USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 19
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May Cette
1902.
· 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.
Primary,
No.
RETURN OF THE DEATH
OF
Same OS, Kurpatriel at 18 Washington Cherne
Date, May 3 ._ 190.2.
Filed, May 5, 1902.
[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 lie 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 facts required by section 1, to the board of healthi 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.
..... . 1 11- -
may 8
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,
almira Sale Pomroy
Sex, Color,
Date of Death, .
May 8
1902; Age, 63 Years, 5 Months, 22 Days.
Maiden Name, { If married, widowed !
or divorced. almira Sale Belcher (Widow)
Husband's Name, Senge King Pomroy
Single, Marion, Widowed or Divorced, Occupation,
*Residence, { If out of town, )
Madison avenue Hintenage mass
also state fully.
Place of Birth, north Chelsea Mare, now Perece
*Place of Death,
Madison avenue Winthrop
Name and Birthplace of Father, James Su. Belcher ( Chelsea)
Maiden Name and Birthplace of Mother, Lavisa Sale (Chelsea)
Place of Interment, (Give name of Cemetery), Foodlawn Cemetery
Dated at Winthrop
Signature and Summer floyd
}
on
may q ""
190 2
place of business of Undertaker. 18 Overman Bleel Winthrop
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t almina & Pomeroy
Place and Date of Death,
died at. Winthrop
Age, 63 Y. 5 M. 22D. May 8 1901/.
Klart Dizem
Primary, Duration, 1 Disease or Cause of Death, } Secondary, Heart Dezenas
Duration,
3 years
1
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
Winthrop Plass
Date of Certificate, May 104 190 2.
* Give also street and uumber, 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.
M. D.
No.
RETURN OF THE DEATH
OF almia Bale Ponroy at
Madison Cienne
Date, may 8'
1902.
Filed, Sway q'
190 2.
[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 deccased 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 iuterment 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.
Penalty for violation not exceeding fifty 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, ..
Olijchalet Carrington
Sex,
Su
.Color,
2/
Date of Death,
may 9'
1902, Age, 7 Years,
5 Months, 0 Days.
Maiden Name, { If married, widowed }
or divorced.
-
Husband's Name, ...
Single, Married, Widowed or Divorced,
Occupation,
Engineer
*Residence, { If out of town, )
? also state fully.
73 Pauline Street Winthrop Mais
battery The
Place of Birth,
*Place of Death,
73 Panchine Street Ht intenot- mass
Name and Birthplace of Father,. andrew Warrington Eachyear me
Maiden Name and Birthplace of Mother, Unknown
Place of Interment, (Give name of Cemetery),
Eastlend me
Dated at Winthrop
Signature and
Summer Floyd
on
may 10
190 2
place of business of Undertaker. 18 German Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Eliphalet darrington
Age, 73 Y.3 .M. /Ő_D.
Place and Date of Death, died at Winthrop1 .3 Pauline It May 9 1902.
Disease or Cause of Death, ¿ Secondary,
Primary,
mitral Insul francy Duration, 3 weeks
Duration,
I certify that the above is true to the best of my knowledge and belief.
Biomedical M. D.
Umstrop mass
Date of Certificate,
Signature and Residence § of Certifying Physician. may 10€ 190 2.
· Give also street and number, if any. t Give sex of infant hot 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.
may2
No.
RETURN OF THE DEATH
OF Eliphaler Harrington 73 Pauline Cheet at
Date,
May9 "
1902
Filed, May 10
٤٠_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 healthi 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 liis 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. Iu 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 inade 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, bas 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.
Damalsse for winletinn not exceeding fifty dollars.
-
-
FILL EVERY BLANK, AND WITH INK ONLY, WRITE VERY PLAINLY.
No. of Death
UNDERTAKER'S RETURN OF A DEATH
SOMERVILLE, MASSACHUSETTS
Date of Į Death May 14
190
Full 2. Name Mary Jane
Iturque
Maiden ? *
gray
Full Name of Husband )
Charles R.
Sex Colort
Single, Married, Widowed, or Divorced
Date of Birth )
Supposed Age 83 Yrs .- Mos.
Days.
if obtainable §
Duration
Residence ( No.)
Main At. Winthrop . Mars. ( Street ) wy, oy C'ity. and State ) Street and Number )
Main St. Neuthrop
-Somerville; Ward
Name of Institution, if any, in which Death Occurred
Length of Time Deceased }
was an Inmate
And Previous Residence
Occupation none
Name of }
Father Unknown
Birthplace )
of Mother Free port Maine somlors. 1 Mark
Town ur City. and State ,
Signature of Undertaker
M. Hilson.
Residence. 103 Crose At, Somerville ( Street ) ( Town or City ) 5
*If a married woman, or a widow. or divorced. ¡Whether White, Black ( Negro or Mixed ), Indian, Chinese, Japanese.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH
Name of )
Deceased Mary Jane.
Supposed Age
83 Yrs. -- Mos. - Days.
Place and Date of Death ( No.) Main Et. Herethrop Som May 1.4 190 2
Disease or
Primary or Immediate Cause asthma
Cause
of Death Secondary or Contributing Cause # old age
Place where Disease was Contracted, ? if other than place of death
I certify that the above is true, to the best of my knowledge and belief.
Signature of Physician
19. J: Metcalf M. D.
Residence 52 ( No.) ( Street ) Um Throp
( Town or City )
# If a Soldier who served in the War of the Rebellion, both the primary and secondary causes of death MUST be given.
The Office of the Board of Health will be open for the granting of permits for burial as follows: Saturdays, 8 A. M. to 12 M .; other days (Sundays and Legal Holidays excepted ), 8 A. M. to 4 P. M.
of Residence S
Place of Death (
Place of Birth Bowdownham Maine. Maiden Name of Mother Sarah Walker
Birthplace )
of Father Forest Hills Com. Place of Interment ( Cemetery Francie
(Street ,
DURATION one week
Name
Тагу у. Двигай Way 14 "19.
[2-01-37-XXXM.]
Permit No.
RETURN OF DEATH. BOSTON.
Winthrop
1902
Year,. 1899
Years,
Date of death Year,
Month, may Birth
Month, may Age Months, 6
I. Day, 14.0
Day, 1.V
Name in full, Charles Boutin
Maiden name,
Residence, 10 Marchalisa White. Color Black (Negro or mixed). Indian. Chinese. Hetprinese.
Wife of .....
Place of death Street, 1 10 Marchall
Place of birth,
Number, Winthrop
Occupation,
Name of Father, Gerard
Maiden Name of Mother, Ella Lavoix
Birthplace of Father, St. John 4. 2. Birthplace of Mother, Chelsea Mars
Place of interment, Holy Cross malden M. r. Kelly
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, 190
.
Name and age of deceased, Charles Bouton Age, 3 years.
Date and place of death, *.. Winthrop Mais
Disease Chief cause,.
Contributing cause, Blood Roman
Chief cause, Two weeks
Duration Contributing cause, 4 days
I certify that the above is true, to the best of my knowledge and belief.
Name and residence ? of physician, } Wuchrop ro. Soula M.D.
* If in an institution, state how long an inmate and previous residence.
The office of the Board of Health will be open for the grenting of permits for burial, as follows : - Saturdays, 9 A. M. till | P.M., except during the months of June, July, August and September, when the office will be closed on Saturdays et 12 M. ; Sundeys, 10 A. M. till 12 M. ; Holidays, from 10 A.M. till 12 M .; other days, from 9 A.M. till 5 P.M.
Days ... 17
Male. Female.
Sex Conjugal condition
Single. Married. Widowerl. Divorced. Widow of
Diptheria
Charles Routin May1ty 1902
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.)
Date of Death, .. Funda Muy 18th 190 2
Full Name of Deceased Amanda MEloma Davis
If a married or divorced woman or a widow give also
Maiden Name, Amanda Me Reaper Name of Husband, Thomas aparis
Sex, Smale Color, White Single, Married, Widowed or Divorced,
Age, y 3 Years, 3 Months, 2 2 Days. Occupation,
* Residence { If out of town, } { also state fully. Winthrop (22 Winthrop Street)
Place of Death,
Winthrop
(22 Hartu Cheel
Place of Birth,. Stirling Sterling Mark , Lucian Roper Name and Birthplace of Father, Betary Roper
Maiden Name and Birthplace of Mother, ‹‹
Place of Burial (Give name of Cemetery), Stirling Moss
Dated at May 19 190 2 place of business - of Undertaker.
Signature and
Summer Floyd
on
Huithof, Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
amanda Melona Davis
Age, 73 x 3 M. 22D.
Place and Date of Death,
died at 22 UmshopST min 18 190 2. Chronic Interculosis the loving Duration, 8 120
Disease or Cause of Death, # Immediate,
Duration, 1
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
(31 melcal M. D.
of
Certifying Physician. 7 (mm 20℃
190 2
Date of Certificate,
· 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
- Primary,
No.
RETURN OF THE DEATH
OF amanda W. Davis 22 Winthrop. Sheel at
Date, May 18" 1902 Filed, May 19' 190 2.
2
[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 city or town in which the death occurs, shall, within five days thereafter, canse notice thereof to be given to the board of health or to the town clerk.
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 shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate 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 the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. 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, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of snch statement and certificate, shall forth- with nanntoroinn and transmit. it to the clerk of the city or town for registration. Penalty for violation not exceeding fifty dollars.
FORM C.
Commonwealth of Massachusetts.
May 22
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.)
Date of Death, May 22' 190 2
Full Name of Deceased,. Hannah S, alger
Maiden Name, Hannales, Malcolm
If a married or divorced woman or a widow give also Name of Husband, .. David alger
Se x te male Color,
Single, Married, Widowed or Divorced,
Age, 83 Years,
30 Months,
Days. Occupation,
Canton mass
* Residence ( If out of town, )
{ also state fully. ]
Place of Death,
10 north avenue Hintrop Mass
Place of Birth,
China que
Name and Birthplace of Father, David Malcolm (China me)
Maiden Name and Birthplace of Mother, Lydia Studey (China me)
Place of Burial (Give name of Cemetery)
milford How Hanpeste
Dated at Menttrop
Summer Floyd
on
May 23'
190 2
Signature and place of business of Undertaker. 18 Overman Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Ofarmah & alger
Age, 83 8. 2 M. 3 D.
Place and Date of Death,
died at
Winthrop may 22"
190-2
Primary,
Duration,
Disease or Cause
of Death, #
Immediate,
Senility
Duration,
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,
Clay 24
190 2.
* 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF
Harmah & alger at 10 North avenue .......
Date,. May 221 190 2 ..
Filed, May 23 190 .... 22
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honseholder in whose house a death oceurs and the oldest next of kin of a deceased person in the eity or town in which the death oceurs, shall, within five days thereafter, eause notice thereof to be given to the board of health or to 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 board 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 request of an undertaker or other anthorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required faets.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate eause of death as nearly as he ean state the same. Penalty for refusal or negleet, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tifieate required by seetion 10, enter thereon the facts required by seetion 1, and return it to the board of health or to the elerk of the city or town in which the death occurred. The person making such return shall receive from the eity or town a fee of twenty-five eents.
[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 body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth-
Penalty for viola ion not execoding fifty dollars.
FORM C.
Commonwealth of Classachusetts.
May 22
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.)
Date of Death, May 22" 190 2
Full Name of Deceased,
Phoebe Jane Burgher
Maiden Name, .. "1
fountain
If a married or divorced woman or a widow give also Name of Husband, Stephen K, Burgher
Sex, Color,
Single, Married, Widowed -or Divorced, ..
Age, ny 6 Years, Months, 12 Days. Occupation,
* Residence { If out of town, } ( also state fully. §
Carrotsone Staten Deland N. Y.
Place of Death, 4 Quincy avenue-Winthrop Highlands
Place of Birth, newdoyle, ostaten Island
Name and Birthplace of Father, Anthony Burgher (Unknown)
Unknown
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery) newdorf, Staten Island
Summer Floyd
on
Dated at
May 22"
.190 之
Signature and
place of business
of Undertaker.
18 Overman Stater Ministros
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Primary,
Disease or Cause of Death, # Immediate,
Phoebe Jane Burgher
Age, 164. - M. /2 D.
died at ....
. 4 Runcy ane
May 22,
190 2.
Persummitist
Duration, 5 days
Duration, ays
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Thomas Etgott
M. D.
of
Certifying Physician.
42 Runningy ave, Winthrop Holds.
Date of Certificate, may 22 190 2.
* 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
I
No.
RETURN OF THE DEATH
OF Phoebe Same Burgher. at If Dunicy Chenne
Date,_ May 22" 1902
Filed, May 23 1902.
[EXTRACTS FROM CHAPTER 29, REVISED LAWS.]
SECTION 6. Every householder in whose honse a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
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 shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate 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 the secondary or immediate eanse of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
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