USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 12
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190 /
Winthrop, Was
PHYSICIAN'S CERTIFICATE.
Name and Age of Deccased, t
Eliza Azbella Mathsuk
Age, 53Y. ) M.24D.
Place and Date of Death,
Primary,
Disease or Cause of Death, # Secondary,
dicd at.
Winthrop July 17
190 /.
Neurologia com
Heart Disease
Duration,
1 year
Duration,
Several years
I certify that the above is true to the best of my knowledge and belief. Edward Je Gage
M. D.
Signature and Residence S
of
Certifying Physician.
# 1BI Great care
Date of Certificate,
July 19.
190 /.
* Give also street and number, if any. [ Give sex of infant not named. If still born, so state. # If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Ayent of Board of Health.
Signature and place of business of Undertaker.
No. 34
RETURN OF THE DEATH
OF
Eliza abella Mattheus 135 Shirley Street at
July 1ty Date,
190./
Filed, July 18
190_ 1
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forthi the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the elerk of the city or town for registration.
ovonorling fifty dollars.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
année Mattheus
Sex,
Color,
Date of Death,
July 21
190; Age, 24 Years,
Months,
Days.
Maiden Name, { If married, widowed} or divorced.
Husband's Name,
Single, Married, Widowed or Divorced.
-~ Occupation,
Domestic
Winthrop Mars
*Residence, ¿ also state fully. Boston mass
Place of Birth,
*Place of Death,
182 Winthrop Street, Winthrop
Name and Birthplace of Father,. Wadsworth matthews Surry me
Maiden Name and Birthplace of Mother, Hannah L. Loyd Lymi mars.
Place of Interment, (Give name of Cemetery), Fitzwilliam J. By,
Dated at
Winthrop
Summer floyd
on
July 22
190 /
Signature and
place of business
of Undertaker.
Winthrop Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t annie Martinus Age, 24.Y -M -D.
Place and Date of Death,
died at Quick Consumpture Duration, 2 nies
Disease or Cause - Primary,
of Death, }
Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Q. E Johnson. M. D.
Signature and Residence S of
Certifying Physician.
Date of Certificate, July 20 190/.
· Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
{ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
...
Agent of Board of Health.
July 2/ 190%.
No. 35
RETURN OF THE DEATH
OF annie Mattheus L
Winthrop Mase at
Date, July 21 1901
Filed, July 22 1901.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after sueh death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In ease the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
FORM C.
Commonwealth of Klassachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Theffi tierce
.Sex Female Color,
Date of Death July 23
190/; Age, / Years, .... Months, 5 Days.
Maiden Name, {If married, widowed ) or divorced.
- -
Husband's Name,
Single, Married, Widowed or Divorced.
Occupation,
*Residence, { If out of town, )
¿ also state fully.
trailer Ih. Withroke Macs
Boston, mass. 22 Coolidas Sh.
Place of Birth, Charles St withusb Mass
*Place of Death,
Name and Birthplace of Father Edward Perce Somerville Mars Margaret S. Moraw Solo toutes Maiden Name and Birthplace of Mother
Dell Pack Genetiry Matiche Mass Place of Interment, (Give name of Cemetery ) ?.
Aethiop
Summer Floyd
Dated
July 2/4
190 /
on
Signature and place of business of Undertaker.
Winthrop Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Phyllis Pierce
Age, /x- M. 5 D.
Place and Date of Death, died at. Antropo mass July 23 190/ .
Disease or Cause of Death, Secondary,
cholera enfantine Duration, 4 days
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
M. D.
Certifying Physician.
Date of Certificate, July 24. 190/.
· Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
{ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
23
Duration, 5 days
Primary,
Brando- primomed
No. 36
RETURN-OF-THE-DEATH
OF
Thyllis Pierce Charles Street at
Date,
uly 23 1901.
Filed,
ily 24 "
1901.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit thicrcfor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
fifty dollars.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Fed. A. Johnson
Sex, Mala .Color, C , lahuta.
Date of Death,
July 26"
190 %; Age, 21 Years,
... Months, ......... Days.
Maiden Name. { If marnier, widowed } 3
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Sencilla
„Occupation,
SaldiEr.
* Residence, { If out of town, { ? also state fully.
Fort Bas to winthrop, mars. mains.
Place of Birth,
* Place of Death,
Fort Back winthrop mars.
Name and Birthplace of Father,. Unknown
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery), Sherburne W. 04.
Dated at .....
lowchrop mart
Summer Floyd
on
July 26"
190 /
Signature and place of business of Undertaker.
Winthrop Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Fred a. Johnson
Age, / Y. -M. D.
Place and Date of Death,
Primary,
Disease or Cause of Death, # Secondary,
died at ..
Fort Banks, Mens.
July 26
190 4.
with peritonitis
acute affrandicités, fulminatiny. Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
E. W. Unikham,
Signature and Residence S
of
M. D.
Certifying Physician.
Intent Rost Surgen s.a.
Date of Certificate,
July 26
190 /.
* Give also street and number, if any. t Give sex of infant not named. If still born, so state. { If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
I
No. 3%
RETURN OF THE DEATH
OF Ofred & Johnson Fort Banke Winthrop at 1
Date,
July 26" 1901
Filed, July 26
190 /.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a deatlı occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after snell death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper anthorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When snel statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Eliza Freeman tonles
Sex,
Color,
Date of Death,
, Quey 30
190/ ; Age, 57 Years,
9
Months,
8
Days.
Maiden Name, { If married, widowed }
or divorced. Eliza Freeman Stalcott
Husband's Name,
John Q1, Qfowler
Single, Married, Widowed or Divorced, Dorchester Mass / Edm Plan
*Residence, { If out of town, )
? also state fully.
Place of Birth, Barnard VI-
*Place of Death,
19 Washington avenue Ninthrojo
Name and Birthplace of Father, James F. Walcott Bamand IT-
Maiden Name and Birthplace of Mother. Rebecca Freeman Barnard TV
Place of Interment, (Give name of Cemetery), .. Royalston UT
Dated at
Obinthat
Signature and Summer Floyd
on
July 31 "
190 /
place of business of Undertaker. 18.0 ferman @ texel Winthrop
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Eliza truman towely Age, 5" x. 9 N. 8 D.
Place and Date of Death,
died at
July 30 190/ .
Disease or Cause | Primary, of Death, Secondary,
noncuiasis of une Bonneles Duration, year
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
S
Cinturato
M. D.
Date of Certificate,
1 190/.
* Give also street and number, if any. t Give sex of infant not named. If still·born, so state. { If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health. 20
Occupation, -
No. 38
RETURN OF THE DEATH
OF
19 grassi avenue Winthrop Mass at
Date,
July 30
._. 190.
Filed,
July 31
190. 1
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death ocenrs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death ocenrs, shall, within five days after the date of suel a death, give notice thereof to the board of healthi or to the elerk of the eity or town in which the death occurred.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the elerk of the city or town within the Commonwealth at which his vessel first arrives after sueh deatlı.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician who has attended a person during his last illness shall forthwith after the death of said person, npon request, furnish for registration a certificate setting forth the required facts.
SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he ean state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the faets required by seetion 1, to the board of health or to the elerk of the eity or town in which the death oeeurred.
[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]
SECTION 1. No human body shall be buried in a eity or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, lias been furnished, with a physician's certificate of the cause of death. When sueli statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.
1. . 1- 8- canadian not avecodling fifty dollars.
COUNTT OF MIDDLESEX
Commonwealth of Massachusetts
NO. OF BURIAL PERMIT.
George Yourley
Name of Husband,
(If widowed, married, or divorced.)
2. Color :
WHITE.
Brick (Negro or mixed).
CHINESE.
3. Sex :
4. Conjugal Condition :
.
SINGLE.
X
MARRIED.
DILORCEL
NOTE. - For Questions 2, 3, and 4, strike out words not applicable.
5. Date of Death
Year, 1901
Month, August 6. Date of Birth if obtainable
Month
fine
7. Supposed Age
Months,
1
14
Day, 019
Days,
8. Occupation,
(Return occupation for all persons 16 years of age and over -if under one xear return occupation of father.)
9. Place of Birth,
10. Name of Father,
(City or Town.)
Glascow, Scotland 12. Name of Mother,
(Full name.) Eliza Morel.
(Maiden name.)
13. Birthplace of Mother,
(State or Country.)
14. Place of Death, No.
Hintheof - maso
Pearl are.
STREET, CAMBRIDGE.
If death occurred in an institution, give the name of same,
Length of time deceased was an inmate,
, and previous residence,
15. Late Residence, No.
21 Houve St.
Street, Somerville (City or Town)
LENGTH OF RESIDENCE (in city or town),
Eight years -
16. Place of Interment,
Hoodlawn
(Cemetery.)
(City or Town and State.)
best Lockhart
SIGNATURE OF UNDERTAKER (or other person making the return),
RESIDENCE, NO.
Somerville Mass
Street,
(City or Town.)
NO. OF BURIAL PERMIT.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH
CAMBRIDGE
190
Name of Deceased* George Gourley Supposed Age, 40 Years,
Months, Days.
Place and Date of Death, No. Plant, Que,
aug 190
Disease or Cause of Death :
Chief Cause, Carin
DURATION.
Que Foto
years
Contributing Causet
erville years
Place where disease was contracted, if other than death,
I certify that the above is true to the best of my knowledge and belief.
Signature of Physician, Frederick & SweetfinD.
Residence, No./ 4900.000
Street,
Socuerode
* Or Sex of Infant (not named).
¡ If a soldier or sailor who served in the War of the Rebellion, Chief and Contributing causes must be given.
MARGIN RESERVED FOR BINDING. FILL OUT WITH INK ONLY, AND WRITE PLAINLY.
CITY OF CAMBRIDGE.
NO INCOMPLETE RETURN WILL BE ACCEPTED.
1. Name, in full
× MALE.
Year,
1861
Years,
40
Day,
24
Freighi- Moravi
Boston
11. Birthplace of Father,
(State or Country.)
Wieland-
24
Acts of 1897, Chap. 437, Sect. 1, 2, 3, 4, 5, 6, 7.
Steriox 1. No undertaker or other person shall bury a human body in a city or town, or remove therefrom a human body which has not been buried, except as provided in section two of this act. until he shall have received a permit so to do from the board of health. other than the selectmen, or its agent duly appointed for the purpose of issuing such permits, or if there is no such board from the clerk of the city or town in which the person died; and no undertaker or other person shall exhume and remove a human body from a city or town, or from one cemetery to another, until he shall have received a permit so to do from the board of health or its agent aforesaid, or from the clerk of the eity or town in which the body is buried. No such permit shall be issued until there shall have been duly delivered to sueh board, or agent, or clerk, as the case may be, a satisfactory written statement containing the facts required by law to be returned and recorded, which statement in every case of an original interment shall be accompanied by a satisfactory certificate of the attending physician, if any, as required by law, 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, or is insufficient, the chairman of the board of health, if a physician, or any physician employed by said board or by the selectmen for the purpose, shall upon application make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner only shall 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 forthwith countersign and transmit the same to the clerk of the city or town for registration. The person to whom the permit is so given, and the physician who certifles to the canse of death, shall thereafter furnish for registration any other necessary information that can be obtained as to the deceased, or as to the manner or cause of the death, which the elerk or registrar may require.
SECTION 2. No undertaker or other person shall bury in a city or town a human body or the ashes thereof brought into this Commonwealth from withont its limits until he shall have received a permit so to do from the board of health, other than the select- men. or its agent duly appointed to issne such permits, or if there is no such board, from the clerk of the city or townin which the body is to be buried or the funeral rites are to be held : provided, however, that if there is a person duly appointed to the care of the cemetery or burial ground in which the interment is made, and there is a record kept of the names of all AS Priol therein, or if there is a-duly appointed superintendent of burials in such city or town who keeps a record of interments. aid permit may be issued by such person having such care or by said superintendent of burials. Said permit may be granted mon delivery to said board, agent, clerk, superintendent or person having such care, as the ease may be, of a certificate giving the nanie the deceased person, his age as nearly as can be ascertained, the cause of death, the name of the city or town where he ist resided or from which the body was brought, or, if the death occurred at sca, the name of the vessel upon which it occurred, and any other facts requited for record which could be obtained with reasonable exertion. When such certificate is delivered to the board of head or to its agent, or to the superintendent or person having such care, the board, agent, superintendent or person having car hall forthwith. countersigh and transmit the same to the clerk of the city or town; and if the deceased person was at hic time o nis decease a resident of salg city or town the elerk shall record the same in the books kept for recording deaths; IN the decea: at the time of his death a resident of any other eity or town within this Commonwealth said clerk shall forthwith forward clerk of such other cify or town a certified copy of the certificate mentioned in this section.
SECTION 3. No person having the care of a cemetery or burial ground shall permit a human body to be buried thext or removed therefrom, or permit the ashes of a human body to be removed therefrom, until there has been delivered to him the permit fo the burial ofremoval of said body or ashes, nor permit the ashes of a human body to be buried therein until there has been delivered to lilm a certificate that the burial permit and the certificate of the medical examiner prerequisite to the cremating of vid bod have been duly presentedl.
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