USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 14
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# 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.
.
Sylvanus Payne died at .. Winthrop Mass
Age, SOY. / M .. ...... D.
No. 45
RETURN OF THE DEATH
OF
Бувranue Payne nos Scritto Sweet at
Date, auquel 28' 190 ...__
Filed, august 29 190_ 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 oceurs, 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 negleet 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 faets 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.
Desalty for violation on not exceeding 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,
Onen nue Carthis
Sex.
m
Color,
Date of Death,
September 8
190; Age, J6 Years, ~Months, Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorcek.
Occupation,
Labour
*Residence, { If out of town, )
35 fremont Sheet
¿ also state fully. 3
Cork, Ireland Winthrop
35 Fremont Street Sanitary,
*Place of Death,
Name and Birthplace of Father, Timothy Mccarthy
Ellen Riordan
Maiden Name and Birthplace of Mother
Place of Interment, (Give name of Cemetery), Habe Crees Cemeter(Malden)
Dated (at
Marihuop
on
September 9'
190/
Signature and place of business of Undertaker.
Summer Floyd
Scunthor Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
owen An Carthy
Age, 56Y .~. ~ D. h
Place and Date of Death,
died at
35 Fremont ST
September 8 1901.
Disease or Cause | Primary, of Death,# Secondary,
Haemophysio Photosis Pulmonaris
Duration,
5 min
Duration,
2 yrs
I certify that the above is truc to the best of my knowledge and belief.
218 metcalf
Signature and Residence S of
Certifying Physician.
Wwwstrop mass
M. D.
Date of Certificate, Sufit10 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.
Place of Birth,
No. 46
RETURN OF THE DEATH
OF Onen S. Carty 35 Fremant@Sheet at
Date, September 8 11 1901
Filed, Bejelenter 10 190_
[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 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 forthiwith 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 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 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,
Henry Of Shaneck
Sex,
Color,.
Date of Death,
September 14 190 /; Age, 53 Years, M
Months, .
25 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Green
*Residence, { If out of town, { ? also state fuly. 3 6. Main Street, Winthrop Mass
Place of Birth,
Germany
*Place of Death,
64 Main Street- Stintinoto quase
Name and Birthplace of Father, Herman Johann Shaneok-Germany
Maiden Name and Birthplace of Mother, Katharine
Germany
Place of Interment, (Give name of Cemetery) Handlar Cemetery
Dated at
Minsthop
Signature and
Summer @floyd
Dejetenter 16"
190 /
place of business
of Undertaker.
Stirithrop Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Henry 7. Shaneck
Age, 5 3 Y.
1.25-
.D.
Place and Date of Death,
died at
8) tham It worthop maxptica
190/.
Primary,
Disease or Cause of Death, Secondary,
Urauma Duration, Chronic Interstitial hephane Duration, 2 yrs
I certify that the above is true to the best of my knowledge and belief.
1318 metcalf
M. D.
Date of Certificate,
Seja 14.
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.
Signature and Residence S of Certifying Physician.
umshop mars
No.
RETURN OF THE DEATH
OF
Henry OF, Shaneck at 6 r main Street
Date, Dejetenter 14-" 1901
Filed, Sesetember 16 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 elerk of the city or town iu 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 seetions 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, furuish 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 eause 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.
inn nat eveerding fifty doll dollars.
FORM C.
Commonwealth of Classachusetts.
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,
Mary ann Oleard
Sex,
Color,
22
Date of Death,
September 14
190 / ; Age,. 36 Years, Months, Days.
Maiden Name, { If married, widowed ) or divorced.
Mary ann Odellough,
Husband's Name,
William OHeard
Single, Married, Widowed or Divorced,
Occupation,
Housewife
*Residence, { If out of town, )
? also state fully. 3
Centre Sandarich W, Or.
Place of Birth,
*Place of Death,
no 9. Sumypide avenue
Name and Birthplace of Father, William Wellough Nova Scotia
Maiden Name and Birthplace of Mother, Elizabeth b. M. Heffie nova Scotia
Place of Interment, (Give name of Cemetery), Centre Sandwich N. Or.
Dated at Minthaps
Signature and
Summer @floyd
on.
September 16"
.. 190 /
place of business
of Undertaker.
Stirithrop Wass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Primary,
Disease or Cause of Death, ţ Secondary,
died at ..
9 Sunny side Av. Seff. 14t 1901.
Duration,
Nasal Hemorrhage Duration, one hour
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
A. B. Domman
M. D.
Certifying Physician. Neither, Maar.
Date of Certificate,
Syl. 16th
190 /.
* Give also street and number, if any. f 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.
Mary ann Heard.
Age, 36Y .- M. ~ D.
No. 48.
RETURN OF THE DEATH
OF
Mary ann Heard
at nog Sunnyside are
Date, September 14" 1901.
Filed, September 16" 1901.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every houscholder 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 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, 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 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.
la fou solation not exceeding 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,
Nalisida rooks
Sex
Color,
Date of Death,
Sept 24
190/; Age, 61.
„.Years,
1
Months,
18
Days.
Maiden Name, § If married, widowed }
or divorced.
-
Husband's Name,
1
2
Single, Married, Widowed or Divorced,. Occupation, none
no.5" Perkins Steel
Place of Birth,
Balón Mass
no5. Perkins Street( Winthrop Mas)
*Place of Death,
Name and Birthplace of Father, Jonathan Brooks -Jempleto Mars)
Maiden Name and Birthplace of Mother, Nancy Pierce - Beton mass
Place of Interment, (Give name of Cemetery),
Mount Hope - Cemetery
Dated at
Anthropo
Summer Floyd
on
September 25'
190/
Signature and place of business of Undertaker.
It inthis wass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Malinda Brooke
Age, Y. .M. .D.
Place and Date of Death,
died at Anthrop
Sept. 24. 190 /.
Carcinoma of breast Duration, 23 yry.
Disease or Cause - Primary,
of Death, # Secondary,
Duration, 5 days
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
D.S. Carter, M.D
M. D.
Certifying Physician. Winthrop, Mais
Date of Certificate, dent, 24 th 190/ .
* Give also street and number, if any. t Give sex of infant not named. If still-born, 80 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.
*Residence, { If out of town, )
¿ also state fully. 3
No. 49
RETURN OF THE DEATH
OF Malinda Brooke No5, Parking Sheet at
Date, September 24 1901. Filed, Sylember 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 or 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.
nto &saladins sat avneeding fifty dollars.
-
COUNTY OF MIDDLESEX.
CITY OF CAMBRIDGE.
Commonwealth of Massachusetts
NO. OF BURIAL PERMIT.
NO INCOMPLETE RETURN WILL BE ACCEPTED. miriam Poole
Name of Husband, Calvin Pole
1. Name, in full
(If widowed, married, or divorced.) 2. Color : 4. Conjugal Condition : SINGLE WHITE. BLACK (Negro or mixed).
CHINESE.
NOTE. - For Questions 2, 3, and 4, strike out words not applicable.
Year, 1901
Year, 1825
Years, 76
5. Date of Death
Month, Serve- 6. Date of Birth if obtainable < Month, may 7. Supposed Age < Months, 4
Day, 28
Day,
2/
Days, 7
8. Occupation, (Return occupation for all persons 10 years of age and over -if under one year return occupation of father.)
Falmouth ME
10. Name of Father, Nicholus Hall ..
(Full name.)
12. Name of Mother, Harmal Hall (Maiden name.)
14. Place of Death, No.
28
PHHAT, GAMHEILIGE. Winthrop Mas
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.
60
, austin
Street,
Cambridge
(City or Town)
LENGTH OF RESIDENCE (in city or town),
25 years
16. Place of Interment, Cambridge Cemetery. (Cemetery.)
(City or Town and State.)
SIGNATURE OF UNDERTAKER (or other person making the return),
RESIDENCE, No. 544 Mais. Oft -Street,
undson Litchfield. Cambridge (City or Town.)
NO. OF BURIAL PERMIT ..
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH
1
Name of Deceased* Miriam Poole
Supposed Age, 76 Years, 4 Months,
7 Days.
Place and Date of Death, No. 28 Cottage Ave, Winthrop
Disease or Cause of Death :
Chief Cause, Quarian Cych
Contributing Cause
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, Millique J. Parten
M. D.
Residence, No. 148 Crear Clav
Street, Printhrow (City or Town.)
* Or Sex of Infant (not named).
t If a soldier or sailor who served in the War of the Rebellion, Chief and Contributing causes must be given.
The office of Board of Health will be open for the granting of permits for burial as follows : Saturdays, 8 A.M. till 2 r.M. ; Sundays and Holidays, 12 M. till 1 r.M. ; Other Days, from 8 A. M. till 4 P.M.
BE VERY CAREFUL TO FILL ALL BLANKS IN INK
FOVERT
MARGIN RESERVED FOR BINDING.
FILL OUT WITH INK ONLY, AND WRITE PLAINLY.
9. Place of Birth,
Fahreich Mainz
11. Birthplace of Father, A
(State or Country.)
13. Birthplace of Mother,
Falmouth Mainz
(State or Cegintry.)
Cottage Ave. Winthrop Reach
Cambridge
: Winthrop. Sept. 28 190 /
Street, Cambridge, Sep1: 28 190 / DURATION. Uncertain
3. Sex :
MA ...
FEMALE.
WIDOWED.
Acts of 1897, Chap. 437, Sect. 1, 2, 3, 4, 5, 6, 7.
Srediox 1. No undertaker or other person shall bury a human body In a elty or town, or remove therefrom a human body which has not been buried, except as provided in section two of this net. until he shall have received n 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 elerk 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 city or town in which the body is buried. No such permit shall be issued nutil there shall have been duly delivered to such 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, carly 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 upou application make such certifleate as is required of the attending physician ; and in case of death by violence the medical examiner only shall make the sune. When sueh satisfactory statement and certificate are delivered to the board of health or to its agent the board or agent shall forthwith countersigu and transmit the same to the elerk of the eity or town for registration. The person to whom the permit is so given, and the physician who certifles to the cause of Month, shall thereafter furnish for registration any other necessary information that can be obtained as to the deceased, or as to the manner or canse of the death, which the clerk 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 without 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 issue sneh permits, or if there is no such board, from the clerk of the city or town in 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 have the care of the cemetery or burial ground in which the interment is made, and there is a reeord kept of the names of all persons buried thercin, or if there is a duly appointed superintendent of burials in sneh city or town who keeps a record of interments, said permit may he issned by such person having such care or by said superintendent of burials. Said permit may be granted upon delivery to said board, agent, clerk, superintendent or person having such eare, as the ease may be, of a certificate givin's Nie namd the (leeeased person, his age as nearly as can be ascertaincd, the cause of death, the name of the city or town er ressed or the facts from which the body was brought, or, if the death oceurred at sea, the name of the vessel upon which it occi required for record which could be obtained with reasonable exertion. When snch certificate is delivered The Ward of 1gh, or care 's to its agent, or to the superintendent or person having snch eare. the board, agent, superintendent or persog Savir forthwith countersign and transmit the same to the clerk of the city or town; and if the deceased perso was at the time of decease a resident of said city or town the clerk shall record the same in the books kept for recording deaths it if the A ceased is at the time of his death a resident of any other city or town within this Commonwealth said elerk shall fthwith forward to the clerk of such other city 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 therefrom. or permit the ashes of a human body to be removed therefrom, until there has been delivered to In the permit or burial or removal of said body or ashes, nor permit the ashes of a human body to be buried therein until there has beenDelivered him a certificate that the burial permit and the certificate of the medical examiner prerequisite to the cremating of syd body hid been duly presented.
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