USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 5
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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),
Eliza a. Bufferce
(Name of Husband),
Walter Wilkie
3. Sex, and whether single, Married, or Widowed,
Female
Widowed
White
...
5. Age, 78 Years, 0 Months, 23 Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
9. Place of Death, .
Fremont8h
10. Place of Birth, .
Buffalo n.Y.
11. Name of Father,
Enfin
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Winch: 1- Cemetery
1
Dunne
Floyd
Signature of Undertaker or other person making the Return, . .
DATED at Winthrop
, On Silver, 18"1897
* 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. Dee., 1895 .- 5,000.
L
.
le
4. Color,t
Vicar, 18 ' 1897 Eliza a. Wilkie
5
[ 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 deecased; his age, the disease of which he died, the duration of his last sickness, and the date of his deerase; 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 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 botli 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 snch 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 sueh 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 ehapter, 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 sueh certifieate 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 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.
Eliza
Name and Age of Deceased,*
Date and Place of Death, t - died at ...
Disease or Cause of Death, - of
(Primary und Secondary.) }
Duration of Sickness, -
I certify that the above is true, to the best of my knowledge and belief.
N
Signature and Residence of Certifying Physician,
Date of Certificate,
A (2 march 20189 7
* Or Sex of Infant (not named). If stillborn so state.
¡ If child died immediately after birth so state. Plate. F.d. October, 1895. - 5,000.
{ If a soldier or sailor who served in the War of the Rebellion.
78 yr. 23 days Age, / Zuarch 18 1897, Cancer a' Stanach. 1
[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, wheu 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 samc.
to make such certificate he shall forfcit to the treasurer the sum of ten dollars for the use of the town in which he resides.
If a physician refuses or neglects
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 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 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 physiclan cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chalrman 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 samc 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,.
las.
225
Name and age of deceased :
Gestione Watthen.
Age:
21
.yrs ........ ..... mos. dys.
Date and place of death:
mas.
225
certainsto -1horas
Disease or cause of death :
fricile
... ....
...
Duration of disease.
I certify that the above is true, to the best of my knowledge and belief.
Name and residence )
of physician.
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.
189 ..
UNDERTAKER'S RETURN .- Boston.
Date of death, March 22'
189 ...
Name,
Gertrude M. Natheys
Maiden name,*
Sex,
Marriett, single, or widow of
Single wife of
Color,
W Age 21 years, 5 mos., 13 days. Residence,
Coral avenue O Spray
Place of death ( ( street and)
number )
Coral avenue Beau feray ward 2
Place of birth,
Omeville Mass Occupation,
Book-Keeper
Name of father,
William
Maiden name of mother,
Elizabeth O. Jordan
Birthplace of father,
Para Sertía
Birthplace of mother,
Upra Sentía
Place of interment,t
Hardlawn Cemetery
* If a married woman or a widow. + Give the name of the burial ground.
Signature of Undertaker : Summer Floyd
Marita Mass
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
March 31" 189%
Claviera B. dinibat !!
2. Name, .
(Maiden Name), (Name of Husband),*
Fernale
3. Sex, and whether single, Married, or Widowed,
garcia
Stile-
4. Color, ¡
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,
Signature of Undertaker mother-person making the Return, .
-r
DATED at Thru
, on
2271 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., 1895 .- 5,000.
66 Years, 1 Months, ... ...... Days.
Of Burhan
6. 1
[ 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 siekness, and the date of his deeease; and a physician who has attended at a birth of a child dylng 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 dcad. 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. Iu case the deceased was a soklier or a sailor who served in the war of the rebellion, the physician shall glve bot !: the primary and the secondary or immediate cause of death as nearly as lie can state the same. If a physician refuses or negleets to make such certificate he shall forfeit to the treasurer the sumn 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 permlt 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 canuot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of licalth or any physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make snell 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 elerk 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,*
Claricea B. Ingraham
Age,
66 yrs 4 anos
Date and Place of Death, t - died at. Winthrop (Marshall SV) March 21" 18947, Cerebral Meningite
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness,
of .
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, ..
Date of Certificate, L
1897
* Or Sex of Infant (not named). If stillborn so state.
If child died immediately after birth so state. Plate. Ed. October, 1895 .- 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 le lied, the duration of his last sickness, and the date of hils 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, fortliwith 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 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 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 snch permit shall be issned 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 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.
· Commontocatth 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,
22 Years,
X
Months, ..
2 Days.
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,
Louis. Marcham David Hathaway Emily 15
12. Name of Mother, (Maiden Name), South Warchan
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, . ·
DATED at
, on
march31
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., 1895. - 5,000.
March 312h 97 Edward C. Hathaway
Jungle ...
... ..
Consumption 3 years
South Wareham Mese
Windhoos Just
Lunacy, Missouri
Marchand
[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 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 dyhng 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 he ean state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of teu 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 faets required by this chapter to be returned and recorded, together with the certificate of the attendiug 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 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; aud iu 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 aud 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 aud 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.
-2 JG
PHYSICIAN'S CERTIFICATE.
Age, · Name and Age of Deceased,*
1
Date and Place of Death,t -
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness, - -
of.
died at theep ( che cho, Pc. 1 189,, Vabienton ery the Lunga a foort 3 learn
I certify that the above is true, to the best of my knowledge and belief.
-
911. Signature and Residence of Certifying Physician,
Date of Certificate,
189
·
* Or Sex of Intant (not named). If stillborn so state.
[ If child died immediately after birth so state. Plate. Ed. October, 1895 .- 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 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 (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 furuish 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 Ilfty 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 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.
Name and age of deceased : Lillie B. Chase
Boston,
April 14'
189.
Age ... 20 yrs. 9 . mos ..
dys
Date and place of death : April 14-97
Cottage Park Road Winthrop
Disease or cause of death : .
Diabetes
...
Duration of disease .*
Fem years
I certify that the above is true, to the best of my knowledge and belief.
Name and residence
1
Some. M. D.
of physician.
* 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.
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