USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 30
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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, april. 13th 1903.
Full Name of Deceased, Donald Redman Reed.
Maiden Name,
If a married or divorced woman or a Widow give also Name of Husband,
Sex, male Color, White Single, Married, Widowed or Divorced,
10 Hours
Age, Years, Months, ( -Days. Occupation,
* Residence also state fully. )
{ If out of town, }
31 River Road. (31 Rues Road
Place of Death,
Winthrop. Maso. (31 River Road
Place of Birth,
winthrop. mass.
Name and Birthplace of Father, ..
ww k Reed- Boston
Maiden Name and Birthplace of Mother, Reading Lucy a Summer. Reading
Place of Burial (Give name of Cemetery), Woodlawn. Cemetery
Dated Withrap. mass.
Signature and
Summer Floyd
3
on
april.
1903.
place of business
of Undertaker.
18 Oderman Sheet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Donald Redmond Reed Age, - Y. - M. D.
Place and Date of Death, died at. 31 Rice Road Michael afel 12 1903.
Primary, Compression of Bram. Duration, 1 day
Disease or Cause
of Death, #
Immediate,
Som
Duration,
1 day
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
F. C. Hodydan M. D.
Certifying Physician. 83 Salm St. Malden
Date of Certificate, Cfril 13 1903.
· 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.
RETURN OF THE DEATH
OF
Donald Redman Reed at 31 Rue Road
Date,. ajerie 12 "
190: 3
Filed, april 14
190 3 .. .
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every houscholder 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 nider 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 ilhiess, 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 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 snch 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, nntil 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.
Di
1
[11-'02.37.1.M.]
Permit No.
RETURN OF DEATH. Winthrop BOSTON, MASS.
Date of Death, C april 18the 1903
Name in full, forest to more.
(If a married or divorced woman give maiden name, also name of husband.)
Se.v, Male. Color,
(White, Black, Mixed, Chinese, Condition, Married (Single, Married, Widowed or Divorced.)
Indian, etc.) Click.
Age, 46 Years, 3 Months, / 3. Days. Occupation,
Residence, ... Wanthiof mass.
Ward,
Place of Death, 73 Hermon & Winthrop Mass.
(State year month and day.)
Place of Birth,
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, Place of Interment,
John moore.
Mary JAve
Nalifax. n.S.
Marcin Cemetery de helse a mass (Inspiraque. Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop Boston, aferie
190.3 ..
Name and Age ? of Deceased, Forest to moore Ige, 46 years.
Date and april 13 1903. No 13 Herwon't Winthrop Mass.
Place of Death,* ) Chief cause. Pernicious anaemia. ...... Disease Contributing cause,
Chief cause, 3
years
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name und Residence of Physician, 06. O Sonde M.D.
* If an institution, state how long an inmate and previous residence.
We willrop
21
Boston Mass, Date of Birth, Dec 31 1856.
England.
ajerie 13"1963 Filed april 14" 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,
190 3
Full Name of Deceased, Manybay
Scott
Maiden Name, ...
{married ON divorced ! woman or a widow give also (
Name of Husband,
Sex,
Color,
Single, Married, Widowed or Divorced,
Age, ~ Years, 9 Months, Days. Occupation, Danke Nunchuk Mais * Residence { If out of town, } { also state fully. } 5 Place of Death,
Place of Birth,
Boston Mass
Name and Birthplace of Father, Tuy. Tynel Scott. Wheeling Via Maiden Name and Birthplace of Mother, Esta. Porhier. Bryan Texas,
Place of Burial (Give name of Cemetery) Wheeling Next Vine.
Dated at 185-/april on 190 3
Signature and place of business of Undertaker. Menthat Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Maybay Scott
Age,
1 8.9 M. 8 D.
Place and Date of Death,
died at
Queuna imparator sendo Lickimia
Duration,
1 ms
Primary, Disease or Cause of Death, ţ Immediate, Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence § of
KAmel call
M. D.
Certifying Physician. afusil, 8h 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.
1903
Date of Certificate,
Char. QQ. Bennison
No.
RETURN OF THE DEATH
OF
Marybay Scott For Banks at
Date,- april 18" 190 3
Filed, ajene 19" 1013
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death oceurs 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, eause notiec 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 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 faets.
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 eanse of death as nearly as he can 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 čer- tificate required by seetion 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 eity or town a fee of twenty-five eento.
[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 lave, 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-
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,. Cjene 21
190 3
Full Name of Deceased,
Eliga Mercer Soule
Maiden Name, Eliga mercer Henderson
If a married or divorced woman or a widow give also Name of Husband,
LDN Horatio S. Sule
Sex, Color, Single, Married, Widowed or Divorced,
Age, 71 Years ,
9 Months, Days. Occupation,
* Residence { If out of town, { ¿ also state fully. 3
117 Winthrop Street Winthrop Mark 11 "
Place of Death,
Place of Birth,
Name and Birthplace of Father, William Henderson "Scotland"
Maiden Name and Birthplace of Mother, Mary Henderson Scotland
Place of Burial (Give name of Cemetery),
Stinthropo Cemetery
Dated at. Orinterop
Signature and Summer Floyd
on
Marie 22(
1903
place of business of Undertaker. 18 Herman Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Eliza Mercer Soule Age, 71 5.9 M.
D.
Place and Date of Death,
died at.
Winthrop april 21".
190 3.
Primary,
Gerebral hemorrhage Duration, 3 со
Disease or Cause of Death, } Immediate, " Embolisin
Duration, a few hours
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,
23
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 town.
Agent of Board of Health.
NO.
RETURN OF THE DEATH
OF
Oliga Mercer@oule at 11 y Sinthose Sweet
Date,. ajene "1" 190 3.
Filed, Marie 22 190
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 thercafter, 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. 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 funcral, 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 thercfrom 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 ovoending fifty dallara
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, ... april
24/ 190 2
Full Name of Deceased,.
Maiden Name,
Larson
If a married or divorced woman or a widow give also - Name of Husband, Petrus Peterson
Sex, Female Color,
Single, Married, Widowed or Divorced,
Age, 67 Years, Months, 16 Days. Occupation, / Innenkuchen
* Residence [ If out of town, } { also state fully. j .
Baradar
Place of Death, Bourdain Il-
Wartet Mass
Place of Birth, Bohus Lan Swissden
Name and Birthplace of Father, Rasmuson Passion
Maiden Name and Birthplace of Mother, Berta. Larson
Place of Burial (Give name of Cemetery), Forest Hill Cundany letice. R. Bennison
Dated at 24 day Chux 190.3 on
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Laurana Peterson
Age, 6 8. 6 M 16 D.
Place and Date of Death,
died at 42. Finom XI are 24 190 3
Primary,
amar of Vulva
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
21 metiatt M. D.
Signature and Residence S of Certifying Physiclan.
Umshop
Date of Certificate, alla 51
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 Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Disease or Cause of Death, # Immediate,
NO.
RETURN OF THE DEATH
OF
Lamina Peterson at Bowdoin Street
.....
Date, apare 24 190 3
Filed, ajene 25 190.
3
[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, 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 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 sneh 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 bnry 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 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 eountersign and transmit it to the elerk 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, Ojene 30'
190 3.
Full Name of Deceased, alice norton Joff
Maiden Name, alice Martin Soleschand
If a married or divorced woman or a widow give also
Name of Husband, Everard E. Joff
-Sex, Color,
Single, Married, Widowed or Divorced,
Age, 52 Years, Months, 26 Days. Occupation,
Winthrop Tase
* Residence (If out of town, { ( also state fully. ) Place of Death, 86 Pleasant Steel
Place of Birth,
Brooklyn Com
Name and Birthplace of Father, Charles Cleveland Kroklyn Con
Maiden Name and Birthplace of Mother, Julia Snow Odampton Como
Place of Burial (Give name of Cemetery),
Minul Pleasant Cemetery arlington Mas
Summer Floyd
Dated at.
Signature and
May 201
190 3
place of business
of Undertaker.
18 Overmich Street
3
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t alice Walton Goff
Age, 524~M26D.
Place and Date of Death, died at 86 Pleasant Street alenie 30 1903.
Primary,
Camar 1 Vitorias
Duration,
Disease or Cause
of Death,;
Immediate,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
somel call
M. D.
Certifying Physician.
Date of Certificate, may 4 190
· 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.
RETURN OF THE DEATH
OF
Ulice Warten Goff at :86 Pleasant Sweet
Date,
190 3
Filed, Nay 4
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, 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 ", five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the reqnest 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 cause 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- tifieate 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 " 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. 1
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name
Patin
varela Qu
Sex,
Color, 1
Date of Death, 6 %
1993; Age, 76 Years,".
Months,
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Massief Occupation, Chor Makine
*Residence, { If out of town, ) ¿ also state fully. Limerick PriA, Hinttrop
Place of Birth,
*Place of Death,
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Dated at Hru throb
on
mar, 7 mm 190 3,
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at
190
afrobuy central Demornay Duration, 2 days
Primary,
Disease or Cause of Death, # Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence İŞ of
(315 )nel cas)
M. D.
Certifying Physician.
Date of Certificate, may 7 190 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.
1
Agent of Board of Health.
No.
RETURN OF THE DEATH
Ão Patriote Canigan at Limerick Park
Date, May 6"
1903
Filed, May 1
190 3.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death oceurs, 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 elerk of the city or town in which the death oeeurred.
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 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 faets.
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 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 inade in accordance with seetion 10, and return it, together with the facts required by section 1, to the board of health or to the elerk 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 eity or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issned 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 eity or town for registration.
SECTION 5. Penalty for violation not exceeding fifty dollars.
[11-'02.37-LM.]
Permit No ..
RETURN OF DEATH. BOSTON, MASS.
Date of Death, May 6-1903 Name in full, Still Come Alive
(If a married or divorced woman give maiden name, also name of husband.)
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