certificate : Penalty for refusal or negleet, ten dol
Any person having charge of the funere certificate made in accordance with section health or to the clerk of the city or town in
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,
10/1819
adelina Ramadale Heia
05 Fernanda
4. Color, t
5. Age, 59 Years, .....
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 or other person making the Return, .
DATED at
4 Sement Chest 11/00 7 2
Baykal
Chamber
18
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion.
{ If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what. [Be very particular to fill all Blanks.] Plate. Ed. May, 1895 .- 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- 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 ease 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 negleets 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 auy physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such ecertificate 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 whoin 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, t Place and Date of Death,
Disease or Cause of Death, §
adeline Q Gove Age, .. died at Mindenof December 10'
189
9
monia Typhoid
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
M. D.
Winthrop
Date of Certificate,
Dec 175
1899.
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If child died immediately after birtli, so state. § If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
...
at
Dat
File
The provisions of chapter 444 of tl oldest person next of kin present at the ti which a death occurs, shall, within five da the clerk of the city or town in which thic The commanding officer of a vessel or to the clerk of the city or town within 1 Penalty for neglect to comply with t A physician who has attended a pe request, furnish for registration a certificate Penalty for refusal or neglect, ten d
Any person having charge of the fun certificate made in accordance with section health or to the clerk of the city or town
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Gra MU Dames
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex,
Color,
Date of Death,
December 31
1899; Age, 29
.Years,
8
Months, 22
Days.
Maiden Name, { If married, widowed ) authen
or divorced.
Husband's Name, William D. Dames
Single, Married, Widowed or Divorced, Married Occupation,
* Residence,
If out of town,
19 Bowdown Street
also state fully. y
Place of Birth, Charlottetown 9 6, Epland
*Place of Death,
49 Bowdown Street Winthrop
Name of Father,
Orilliam & authen
Birthplace of Father, . anna aitRan
Maiden name of Mother,
Charlottetown P/6, Esland
Birthplace of Mother,.
Jememary Deposit- Recevant
Place of Interment, (Give name of Cemetery),
Dated at
Hinttrop
on
January !"
19900
Signature and place of business of Undertaker.
Summer Floyd
1
No.
JRN OF THE DEATH
OF
-
189
.
-
1
189
Acts of 1897 require that every householder in whose house a of the death of any of his kindred, or the person in charge of after the date of such a death, give notice thereof to the board ath oceurred. (Sec section 6.)
ill give notice of the death of any person under his charge to th Commonwealth at which his vessel first arrives after such death. , requirements of sections 6 and 7, five dollars. (See section 8 on during his last illness shall forthwith after the death of setting forth the required faets. (See section 10.)
lars. (See section 11.)
eal rites preliminary to the interment of a human body shall obt 10, and return it, together with the facts required by section which the death occurred.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, Place and « Date of Death, ; Disease or Cause of Death, §
Eva IM Douanes Age 29× 8 M22D.
December 1899
died at
Precumonia
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
M. D.
Date of Certificate, 2 mon
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If child died immediately after birth, so state. § If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
....
at
Dat
File
The provisions of chapter 444 of tl oldest person next of kin presen at the t which a death occurs, shall, within 6. the clerk of the city or town in which the The commanding officer of a vessel : or to the clerk of the city or town within Penalty for neglect to comply with1 A physician who has attended a pe request, furnish for registration a certificate Penalty for refusal or neglect, ten d Any person having charge of the fun certificate made in accordance with section health or to the clerk of the city or town
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