USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 28
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Place of Burial (Give name of Cemetery), ..
Signature and Summer floyd
Dated at.
on February 2,5€ 190.3
3
place of business of Undertaker. 18 Herman Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Ona angeline Games Age, 60 x- MI.21 D.
Place and Date of Death,
died at ..
48000 Gave Road February 241903.
Primary,
Diabetes Mellitus Duration, Sixmonths
Exhaustion
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
EdwinStanding M. D. of Certifying Physician. Parttett RoadWinthanh males.
Date of Certificate, Diel
a 25,903.
* 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.
Disease or Cause of Death, ¿ Immediate,
RETURN OF THE DEATH
OF
Ora angelinie Otames
at
48 Oak Park Road
Date, Otahuary 21
10 .3
Filed, February 190 3
[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. If of a child born dead, both the birth and death shall be reported as " stillborn ". Penalty for neglect fifty dollars.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary und 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 tho 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- 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 Classachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
Date of Death, February 27" the
(FILL OUT WITH INK ALL NAMES TO BE IN FULL.)
Full Name of Deceased, Charles Ma Buckley
Maiden Name,
If a married or divorced woman or a Widow give also
Name of Husband,
Sex, Color,
Single, Married, Widowed or Divorced,
Age, 67 Years, Months,
Days.
Occupation,
Slove Dealer
* Residence ( If out of town, } Winthrop Mass { also state fully. }
Place of Death, 19 River Road
Place of Birth, Deering que
Name and Birthplace of Father, Charles & Buckley - Portland Alle
Maiden Name and Birthplace of Mother, Sarah Stevens Portland the
Place of Burial (Give name of Cemetery), Evergreen Cemetery Deering Die
Dated at- Otiniños
Signature and
Summer Cloud
on February 24 " 1903 place of business of Undertaker.
18Overman @street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Charles Melin Buckley Age, 67 8 CM ND.
Place and Date of Death,
died at
19 River Road February 24 1903.
Disease or Cause of Death, Immediate,
Duration,
Half hour.
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
Albert BB. 001 Mars M. D.
Certifying Physician.
Wenttuo Man.
Date of Certificate, FIG
V
1903.
* 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,
Duration,
RETURN OF THE DEATH
OF
Charles Melvin Buckley at 19 River Road Omitrop
Date, OFfelmany 27
19003 ..
Filed, 6 February 28 190
3
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death ocenrs 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 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 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. If of a child born dead, both the birth and death shall be reported as "stillborn ". Penalty for neglect fifty dollars.
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 lias 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 us physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement aith ertifiente, shall forth- with countersign and transmit it to the clerk of the city or town for registration. Penalty for violation not exceeding fifty dollars.
[11-'02.37-LM.]
Permit No .. ..
RETURN OF DEATH. BOSTON, MASS.
Date of Death,
march 3/03
Name in full, James 26 jones
(If a married or (wa bore alis maiden name, also name of husband.)
Se.v. male Color Iffuite
Condition. single
(White, Black, Mixed, Chinese,
Single, Maria, Widowed or Divorced.) Indian, etc.) Age, 22 Years, ~Months, ~Days. Occupation,
Residence, 176 ShirleySt Whithrah Ward,
Place of Death, 176 Shirley St Winthrop mass
State year, month and day.)
Place of Birth, Unknown.
Date of Birth, Unknown
Name and Birthplace of Father, 1 Maiden Name and 1 Birthplace of Mother, ) Place of Interment, ...
mitttake Basil Fostulchins Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
BUSTOTE Mar. 3. 1903.
Name und Agel
of Deceased, James de Jones .Age, 22 years.
Date and Mar. 3. 1903, Monthsof, Mass.
Place of Death,* S S chief cause, .. . Pulmonary
Disease -
Contributing cause,
Chief cause, Uncutane
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence !
of Physician, Mg. Parler winthrop M.D.
* If an institution, state how long an inmate and previous residence.
LUNA21
James CV, Jones march 3" 1903 1
Filed March 4 "1903
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,
march
9''
190 3.
Full Name of Deceased,
Carter Baker
Maiden Name,
If a married or divorced woman or a widow give also } Name of Husband,
Sex, Color, 2 Single, Married, Willowed or Divorced,
Age, 77 Years, Months, 24 Days. Occupation, Fisherman
* Residence ( If out of town, } ¿ also state fully. }
Winthrop mass
Place of Death, Hashington avenue,
Place of Birth, Duxbury mass
Name and Birthplace of Father, Redige Bakker= Duplury mass
Maiden Name and Birthplace of Mother, Hannah Chandler,
Place of Burial (Give name of Cemetery),
Signature and Summer floyd
Dated at March 10 .190 3
place of business
of Undertaker.
18 Overman Steel
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Edenry B. Baker
Age, 778. 1. 24/D.
Place and Date of Death,
died
at Winthrop- march '9'"
190 3
Heart Failure
Disease or Cause Primary,
of Death, ţ Immediate,
Duration,
I certify that the above is true to the best of my knowledge and belief.
BAMet call
M. D.
Mars
Date of Certificate,
Signature and Residence § of Certifying Physician. March 10 190 3.
* 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 toun.
Agent of Board of Health.
on
Duration, ?
No.
RETURN OF THE DEATH
OF
Henry , Baker at Winthrop Mass
Date, Perauch 9'
190 3
Filed, March 10 190 3
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ] +
SECTION 6. Every honscholder 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, 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 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. If of a child born dead, both the birth and death shall be reported as " stillborn ". Penalty for neglect fifty dollars.
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 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 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.
[11-'02.37-LM.]
Permit No.
RETURN OF DEATH. Winthrop BOSTON, MASS.
.
Date of Death, March 13 0 1903. 1 Name in full, Charles Burgher,
(If a married or divorced woman give maiden name, also name of husband.)
Se.v, male, Color, phili (White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Condition, married
Indian, etc.)
Age, 44 Years, Months, Days. Occupation,
Residence, Winthrop mass,
Ward,
Place of Death, 4 Quincy ave Winthrop Mass,
(State year, monthand day.)
Place of Birth, Staten Island hy, Date of Birth, March 9 1858.
Name and Birthplace of Father,
Stephen Ko Burgher Staten Island h.y.
Maiden Name and Birthplace of Mother, )
Phele Fountain Staten Island n.y.
Place of Interment, Woodlawn Cemetery OSpraque.
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop , March 14th
190.3 .
Name and Age of Deceased, Charles Burgher. .Ige. 44 years.
Date and march 13# 1903. No L Bringy ave Winthrop mass Place of Death,* Chief cause. acute military Tuberculosis
Disease ‹ Contributing cause,
Chief cause, * months
Duration Contributing cause.
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ! of Physician, Thomas Eligott
* If an institution, state how long an inmate and previous residence.
42 Quimay give Winthrop M.D. . .
1921
@mailes
lugner March 13- 1903
Filed March 14" 1963
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, March 14 "
190 3.
Full Name of Deceased, Louis Lativiery.
{If a married or divorced } woman or a widow give also (
Maiden Name, X
- maly
Sex,
Color, L white Single, Married, Widowed or Divorced,
Age, 26 Years, Months, Days. Occupation,
* Residence (If out of town, } ¿ also state fully. ) ....
Ft. Bacolo, mass. Obenthrop
Place of Death, Fort Back's maass. (Scrittop)
Place of Birth, It John, Canada
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery), Fall River Mass
Dated at. Fr. and Wichop mart. / Signature and place of business of Undertaker. 18 Herman Steel
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Lowes Lariviere
Age, 268. VID.
Place and Date of Death,
died at
7h. Barcos, ucars. Mich., 14 1903.
Primary,
Unknown "Went failure) Duration, -
Disease or Cause
of Death, }
Immediate,
Imknown( Heart failure Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician. March 14" 1903. 3
Watter Ex
M. D.
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.
Buther
Countersign and transmit to the clerk of the city or town.
Juge Larivière
Agent of, Board of Health.
F1, Bautis, Medo VA.
}
Summer Floyd
march
190
Name of Husband,
NO.
RETURN OF THE DEATH
OF Laus Larivané Fort Banks at
Date, March 14 1903
Filed, March 14 190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honscholder 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, 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 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. If of a child born dead, both the birth and death shall be reported as " stillborn ". Penalty for neglect fifty dollars.
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- 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 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, March 19 "
190 3
Full Name of Deceased,
George Award Seuklury
) Maiden Name,
¿ Is a married or divorced woman or a Wlow give also } Name of Husband,
Sex, Color,
Single, Married, Widowed or Divorced,
Age Years, Months, / Days: Occupation, ~
* Residence { If out of town, }
( also state fully. § Buchanan Street, Winthrop
Place of Death,
Place of Birth, Winthrop mars
Name and Birthplace of Father, Odtoward & Jerkshuy- Hinton
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery). Winthrop Cemetery Winthrop Mars
Dated at March 201 1903
Summer Floyd
on
Signature and place of business of Undertaker. 1) Sterman Sweet
PHYSICIAN'S CERTIFICATE.
1 Hour
Name and Age of Deceased, t George Howard Jenkshry Age, ~~ ~ D.
Place and Date of Death,
died at Hinttrop Buchanan IT-Mar191903.
Disease or Cause of Death, ¿ Immediate,
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of Certifying Physician.
M. D.
Date of Certificate, 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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Primary,
Hour
RETURN OF THE DEATH
OF
at
Date,
190
Filed,
190
[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, eansc 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 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 authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts. If of a child born dead, both the birth and death shall be reported as " stillborn ". Penalty for neglect fifty dollars.
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 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 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 sneh 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. 17
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.)
Tro Thous Lavoir
Sex, male Color,'
Date of Death, nav 20m
190; Age, ~Years,
/ Month, ~ Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Aring de Occupation,
*Residence, { If out of town, ) ¿ also state fully. 36 mais 11, Huichroth mass,
Place of Birth,
*Place of Death,
35 main St. Haithrop Mais
Name and Birthplace of Father, : Latua Lavoir, Quebec. Law,
Maiden Name and Birthplace of Mother, Door & Murphy, Portland, ME,
Place of Interment, (Give name of Cemetery),
Italy Cabool Maldau
Dated at
mar 20th
190 3.
Signature and place of business of Undertaker.
Strach S. Maloney (46 ) bitten off Of
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Kro Thomas Wawrzy Age, - Y. / M. D.
Place and Date of Death,
died at ... Hinterop
Mar 204 1903.
Primary,
Whooping Cough.
Disease or Cause of Death, # Secondary, Capillary Bronchitis
Duration, fewdays, 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. 15 Princeton 845 EBook
Date of Certificate, March 21 190 3.
· 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.
on
No.
RETURN OF THE DEATH
OF Les Thomas Lawiny 35 Mais Steel
Date, March 20
1903
Filed,. March 21 190 3
[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 thic same. Penalty for refusal or neglect, teu 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.
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