USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1897-1899 > Part 8
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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
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, carly 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 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.
No.
Commonboralty of Massachusetts.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
201/1/89
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. Oceupation, . ·
9. Place of Death, .
10. Place of Birth, .
11. Name of Father, ·
12. Name of Mother, · (Maiden Name),
13. Birthplace of Father, .
Poland Snc
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
-
DATED at
on Aime 111 189.
* 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.
210
80 Years, 9 Months, C. .. Days.
......
Bluecenti
Greene me
20
[ 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 fast 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. Iu 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.
2.45
PHYSICIAN'S CERTIFICATE.
₹
Age, 80 gx-/mos
Name and Age of Deceased,*
Date and Place of Death, İ - , died at.
Hintof (Drach are" June 1" 18047.
Disease or Cause of Death, - of
(Primary and Secondary.) }
Duration of Sickness, -
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician,
Date of Certificate,
~ h. f . Que 4. 189) .
* 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.
# 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 deecased, his age, the disease of which he (lied, the duration of his last sickness, 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 faet that such a ehild 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 eanse of death as nearly as he ean 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 bry 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 eity or town, from the city or town clerk. No such permit shall be issued until there has been delivered to sneh board, or agent or clerk, as the ease may be, a satisfactory written statement containing the faets required by this chapter to be returned and recorded, together with the eertifleate of the attending physician, if any, as required by seetion three of this chapter, or in lien thereof a eertifleate 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 eity or town for the purpose shall, upon request of said board, agent or clerk, make sneh certifieate as is required of the attending physician ; and in ease of death by violence the medical examiner shall, if requested, make the same. When sueli satisfactory statement and certifieate are delivered to the board of healthi 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 eanse of the deatlı, 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- ing fifty dollars.
To the Clerk of the City or Town in which the death oc
Date of Death, .. June 8'
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
1897
Full Name of Deceased,
Maiden Name, .........
€
Reker
If a married or divorced woman or a widow give also Name of Husband, ... ........ +
While Single, Married, Widowed or Divorced, Bex, Male Color,
Age, 3 Years, 4 Months, 27 Days. Occupation,
& Residence
{ If out of town, {
( also state fully. f ..
Winthrop mass
Place of Death,
1. fremont Street
Place of Birth,
I Fremont Sheet Winthrop Mass
Name and Birthplace of Father, august Becker- East Boston
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery)
Wordlawn Cemetery Create
Dated at Winthrop
Summer floyd
on June 9'
Signature and
place of business
of Undertaker.
18 Heren Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Otto Wanulrope Beaker
Age, 0 84
M.27
D.
Place and Date of Death,
died at
Minitrop
lune of
1897
Primary,
malignant Ayletheria Duration,
Disease or Cause
of Death, ¿
Immediate,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Qr Bi me michael
M. D.
of
Certifying Physician.
Bart Berlin
Date of Certificate,
2580%
...
......
..........
RETURN OF THE DEATH
OF Otto Winthrop Beeper 1 Fremall Sheel at
Date, _.
June 8"
Filed,
time 800
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death occurs and the oldest next of kin of a deceased person in the or town in which the death occurs, shall, within five days thereafter, eause notice thereof to be given to the board of health o the town elerk.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the rd of health or to the elerk of the eity or town within the Commonwealth at which his vessel first arrives after such death. SECTION 8. Penalty for negleet to comply with the requirements of seetions 6 and 7, five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the rest of an undertaker or other anthorized person or of any member of the family of the deceased, furnish for registration 'rtificate setting forth the required facts.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and secondary or immediate cause of death as nearly as he ean state the same. . Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who lias charge of a funeral, shall forthwith obtain the physician's cer- ate required by section 10, enter thereon the facts required by seetion 1, and return it to the board of health or to the elerk he city or town in which the death occurred. The person making such return shall receive from the eity or town a fee of nty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a eity, or town or remove therefrom a human y which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a
No.
Commontocalth of Massachusetts. 6
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),
Shine 13"18,9% Chite nut
2.13
3. Sex, and whether single, ! Married, or Widowed, 1
4. Color, i
5. Age, .
Years, 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.
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father,
14. Birthplace of Mother, .
15. Place of Interment,
1
١ Summer 1
,
18
4
.
* 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., 1896 .- 5,000.
Signature of Undertaker otherperson making the Return, .
DATED at
Viment ana 1
[Public Statutes, Chapter 32, as amended by Acts of 1888, 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 ehild 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 physleian refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the nse of the town in which he resides.
SECTION 5. No undertaker, sexton or other person shall tiry in a city or town or remove therefrom a human body nntil lie has received a permit so to do from the board of healthi or its duly appointed agent, or, if there is no board of health in such eity or town, from the city or town clerk. No such 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 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 fortl with eountersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so give shall thereafter furnish for registration any other information as to the deceased or to the inanner and cause of the death, as t clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not excee. ing fifty dollars.
-
6
PHYSICIAN'S CERTIFICATE.
Charlotte M Collins Antrop (Somerset are) June 13" 180%
Age, 32-6-21
Name and Age of Deceased,*
Date and Place of Death,t died at
Disease or Cause of Death, - (Primary and Secondary.)} 1 Duration of Sickness, - -
I certify that the above is true, to the best of my knowledge and belief.
"gnature and Residence of Certifying Physician,
Date of Certificate,
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.
,
of Tuberculosis
[ 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 (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 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 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 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 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 certifleate as is required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same. When sneh satisfactory statement and certificate are dellvered 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 eause of the death, 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- ing fifty dollars.
No ..
Commontorattly of 2Massachusetts.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
Martes 1 6 1897
2. Name,
(Maiden Name),*
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age,
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, .
Withurp
Licciana A. Menclo
11. Name of Father,
12. Name of Mother, ·
(Maiden Name),
gal
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Winthrop Con ile.
Signature of Undertaker or other person making the Return, .
DATED at
on June 16 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.] Plate. Ed. Dec., 1895 .- 5,000.
.........
10. Place of Birth, .
Shirley Street
[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, fortliwith furnish for regis- tration, a certificate statiug, 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 lias 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 refnses to make a certificate as aforesaid, or makes a false statement thereiu, 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 treasurcr 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 dnly 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 liereinafter provided. If there is no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enongh for the purpose, the chairman of the board of healthi 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 tlie 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,*
Love & Daniels
Date and Place of Death, t - died at
Winthrop (Charley Rd) June 16 1804 Age, / mo
Disease or Cause of Death, - (Primary and Secondary.) } Duration of Sickness, -
of Max nutrition
Formaneclar I certify that the above is trug, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, 2.19. mais /2/2
Date of Certificate,
11 189%.
* Or Sex of Infant (not named). If stillborn so state.
¡ If child died immediately after birth so state. Plate. Ed. October, 1895 .- 5,000.
turf 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. j
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 aud 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 chilld dying immediately thercafter, or at the birth of a stillborn child, shall, when requested, forthwith furuish 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, 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 bothi 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 forfcit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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