Town of Winthrop : Record of Deaths 1900-1903, Part 7

Author: Winthrop (Mass.)
Publication date: 1900
Publisher:
Number of Pages: 564


USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 7


Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).


Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36


on


December .5"


190 6


Signature and


place of business


of Undertaker.


Withney Mars


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Dorothy. Soule


Age,


Y.


M.


.D.


Place and Date of Death,


died at ..


Winthrop December.5


190 C.


Disease or Cause of Death, #


Primary, Secondary,


Duration,


Duration,


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence of Certifying Physician.


HJ Sunk


M. D.


Date of Certificate,


December 5"


190 O.


· 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.


No.


RETURN OF THE DEATH


OF


at


Date,


190 ....


Filed,


190


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the elerk of the city or town within the Commonwealth at which his vessel first arrives after 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 the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


n __ 1- fax violation not avecerling fifty dollars.


FORM C.


Commonwealth of Classachusetts.


No.


54


RETURN OF A DEATH.


To the Clerk of the City or Town in which the death occurred.


Name, .


DanielTo


WITH INK. ALLNAMES TO BE IN FULL.)


Sex


male Color, white


Date of Death,


Dec. 16


1900; Age 80


.Years,


-Months, ~Days.


Maiden Name, { If married, widowed) or divorced.


Husband's Name,


Single, Married, Widowed or Divorced,


Fridowell Occup


Occupation,


Stable berpr


*Residence, { If out of town, )


¿ also state fully.


Boston, mass.


Oswego, New York


Place of Birth,


Shirthop, mass 169 Thirty Streep


Name and Birthplace of Father,


Maiden Name and Birthplace of Mother,


Place of Interment, (Give name of Cemetery),


Dated at


Hinterof mass.


Bummer Floyd


1


on


Dec. 17


1900


Winthrop mars.


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Danie T. Ella


Age, So Y ......


M.


D.


Place and Date of Death,


died at.


Finition, Maso.


- Primary,


Duration,


Disease or Cause


of Death, ¿


Secondary,


Duration,


Afew hours


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence


M. D.


of


Certifying Physician.


Wirtho Man


Date of Certificate,


Offer. 1712


1900.


* 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.


*Place of Death,


Signature and place of business of Undertaker.


No.


RETURN OF THE DEATH


OF


at


Date,


190.


Filed,


,190_


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a deatlı 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 healthi 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 forthi the required facts.


SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, lias been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Healtlı, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


SECTION 5. Penalty for violation not exceeding fifty dollars.


FORM C.


Commonwealth of Massachusetts.


No. 55


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.)


Name,


Stilebom Enfant


.Sex


Male Color,


71


Date of Death,


December 23


.190 0 ; Age, ..


.. Years,


2


Months,. [ ..... Days.


Maiden Name, { If married, widowed ) or divorced.


Husband's Name,


Single, Married, Widowed or Divorced,


Occupation,


Emerson Street (Off Mais (1)


*Residence, § 1f out of town, )


also state fully.


Place of Birth,


11


11


11


11


1,


*Place of Death,


11


Name and Birthplace of Father,


James Hester- Ireland


Maiden Name and Birthplace of Mother, Sarah Crowley- Ireland


Place of Interment, (Give name of Cemetery),


Dinetrop? Co enelery


Dated at


Winthrop


Summer Floyd


December 23°


190 0


Signature and


place of business


of Undertaker.


Winthrop, Mais


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Still Com Confand(tester)


.Age,


Y.


.M.


... ... D.


Place and Date of Death,


Primary,


died at.


Houttrop (Emerson Street) Decre 1900.


Duration,


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 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 Secondary Cause.


Countersign and transmit to the clerk of the city or town.


.......


Agent of Board of Health.


No.


RETURN OF THE DEATH


OF


at


Date,


190.


Filed,


190.


[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 healthı 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 aud 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 the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Auy person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration


SECTION 5. 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.)


Name,


etemneth H, Tempton


Sex,


Color,


Date of Death, formany 11


.190/ ; Age,


.Years,


1


... Months,


21 Days.


Maiden Name,


( If married, widowed


or divorced.


Husband's Name,


Single, Married, Widowed or Divorced,


Occupation,


*Residence, { If out of town, )


¿ also state fully. §


(Minibuss Mas


Minttrop (marshall free)


Place of Birth,


Winthrop (Marshall Stid;


*Place of Death,


Name and Birthplace of Father,


Herbert Kompeti -Nome Tertia


Maiden Name and Birthplace of Mother,


Mina Reau. _ Nova Veolia


Place of Interment, (Give name of Cemetery), (Mintto), Cemetery


Dated


at


Winthrop.


Summer Floyd


on


January 12 1901.


place of business


of Undertaker.


Winthrop Mass


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


.Age,


Y.


M. . .. .... D.


Place and Date of Death, .


died at


Marshall Str. Wintherh. Jan. 11 1901.


Primary,


Scarletina Maligna


Duration,


Trodags


Duration,


I certify that the above is true to the best of my knowledge and belief.


Crank Jillian.


M. D.


Signature and Residence §


of


Certifying Physician.


15-Princetar Str


Date of Certificate,


Jan 1 2


190


Part portun,


· 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.


1


1901


-


Disease or Cause


of Death, #


Secondary,


Signature and


No.


RETURN OF THE DEATH


OF


Kenneth Of Kenyaton


Marchace Steel at


Date, January,


190 ......


Filed, Jamay,


1902.


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a deathi 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 fortli the required facts.


SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


0- sinlation not avreading fifty dollars.


202


[Form No. 37.]


10


RETURN OF DEATH. BOSTON


1


1 Year, 1901. Month Jau.


Birth


Month, Jan. Age


Years, Months .


Day , ... 13.


Day, 10.


Days ... 3


Name in full avjoris f: Kintry


Maiden name,.


Residence, Hinttrop White. Black (Negro or mi.ved).


Sex Conjugal condition


Single. Married. Widowed.


Color


Chinese. Japanese.


Wife of


Place of death Street, 109


Number.


Place of birth,


Occupation, Frachon)


Club


Name of Father Land 2.


Maiden Name of Motherallermig


Gibrains Birthplace of FatherSommille MauBirthplace of Mother Brain


Place of interment,


1


Undertaker:


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Boston, Jan 13,


190 %.


Name and age of deceased,


ert. Marjorie Mc Kinley.


, Date and place of death, *.


Days Jang 13-1901. 109 Main St Hinthint


Disease


Contributing cause,


Chief cause, Difficult labor


consequent


Duration. Contributing cause, Difficulty of and delay in delivery o cheed al birth!


I certify that the above is true, to the best of my knowledge and belief.


Name and residence ) of physician,


Allut B. for


O. M.D.


* If in an institution, state how long an inmate and previous residence.


The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays; 9 A. M. till | P.M .. except during the months of June. July, August and September, when the office will be closed on Saturdays at 12 M. ; Sundays, 10 A.M. till 12 M . Holidays, from 10 A.M. till 12 M. ; other days, from 9 A.M. till 5 P.M.


Winthrop


Permit No.


Y'ear, 1901


Date of death


Female. Mate.


Divorcea. Widow of


sam


Chief cause,


marjorie me Riley 109, Mani Street January 13 " 1901


03 [1.'00.37-XX M.] 1901


Permit No.


RETURN OF DEATH. BOSTON.


Year, 1901


Date of death


Month Pan Birth


Year, .. Month, 1 Day,


Day, 17 Margaret Le Berry Residence,


Name in full,


Maiden name,


Driscoll Singte. Married. Widowed.


Color


Indian. Chinese. Japanese.


Wife of.


Walter Barry


1


Divorced.


Widow of.


Place of death Street, Highup Sea Fram avenue


Number,


Place of birth,


Occupation, Somalie


Name of Father, Daniel Maiden Name of Mother Lathering Dacry


Birthplace of Father, als Eland Birthplace of Mother, Island


Place of interment, Calvary Cemetery


Undertaker.


PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.


Boston, 190 . .


Name and age of deceased, Margaret le Barre, Age, 47 years. 3mm


Date and place of death,*


Disease 1 Chief cause, fatty decreation of that.


Contributing cause,. Vente à l'ye tra


Chief cause .......


Duration Contributing cause,


I certify that the above is true, to the best of my knowledge and belief.


Name and residence ? of physician, Frank A. Allen M.D.


* If in an institution, state how long an inmate and previous residence.


The office of the Board of Health will be open for the granting of permits for burial, as follows : - Saturdays, 9 A.M. till | P.M., except during the months of June, July, August and September, when the office will be closed on Saturdays at 12 M. ; Sundays, 10 A.M. till 12 M. ; Holidays, from 10 A.M. till 12 M. ; other days, from 9 A.M. till 5 P.M.


Days, Winthrop


White. Black (Negro or mixed).


Sex- Female.


Conjugal condition


Years, .. 43 13


Age Months,


.


Margaret Q, Barry Sea Fram avenue January 1 ' " $900


1


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.)


Name,


Lydia 8, Egan


.Sex,


Color, n


Date of Death,


January 20


1901


Age, 60 Years, Months, ~ Days.


Maiden Name, " If married, widowed {


or divorced.


Lydia B, Gould


Husband's Name,


OThomas Er, Egan


Single, Married, Widowed or Divorced, Occupation,~


*Residence, { If out of town,


Winthrop Mass


¿ also state fully. 3


Place of Birth, Piermont CH. O.


*Place of Death,


2010 Pearl avenue (Minitrop) Ocean Spray


Name and Birthplace of Father, John Hould


Maiden Name and Birthplace of Mother, ... Eliza Bosworth


Place of Interment, (Give name of Cemetery), Cambridge Cemetery


Dated at


Signature and


Dummer Floyd


on January 2%


1901 place of business of Undertaker. Winthrop mars.


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Lydia B. Egan


Age, 65 Y.


M.


.. ..


.D.


Place and Date of Death,


died at 10 Pearl Av. Wenig Mean. Jan. 20 1901. Cancer Duration, Bet. 1 and 2 year


Duration,


I certify that the above is true to the best of my knowledge and belief.


A.B. Norman M. D.


Signature and Residence of Certifying Physician.


Date of Certificate,


Feb. (Se


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 Secondary Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of Health. Jan 20


Primary,


Disease or Cause of Death, # Secondary,


No.


RETURN OF THE DEATH


OF Lydia B. Egan 10 Years avenue at


0, Spray


January 20 1901 Date,


Filed, January


.190 ___.


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a deathi 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 thercof 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 forthi the required facts.


SECTION 11. In case the deceased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate inade in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefromn, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued nntil a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


nemnadine 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.


Name,


Parise Madeline Hanson


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


.. Sex,


St


21


Date of Death, .


January 21/901


HIF ; Age, Years


Months, .Days.


Maiden Name.( Af married, widowed ) or divorced.


-


Husband's Name,


1


Single, Married, Widowed or Divorced, Occupation,


*Residence, { If out of town,


Winthrop (Highlands Mass


? also state fully. §


Place of Birth,


no.20 Sagamore Cience


*Place of Death,


no 20 Sagamore Chenne


Name and Birthplace of Father, Williams, Olanson-Deering me


Maiden Name and Birthplace of Mother, avis I. Parker-&Deering the


Place of Interment, (Give name of Cemetery), Winthrop Cem.


Dated at


Winthrop


Summer Floyd


January 22 1901


place of business


of Undertaker.


Minttrajo mass


PHYSICIAN'S CERTIFICATE.


Name and Age of Deceased, t


Sowie Madeline Har ~. ~ M. V.D.


Place and Date of Death,


died at


Uken Farannovale


Duration,


3cl


Jamy 2190/.


Disease or Cause of Death, ; Secondary,


Primary,


Premalite


Duration,


3dl


I certify that the above is true to the best of my knowledge and belief.


Signature and Residence of Certifying Physician.


Sahurson M. D.


Date of Certificate,


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 Secondary Cause.


Countersign and transmit to the clerk of the city or town.


Agent of Board of Health.


Color,


-


Signature and


No. .5


RETURN OF THE DEATH


OF Louise Madeline Hanson 20 Задатые Сление at


January


Date, anuary 21 1901.


Filed, January 2


[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]


SECTION 6. Every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred.


SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the 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 the same. Penalty for refusal or neglect, ten dollars.


SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.


[EXTRACTS FROM CHAPTER 437, ACTS OF 1897.]


SECTION 1. No human body shall be buried in a city or town or removed therefrom, until a permit therefor shall have been received from the proper authorities. No such permit shall be issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When such statement and certificate are delivered to the Board of Health, the board or agent shall forthwith countersign and transmit the same to the clerk of the city or town for registration.


SECTION 5. 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.




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