USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 6
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37 | Part 38 | Part 39 | Part 40 | Part 41
UNDERTAKER'S RETURN .-- Boston.
Date of deathì,
189Z. Name,
Lillie 13 Chase
Maiden name,*
Sex,
Married, single, or widow of wife of
Color, W Age 20 years, 9 mos., 7 days. Residence,
,Collage Park Road
Place of death ( street and number a), Cottage Park Road Winthushard
Place of birth, Ca. Bostona
Occupation Get Herne
Name of father,
Osgood
Maiden name of mother,
Lillie Bruce
Birthplace of father,
Birthplace of mother,
Tambudge
Place of interment,t
Woodlawn.
Cent
* If a married woman or a widow.
t Give the name of the burial ground.
Signature of Undertaker : E. G. Brun
0
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
above 15-1897
1. Date of Death, .
2. Name, ·
(Maiden Name),* (Name of Husband),
3. Sex, and whether single, Married, or Widowed,
4. Color, t
3 ... Years, 2 Months, 13 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,
12. Name of Mother, · (Maiden Name),
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker on other person making the Return, .
DATED at
, on Pavel 15 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. Dee., 1895 .- 5,000.
16.0
Jan
.....
male
5. Age,
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 whleh 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- 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 rebelliou, 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 nntil 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 elerk. 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 faets 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 snch 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 alarte ar maristrar maur rasquira Any person violating any of the provisions of this section shall be punished by a fine not exceed-
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,* Nuovice Other
Date and Place of Death, t -
died at.
Disease or Cause of Death, - (Primary und Secondary.)} ته Duration of Sickness, 9 Y
of .
Age, M3-3-13 Winthrop (Sargent Street apie 1.5 180mg neumonia
10 days
-
I certify that the above is true, to the best of my knowledge and belief.
: Signature and Residence of Certifying Physician,.
Date of Certificate,
avril 18 189 }.
* 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 persou 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 inmediately 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 seetion 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 physielan cannot be obtained, for good and snfilcient 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 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.
Commontocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
May 9" 1897 Ella 10, Payne
2. Name,
(Maiden Name),*
(Name of Husband), *
Jan Inorge F, Payne Efenvale
3. Sex, and whether single, Married, or Widowed,
Mariée Shire
4. Color,t
44
Years,
6 Months,
Days.
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
Ditherap mass
7. Residence,
8. Occupation, .
9. Place of Death, .
0. Place of Birth, .
Bolo Mass
Henry Of, Fare Jay
mary Faci
2. Name of Mother, . (Maiden Name),
3. Birthplace of Father, .
4. Birthplace of Mother, .
Nima metros, Cemetery
5. Place of Interment,
Signature of Undertaker w. other person making the Return, .
Summer Floyd)
ATED at.
, on
May 9"1
189.7
* 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. Dec., 1895. - 5,000.
AN Pracy 9. Brown
5 Thamton Park
1. Name of Father,
South low Mass
Maunchuck N. S.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.1
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 deccased, 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 cause of death as nearly as he can state the same. If a physician refuscs 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 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 licu thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attenumg 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 excecd- ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,'
Ella S. Payne
Date and Place of Death, t - died at
Disease or Cause of Death, - (Primary and Secondary.) ; Duration of Sickness,
Age, 44 ys 6mos Northropof howden Park) May 9" 1897, of Carcinoma I mejlet breast, and Secondary clumin varenby mations suplentes I certify that the above is true, to the best of my knowledge and belief.
Ercy
Signature and Residence of Certifying Physician,
1 Date of Certificate, .
May 10
189
# If a soldier or sailor who served in the War of the Rebellion.
* Or Sex of Infant (not named). If stillborn so state.
t If child died immediately after birth so state. Plate. Ed. October, 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 physiciau 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, tlie duration of liis 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 faet 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, lic shall be punished by a fine not exceeding fifty dollars. In case the deccased 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 he shall forfeit to tlie 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 tlerefrom a human body until lic has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of liealth 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, togetlier with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thercof 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 sliall, 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 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 section shall be punished by a fine not exceed- ing fifty dollars.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred,
1. Date of Death, . .
Thay 9 " 1897 Florence Aoise
2. Name,
.
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
White
5. Age,
20 Years, 5 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, .
.0. Place of Birth,
1. Name of Father,
2. Name of Mother, ·
Susie Farrell · ... (Maiden Name),
3. Birthplace of Father, .
4. Birthplace of Mother, .
5. Place of Interment,
Signature of Undertaker or other person making the Return, . .
-
Summer Floyd)
ATED at
, on ..
may 10'
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 Raecs, specify what.
[Be very particular to fill all Blanks.] l'late. Ed. Dee .. 1895. - 5.000.
Ar 16 F. Lage
188 Longwood Meno Boston
athome
Perkins Street, Si Head
Jacob Ss, Housses
Botón mass
Encontreal Canada
HolyRood Carneten Brocherio
.......
Female (Inigle
[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 siekness, and the date of his deeease; 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 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, 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 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 elerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Name and age of deceased : Florence
Boston,.
alourar
189 ... 7
Age 20 yrs 2 ... mos .. ( .. dys.
FU
Date and place of death:
Disease or cause of death :
aguaated by attack of
acente indirection
Duration of disease :*
I certify that the above is true, to the best of my knowledge and belief.
Name and residence
A Gage
M. D.
of physician.
¿ Quard
*13: Great care
9/ cultural
* It is very desirable to be informed of the duration of the disease.
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, .
1501 16. 1.1.
2. Name,
Share The C C
(Maiden Name),*
(Name of Husband),
3. Sex, and whether single, Married, or Widowed,
4. Color, j
5. Age, 37 Years, 9 .. Months, 2 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, .
1. Name of Father,
2. Name of Mother, ( Maiden Name).
3. Birthplace of Father, .
4. Birthplace of Mother, .
5. Place of Interment,
Signature of Undertaker or other person making the Return, .
1
Daily
Y
1
ATED at
Tive
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. 1 Plate. Ed. Dec., 1896 .- 5,000
[ Public Statutes, Chapter 32, as amended by Acts of ISSS, Chapter 306 ; Acts of 1889, Chapter 221 ; Arts of 1893, Chapter 2'
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for r tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which tied, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child (' immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certific 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 n lects or refuses to make a certificate as aforesaid, or makes a false statement therein, ne shall be punished by a fine not exceedir. fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give be the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or negle 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 eity or town or remove therefrom a human body until li 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 cit. or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent ‹ clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned a recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in ' thereof a certificate as herciuafter provided. If there is no attending physiciau, or if the certificate of the attending physic canuot be obtained, for good and sufficient reasous, early enough for the purpose, the chairman of the board of health or physician employed by a city or town for the purpose shall, upon request of said board, agent or elerk, make such certificate required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the s When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or ageut sha with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so ; hall thereafter furnish for registration any other information as to the deecased or to the manner and cause of the death, a clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not excel ing fifty dollars.
PHYSICIAN'S CERTIFICATE.
" d:
vikme and Age of Deceased,* 59
Date and Place of Death, t - died at
22 Main Sh. Hunthis May 16th 189 7. Carcinoma of Bladdewith Exhausting of
Disease or Cause of Death, - 9
(Primary und Secondary.)} Irration of Sickness, -
Luknom
I certify that the abque is true, to the best of my knowledge and belief.
113% ffe and Residence of Certifying Physician, IStilor
Parks, MD, 31 Princelow St, ER
Date of Certificate,
May 17th 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.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.