USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 34
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I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S Francia a. Harres M. D. of Certifying Physiclan. Med. Sequer
Date of Certificate,
auce. 28
1903
· Give also street and nuruber, if any. | Give sex of infant not named. If still-born, Bo 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 toun.
Agent of Board of Health.
48 Cottage Park Road. aug 27. 1903.
No.
RETURN OF THE DEATH
OF Clarence a, Barney at 48 Cottage Park Road
Date, .. auquel 27" 1903
Filed, august 58. 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 eity 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 ". 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 whont 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 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 eents.
[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 vidaticu
190 No.
Burial permit issued.
For Board of Health.
RETURN. OF A DEATH. TO THE BOARD OF HEALTH. EVERETT, MASSACHUSETTS. NO INCOMPLETE RETURN WILL BE ACCEPTED.
[FILL OUT, WITH INK.] Wayne Austin
Name in full. Year 1903
Year 1403
Years
Date of death Month August Date of birth Month Fem
Months 2
Day
Day 6
Maiden name 1 If a woman, 1
married or divorced.
Husband's name 1 If a woman,
1 married or divorced. 1
Sex-
Conjugal Conditions- Kingk Moulesl.
Divorced.
Occupation (Of person over ten years of age)
Residence ( If out of town state fully)
Place of birth
Leverett Arces
Place of death Herbert . Austin Birthplace Nume of father
Tritan que Guntherof
Ward ..
Reading Mass
Birthplace Basta
Maiden name of mother
Glenwood leemetary levent
Place of interment
J. S. Baudry Jan Undert
. Undertaker.
Ecerett, Mass., Aug. 27 1: 190 3 tercutt Mare . Place of business
PHYSICIAN'S CERTIFICATE.
Hayne Austini
Nume of deceased
Age y. 2 m 2 3.1.
Place and date of death
Triton au Authich Ang 27 1.903.
Disease and cause of death.
Chief' cause Cholera Infantum
..... Duration dwa weeks.
Contributing cause Syphilis
Duration
since birth
I certify that the above is true to the best of my knowledge and belief.
Mg. Panter Residence 250 Shirley St, Winthrop
M. D.
Date of Certificate aug. 27. 1903.
Office Hours of Board of Health/9 A. M. to 12 M. 2 to 5 P. M. May 1 to October 1. Saturdays, 9 A. M. to 12 M.
Days 23
Color- White. Black (neger mixed). Indian.
Male.
-Chinese .- Japanese.
Female.
Strike out words not applicable.
august 27 " 1903 Filed aug 28'1903
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,
28"
190 3.
Full Name of Deceased, Frederik Willem Bartlett
Maiden Name,
If a married or divorced woman or a widow give also Name of Husband,
Sex, Tizedde Color, YVlite Single, Married, Widowed or Divorced, Waclawer
Age, 2, 88 Years, Months,~ Days. Occupation, merchant
* Residence { { If out of town, } It winthrop mass
( also state fully. }
Place of Death Nachry (30 )introp & need
Place of Birth,
Paris Hectare
(maine
Name and Birthplace of Father, Annen Barthel Paris Meine
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery),
Dated at
Signature and
Buminer floyd
Pure 28"V 1903
place of business of Undertaker. 18 Hermund Sheet,
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Frederick De wam Bach H
Age, 868 ~ . ~ D. aug 28' 190 .
Place and Date of Death,
died at
1
Duration,
Duration, 4 days
I certify that the above is true to the best of my knowledge and belief.
signature and ResidenceS of
1 1
M. D.
Certifying Physician.
Date of Certificate, aug 280 1903.
* 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.
Primary,
Disease or Cause of Death, ± Immediate,
Irmia
No.
RETURN OF THE DEATH
OF Frederick William Bailelt
30 Hinthope Sheel at
Hinterof mass
Date, auquek 28 190 3
Filed, august 29 190 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 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 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- 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 .. Name in full, Caroline & Herisson
Left 8/1903
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Color,
Condition,
White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, - Years, Months, / Days. Occupation,
Residence, 9 New town une
Ward,
Place of Death, & Leas Ham are W muchof
State year, month and day.)
Place of Birth, Withof ave Date of Birth,
Difus 1953
Name and Birthplace of Father, Maiden Name and Birthplace of Mother, Place of Interment,
This Je Lane
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,. Jeph. 3. 190 3. Name and Age Caroline Elizabet Hennessy years.
of Deceased,
Date and Sept. 3., 9 dia Foam au; Winthrop
Place of Death,* S
Chief causc. still horn
Disease Contributing cause, Chief cause,
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence Į of Physician, M.X. Porter M.D.
* If an institution, state how long an inmate and previous residence.
2
Caroline to germany September 3" 1909 Filed Seper 4" 1903
[11.'02.37-LM.]
Permit No ...
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, Olive Jeffrey "ne"
Defit 21/1903 Hecl
wife of Heavy Jeffry (If a married or divorced woman give maiden name, also name of husband.)
Se.v. Color,
Condition,
White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 45 Years, Months, Days. Occupation, Residence, 31 Praticar st. Ward,
Place of Death, 11
Place of Birth, Randolph Nt.
Date of Birth, 1858
Louis Hice
Canada
Maiden Name and 1 Birthplace of Mother, ) Place of Interment,
Tas. I. Lacc. Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, September 21 1903
Name and Age y of Deceascd, Olive Jeffry Ige, 45 years.
Date and Septimetin 21.1903 Thurstrop, mas
Placc of Death,*
Chief cause, .. multiple abdominal Sarcoma
Disease Contributing cuuse. Chief cause. Three years
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief. Name and Residence ) of Physician, 1
CE Johnson, M.D.
* If an institution, state how long an inmate and previous residence.
Thistrop. quase.
(State year, month and day.)
Name and Birthplace of Father,
Philancer Bouchard
Defetember 21 "1903 Filed Sejet 22" 1903
FORM C.
Commonwealth of glassachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Date of Death, Sept Ember (FILL OUT WITH INK. ALL NAMES TO BE IN FULL.) RON Ember 221 190 3.
Full Name of Deceased, Clara O. Short
Maiden Name, Clara O, Somg
If a married or divorced woman or a widow give also
Name of Husband,. Owville Q1, Showl
Sex, Color,
Single, Married, Widowed or Divorced,
Age, 5 + Years, Months, Days. Occupation,
~
* Residence { If out of town, } Winthrop Mass
{ also state fully. )
Place of Death, 25 Prospect thenne
Place of Birth, Gambier Ohio
Name and Birthplace of Father, Unknown
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery), ...
Dated at Winthrop
Signature and
univer Floyd
n
on September 23 ...... 190 3
place of business of Undertaker. 18 Sterman & leer
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Clara O. Short
Age, 544. 0M.n.D.
Place and Date of Death, died at 25 Preferel Avenue 2021 2.2 190 3.
Disease or Cause of Death, Immediate,
Primary,
Chithelioma Duration, 3 ers.
Heart failure
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
MS. Portu
M. D.
of
Certifying Physician.
250 Shirley If: Winthrop.
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.
RETURN OF THE DEATH
OF
Clanq O, Show 25 Prospect avenue at
Date, September 22 1903
Filed, September 23 190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honscholder 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 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 shall be issued until there shall have been delivered to such board a written statement, containing the facts required by kor, 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,
September 32"
.190 3.
Full Name of Deceased,
Joseph a. Jdeman
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,
Days. Occupation, merchant
Age, 92 Years, 7 Months, Winthrop Ware
* Residence ( If out of town, } ¿ also state fully. § 33 Sagamore avenue . Highlands Place of Death,
Place of Birth,
Dorchester Mass
Name and Birthplace of Father,
Joseph a. Jolman=Dorchester
Maiden Name and Birthplace of Mother,
Place of Burial (Give name of Cemetery), Forest Drills Cemetery
Dated at ... Of intenop
Signature and
Summer floyd
Desetember 23 1903 on
place of business
of Undertaker.
18 Overnon Sheet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Sketch a. Johan Age, 928 / M. D.
Place and Date of Death,
died at.
33 Sagamore One Sejet 2 21903.
Primary,
denility Duration,
Disease or Cause
of Death, #
Immediate,
Attrangulated Hernia Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
A.l. Carter
M. D.
Certifying Physician.
250 Shirley aty Winthrop
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.
RETURN OF THE DEATH
OF Jnych a, Jolman 33 Sagamore avenue at
Date, September 22 190 3
Filed, September 23 1903.
[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, 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 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 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 negleet 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 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- 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.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.) October 1. 190 3.
Date of Death,
Full Name of Deceased,
John Thurber Ham.
Maiden Name,.
If a married or divorced woman or a widow give also ( Name of Husband, White Single, Married, Widowed or Divorced,
Sex, male Color,
3 Horas 3 Hours
Age, Years, - Months, Days. Occupation,-
* Residence ( If out of town, } ¿ also state fully. ) Itanthrop Mass
Place of Death, Point Shirley (Winthrop, " mass).
Place of Birth, 11
Name and Birthplace of Father, William 6. 26 am, Boston, mass.
Maiden Name and Birthplace of Mother Gran F. Black, Scotland.
Place of Burial (Give name of Cemetery),
Dated at Printtropo
Summer Floyd
01 October 2' 190 3
Signature and
place of business
of Undertaker.
Winthrop mass
PHYSICIAN'S CERTIFICATE.
3 Hours
Name and Age of Deceased, t
Place and Date of Death, died at Point Shirley Oct- 100 1903.
Primary,
Premature Siret 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
A.J. Porter
M. D.
of
Certifying Physician.
Date of Certificate, Oct. 20 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.
No.
RETURN OF THE DEATH
OF John Thuber Gram Print Shirley
Coliber 1" 1903 - at
October / حيـ 190
Date,
Filed, Ochota 2 "
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 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 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, mutil 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.
Date of Death, October 13' (FILL OUT WITH INK. ALL NAMES TO BE IN FULL.) 1903.
Full Name of Deceased, Grilla Word
Maiden Name, Quieta Hovd
If a married or divorced woman or a widow give also Name of Husband,
Sex, Color,
Single, Married, Widowed or Divorced,
Age, 70 Years, Months, ( Days. Occupation,
28 Jempele avenue W. Highlands * Residence ( If out of town, } i also state fully. §
Place of Death, 28 Temple avenue H. Ohighlands Chew Your
Place of Birth,
Name and Birthplace of Father, Otiram Word Saratoga WY,
Maiden Name and Birthplace of Mother, Many Sprague Pompey WY,
Place of Burial (Give name of Cemetery), Garjetteville New York
Dated at Winthrop
Signature and Dimmer Hard
on
October 14 190 3
place of business of Undertaker. Winthrop Dwars
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Carilla Word
Age, YO Y. N.V. ND.
Place and Date of Death,
died at. M. Highlands October 13 1903.
- Primary,
Intercasino( Intestin 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
of
Certifying Physician.
80 Princet: Rt M. D.
Date of Certificate,
Qav 15
حج 190
* 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.
RETURN OF THE DEATH
OF
anilla Word
28, Temple Que at
Detotro 13 1903
Date,
Filed, 190 October 14 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 clerk.
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