USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 22
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No.
RETURN OF THE DEATH
OF
Theresa Rosenbaum
at 2 intheopp
Cor , (Creek + myrtle arevares
190 2
Date,.
Filcd,
July 31
190 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, 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 anthorized 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 canse 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 such statement and certificate, shall forth- ....... ............ for re istenti .. Penalty for violation not according fifty dollars.
FORM C.
Commonwealth of Massachusetts.
2.23
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,
Full Name of Deceased,
Dora
190 2 John, Hace
Maiden Name, Dora John
If a married or divorced woman or a Widow give also Name of Husband,. Chai W. Hall
Sex, Fi- Color, Single, Married, Widowed or Divorced,
Age, 48 Years, Months, / 2 Days. Occupation,
* Residence { If out of town, { Lewis Black Shirley St Wenthust Mas
{ also state fully. §
Place of Death, DEER Creek Townshit, TazwellCo S.l.
Place of Birth,
Name and Birthplace of Father, W™ M. Solar le ochaction County this
Maiden Name and Birthplace of Mother, Hannah Harvey John Lickney to the
Place of Burial (Give name of Cemetery) ....
Chae. R. Dennecon.
Dated at 5 th day of lung 190 2 on
Signature and place of business of Undertaker.
Avertirof Mass.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Dora Johnstall
Age, 48 8. 5 M. 12 D.
Place and Date of Death,
died at.
Winthrop Man
ana, 3 1902.
Primary, - Disease or Cause of Death, } Immediate, Apoplexy
Duration,
Duration,
3 Wahr
I certify that the above is true to the best of my knowledge and belief.
А. В. Дышан
M. D.
Signature and Residence S
of
Certifying Physician.
Wurthof Massachusetts
Date of Certificate,
190Z.
* 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 Rebelllon, 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
Dora Sohne Hace 1
august 3"1902
Date,-
Aluguel 3'
190 2. Filed, ... auquel 3" 190 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 deecased 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 ean 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 elerk 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 such statement and certificate, shall forth-
-vi Indian ant avonline fifty dollars.
[2-01-37-XXXM.]
ana 3
Permit No ...
RETURN OF DEATH. BOSTON.
Date of death
1902 Year, ... Month, aug 30
Birth
- Month,
Years, - Age 3 Months. 1 Dags ...
Maiden name, Male. Female. Wife of ~~
Sex Conjugal condition
Single. Married. Widowed. Divoreed. Widow of.
Color
Chinese. Japanese
Place of death! Street,
Number, Unknown
Place of birth,
Occupation,
Name of Father,
Maiden Name of Mother,
Unknown
Birthplace of Father,
Birthplace of Mother,
Place of interment, Winthrop Cemetery (Suitehen Rot) Bummer Floyd Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, aug. 32 1902.
Name and age of deceased,
.Age, - years.
Date and place of death, Found aug. ?? Winterof Beach Sale for-
Disease Chief cause, .. Contributing cause,
Chief cause,
Duration Contributing cause,.
I certify that the above is true, to the best of my knowledge and belief.
Nume and residence ? of physician,
Francis aHarris 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 granting 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 at 12 M. ; Sundays, 10 A.M. till 12 M .; Holidays, from 10 A.M. till 12 M .; other days, from 9 A.M. till 5 P.M.
Year,
Day Unknown
Name in full, .
Residence,
White. Black (Negra or mived).
(Found on Beach at Collage)
Found on Beach"Cal Nie"
0
august 3" 1902
4
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, ... ang 8."
1902.
Full Name of Deceased, Sarah Elizabeth Griffin
Maiden Name,. Lamont ....
a married or divorced woman or a widow give also Name of Husband, Isaac Griffin
Sex, Female Color, Ichit
Single, Married, Widowed or Divorced,
Age, 79 Years, 10 Months, 26 Days. Occupation,
* Residence { If out of town, { { also state fully. ) .
Place of Death,
19 Washington une. Ve in thanh 19 Dashington Chance Mouthrop Bath me.
Place of Birth,
Name and Birthplace of Father, Samuel Lamont Both me
Maiden Name and Birthplace of Mother, ..
Roxanna murit Soituale
Place of Burial (Give name of Cemetery), .... Winthrop Cenceley.
Dated at Winthrop
Signature and
on
august 8'
.. 190 2
place of business of Undertaker. 18 Herman Street.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Primary,
Disease or Cause of Death, ¿ Immediate,
Chronic Brights Diseaseration, 2 years Chronic Brills Desea & Duration,
I certify that the above is true to the best of my knowledge and belief.
signature and Residence S of Certifying Physician.
C.E Voluuso W. M. D.
Date of Certificate, aug 9 1902.
· Give also street and number, if any. | Give sex of infant not named. If still-born, so state.
t 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.
Sarah Elizabeth Griffin Age, 79 8.10 M. 26 D.
died at Winthrop Qua 8" 190 2.
No.
RETURN OF THE DEATH
OF Sarah Elizabeth Chifun at 19 Washington Che_
Date, august 8'
190 2.
Filed, august 9
190 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 notiec thereof to be given to the board of health or to the town clerk.
SECTION ". 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 canse of death as nearly as he can state the same. Penalty for refnsal 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 hnman body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shull 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 - with countersign 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.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Fannie Nelson
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
.. Sex,
Color,
Date of Death,
august 11
190 2; Age, 40 Years,
3
Months, 20 Days.
Maiden Name, { If married, widowed ) or divorced.
Fannie Raby
Husband's Name, James Christiane & Nelle
Single, Married, Widowed or Divorced,
Married
.. Occupation,
Housewife
*Residence, § lf out of town, {
¿ also state ally. 3
82 Lincoln Sr. Winthrop, Maso.
Place of Birth,
Gael
Cambridge, mass
*Place of Death,
Winthrop. Mass.
Name and Birthplace of Father, Francis Raby
Catherine Boosie
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Winthrop Cemeter-Winthrop mars
Dated at Winthrop
Signature and
Summer Floyd
on
august 12 1
1902
place of business
of Undertaker.
18, Steaua Sheet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Jamin Nelson
Age, 43 Y. . 3 M. 20 D.
Place and Date of Death,
Disease or Cause ( Primary,
of Death, #
Secondary,
died at ....
Winthrop
august 11 St 1902:
Multiple Sarcoma! Duration,
6 months
Valvular heart disease
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
Certifying Physician.
( Venikrop Mass
Date of Certificate,
aug-12
1902_
1
* 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.
M. D.
No.
RETURN OF THE DEATH
OF Fannie Nelson at 82 Lincoln Sheet
Date, auquel 11" 1902
Filed, Quiquel 12 190 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 elerk of the city or town within the Commonwealth at which his vessel first arrives after sueli 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 registratiou 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.)
Date of Death,.
august 1.5"
190 2
Full Name of Deceased, .. Olivia O, Levi's
Maiden Name, Oliva Or Levi's
{Is a married or divorced woman or a widow give also Name of Husband,
Sex, F Color,
Single, Married, Widowed or Divorced,
Age, .. 41 Years, . Months, Days. Occupation, nurse
10 River Road Winthrop * Residence ( If out of town, ) { also state fully. f . 10 Pier Road Santos. Place of Death,
Place of Birth, OStora Serlia
Name and Birthplace of Father, Rice Lenís
Maiden Name and Birthplace of Mother, ... Olivia Of arlow.
Place of Burial (Give name of Cemetery), ... Ianthrop Gemeley
Dated at
on august 16 190 2
Signature and place of business of Undertaker. 18 Otermar Dret
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Olivia Of. Levi's
Age, 78CMND.
Place and Date of Death,
died at
Winthrop 10 Pier Prad aug 15,90 €
Disease or Cause of Death, } Immediate,
Primary,
Valvola Heart Desea Duration,
Duration, Senual years
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physiclan.
Date of Certificate, Cua 17 190 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.
Summer Cloud
No.
RETURN OF THE DEATH
OF
Olivia V. Lewis
....
at 10 River Road
Date, august 1.5" .190 .22.
Filed, auquel 16" 190 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, 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 S. 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 shull 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- l tranamit it to the clerk of the city or town for registration. Penalty for violation 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.)
Date of Death, august 15'
190 2
Full Name of Deceased, William albert Surmer
Maiden Name,
If a married or divorced woman or a widow give also ( Name of Husband, ....
Sex, m Color, 21
Single, Married, Widowed or Divorced,
Age, ~ Years,
8 Months, Days. Occupation,
* Residence { If out of town, { { also state fully. § Harvard Or off Ppene RL
Place of Death,
Place of Birth, Winthrop mass. 11
Name and Birthplace of Father, James D, Surmer Lervisto que
Maiden Name and Birthplace of Mother, ... Lillie Wand Wordside
Place of Burial (Give name of Cemetery)
Winthrop Cemetery
Dated at august 16 190 2 on
Signature and place of business of Undertaker.
18 Overman Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t William aller Jumen Agem8.8 M. D.
Place and Date of Death,
died at
Winthrop (Harvard A) and 5902
Disease or Cause
of Death, #
Immediate,
Primary,
Festro Entoutis
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Siret et
M. D.
Signature and Residence of Certifying Physician.
Date of Certificate, 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
aug 15
Summer Floyd
No.
RETURN OF THE DEATH
OF William aller Jumer at Haward & heel Од Колек. СЛ-
Date, august 15 1902
Filed, august 16 190 2.
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whosc house a death oceurs and the oldest next of kin of a deceased person in the city or town in which the death oceurs, shall, within five days thereafter, cause 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 clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION S. Penalty for negleet 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 anthorized 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 cansc 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 has charge of a funeral, shall forthwith obtain the physician's cer- tifieate required by seetion 10, enter thereon the faets 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 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 such statement and certificate, shall forth- nomit it 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.)
Date of Death,. august 15
case Harvey alexander Hoque 1902.
Full Name of Deceased,
Maiden Name,
If a married or divorced woman or a widow give also Name of Husband,
Sex, Inale Color,
Single, Married, Widowed or Divorced,
Age,. 70 Years, / Months, 9 Days. Occupation, Retired
* Residence [ If out of town, } { also state fully. )
4 Beacon at Minthach Place
Place of Death, 4 Beacon It Winthrop Para
-2
Place of Birth,. Princeton
Name and Birthplace of Father, - Bébloque
Maiden Name and Birthplace of Mother, Sarah Summary
Place of Burial (Give name of Cemetery), ery one In Cemetery 1
Dated at
on
190
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Haney W Hoque Age, 708. 1 M. 9 D.
Place and Date of Death, died at A Beacon at Plug 15- 190 2. Hypertrophy of Postale La. { Duration, 10 years
Disease or Cause of Death, # Immediate,
Primary,
Throne Cystitis Duration, 2 years
I certify that the above is true to the best of my knowledge and belief.
Clarence Grane Lorane .M. D.
Signature and Residence of Certifying Physician. 228 Shuntington are
Date of Certificate, ana 1.6 1902.
Boston
· 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.
No.
RETURN OF THE DEATH
OF
laney a, Ologue at
4 Bacon & heel
Date, august 15" 1902 Filed, august 16" 1.90.2
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