USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 35
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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, 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.
(FILL OUT WITH INK, ALL NAMES TO BE IN FULL.)
Date of Death, October
1903.
Full Name of Deceased,. 2. Aloyl
Maiden Name,
If a married or divorced woman or a widow give also Name of Husband,.
na
Sex, Color,./ mite Single, Married, Widowed or Divorced,
Age, Years, Months, 6 Days. , Occupation,
H3 Minitrop He Pinchup, Hace,
* Residence { If out of town, } ( also state fully.
Place of Death,
Place of Birth, ..
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother, Luna Chelen Lockport IS
Place of Burial (Give name of Cemetery), *
Dated at The wp thewar
on Que 23 / 1903
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Strand Jankelly Beloven Age, Y. NM. 6D.
died at.
Winstrol, Oct 14 "1903.
190 3.
Place and Date of Death,
( Primary,
Mal nutri tain
Duration,
6 days
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
no.
M. D.
Certifying Physician.
Winthrop Man
Date of Certificate,
/Var 23
190 3
* Give also street and number, if any. t 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 Canse.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
RETURN OF THE DEATH
OF Floyd JenRelay Belcher at 43 Minutos Sheet
Date, Colaber 14.". 190 3
Filed, Colate 1.5 كى 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, 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 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 negleet, 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.L.M.]
Permit No ... .......
RETURN OF DEATH. BOSTON, MASS.
Date of Death, (ct, 2%), 1903
Name in full, - Alarry Hister Ruell
(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.)
Age, 25 Years, 10 Months, 8 Days. Occupation, ..
Residence. G. Hathorn Cur. Henthut Ward,
Place of Death,.
Place of Birth, .. Charleston
CEtate year, month and day.) Dec. 19- 18 H
Heter Ó Ruell
Ruston Har.
Name and Birthplace ) of Father, 1 Maiden Name and 1 Birthplace of Mother, ) Place of Interment,.
int 16 4
Prenants Son
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,
190 3.
Name and Age Have Hister Ruell of Deceased,
Age, & 8 years.
Date and Cich 2:1h 19.0 0 Hutton we, Hinthuf Place of Death,*
Chief cause, Pulmonary tuberculosis Disease - Contributing cause, .
Duration Contributing cause,
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ) Will ard A Paul M.D.
of Physician,
* If an institution, state how long an inmate and previous residence.
15T Naward Lt
21 Now Dorchester
Chief cause, Over five years
Indian, etc.,
Date of Birth,
De'd October 27" 19/03/ Filed Oct 28 " 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, October 39" 1903.
Full Name of Deceased, James l. nº Caroley
Maiden Name,
If a married or divorced woman or a widow give also Name of Husband,
Sex, 200 Color,. Single, Married, Widowed or Divorced,
Age, 65 Years, 8 Months, Days. Occupation, blesk
* Residence ( If out of town, } ( also state fully. §
62 Shirley Street (Winthrop, Dass)
Place of Death, Philadelphia
Place of Birth,
Name and Birthplace of Father, James NO: Cawley Philadelphia
Maiden Name and Birthplace of Mother, Many Oxoch Norfolk Va
Place of Burial (Give name of Cemetery), Mount Ot ofer Cemetery Dopchester
Dated at Derober 30 1903
Signature and place of business of Undertaker.
Summer Floyd -18 Herman 21-
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Jauns Me Cauley Age, 65 8. 8 1. 7 D.
Place and Date of Death,
died at Och 29 1903.
Primary,
Sclerosis of Carmary arte on, 34
Disease or Cause of Death, # Immediate,
anguia Pedans Duration, 2 days
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
.M. D.
Date of Certificate, Odlatina 31 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.
1
RETURN OF THE DEATH
James L. M. Canley OF
(6) Shirley Sheet at
Date, Deloter 29
" 1903
Filed, Octobre 31' 190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION G. 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 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 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, October 29 " 190 3
Full Name of Deceased, Charles Or, & learns
Maiden Name,
If a married or divorced woman or a widow give also
Name of Husband,
01 Single, Married, Widowed or Divorced, Sex, 016 Color,
Age, 61 Years, Months, Days. Occupation, Labrer
* Residence " If out of town, } Cherry Street intuof Mass ( also state fully. )
Place of Death,
Place of Birth, mario
Name and Birthplace of Father, Untuam,
Maiden Name and Birthplace of Mother, Unknown
Place of Burial (Give name of Cemetery), . .
Dated_at Ofinthop
Signature and Summer Floyd
on Octota 29 .190 3
place of business of Undertaker. 18 0terman St
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Charles Od, Stearns Age, 6/ 8. ~. ~ D.
Place and Date of Death, died at Winthrop Cherry RI-Ook 291903.
mutual insurance
Duration,
2 cm
Disease or Cause of Death, } Immediate,
Primary,
Heart Facher
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of
Certifying Physician.
Date of Certificate,
oct 31 2
1903
M. D.
* 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
Charles OV, Steame OF
Cherry Steel at
Date, October 29
190 3
Filed, October 31 190 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 ocrtificate 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 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, ... 100 9 th Eliza Bryant Miller Full Name of Deceased,
If a married or divorced Maiden Name, woman or a widow give also ( Name of Husband, Robert. W. 7
Taylor
Sex, Paul Color,
Single, Married, Widowed or Divorced,
Age, 62 Years, 17
Months, Days. Occupation,
* Residence
( If out of town, }
¿ also state fully. ) .
Chicafuck
Place of Death, 17 Collage are
Place of Birth,.
see
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,. E Cija
Place of Burial (Give name of Cemetery), .... BEardestron see
Dated at
Nw 16 th
190
Signature and place of business of Undertaker.
on
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Eliza B. Miller
Age 6 2 x. 11 M. D.
Place and Date of Death,
died at
1) Cottage are combiop Nou 9h
1903.
Disease or Cause of Death, ţ Immediate,
Primary,
Cardiac Sclerosis Mitral Inselfancy Duration, 6 months
Heart failure
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
ace[
B.H. Metcalf
M. D.
of Certifying Physician. Winthrop mass.
1
Date of Certificate,
November 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 town.
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF
Eliza B. Miller at Winthrop-17 Cottage
are ....
Date, november !" 190 3 ..
Filed, november 11" 1.90 3
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honseholder 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 ocenrs, 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 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.
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, nutil 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, ..
Nov 10-1903
Name in full, ... tull, James Duff
Se.x, Jeale
Color, White
Condition Marmel
(White, Black, Mixed, Chinese, (Single, Married, Widowed or Divorced.)
Indian, etc.)
Age, 75 Years,~ Months,. 8 Days. Occupation, Retired chanafacturing Ward,
Residence, Cincinnati, Ohio
Place of Death, 78 Cliff Doc Winthrop Highlands
(State year, month and day.)
Place of Birth, New York N. 3
Date of Birth, Nov 2 1828
Name and Birthplace ) varnes Duff Scotland
of Father,
Maiden Name and Vane Champson
Birthplace of Mother, )
Place of Interment, Deoría Ill
A, Le, Eastman
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston,. November 10th 1903
Name und Agel
of Deceased , James Duff
.Age, 73 years.
Date and November 10th 78 Cliff Avenue Place of Death,* S Chief cause,. Apoplexy
Disease - Contributing cause, Atheroshatous blood vessels
Chief cause, 3 days, and valvular heart disease Duration Contributing cause, 14 months or more
I certify that the above is true to the best of my knowledge and belief. Nume and Residence ? of Physician, Charles H. Cobb M.D.
* If an institution, state how long an inmate and previous residence.
Hotel Oxford
10) 21
Boston mass,
Scotland
(If a married or divorced woman give maiden name, also name of husband.)
1
James uff Died Oct 10"1903 Fired Oct 11 "1923
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, OK semler.
16' 190 3.
Full Name of Deceased,. Charlie Bernice
Maiden Name, -
If a married or divorced woman or a widow give also
Name of Husband,
Sex, 200 Color, Single, Married, Widowed or Divorced,
Age, 78 Years, 9 Months, Days. Occupation, none
* Residence { If out of town, }
24. Bondon't Sheet Winthrop Shoes { also state fully.
Place of Death, 24 Bowdoin Street Winthrop Mass
Place of Birth, Chelsea Mass
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Winthrop amely Winthrop Mars
Place of Burial (Give name of Cemetery),
Dated at November 18 190 3 on
Signature and place of business of Undertaker.
3
18 Hemmin Streel
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Charles Durile
Age, 18 x. 9 M. D.
Place and Date of Death,
died at
Winthrop. norender
16
190 3.
Primary,
Heart disease
Duration,
3 years
Uremia
Duration,
6 months
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
Certifying Physician.
0
Wwwtrop
Date of Certificate,
Non 2.3
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.
M. D.
Disease or Cause of Death, # Immediate,
RETURN OF THE DEATH
OF
Charles (Burnie) at (No24 Boarding Street
Date, Overember 14
190 3
Filed, Chosemler 15 190 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 ocenrs, 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 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 sanie. 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.
5
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, December
1903.
Full Name of Deceased, ada Perkin's
Maiden Name, ada lovojeley
If a married or divorced woman or a widow give also -
Name of Husband, Joseph . Perkin's
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