USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1900-1903 > Part 9
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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 sneh 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.
..
1.11 .==
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,
Dusan Elizabeth Clare
Sex,
Color,
Date of Death,
Marcel 22
190 / ; Age, / Years,
Months,
„.Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,. Occupation,
*Residence, { If out of town, )
Wirth of nie
? also state fully. 3
Place of Birth,
*Place of Death,
Dea Firm Creme
Name and Birthplace of Father,
Theodore C, C 12 Heterford VI-
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery), Juventus Maso
Dated at
on
March 23'
190 /
Signature and
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t .. D. - Susan Elizabeth KarkAge, 13 Y. 8 M. Place and Date of Death, died at Sza Foam Are Withrop , Klar 22 1901. Pneumonia Duration, 5 Paris
Primary,
Disease or Cause of Death, # Secondary,
theart in houston
Duration,
10 hours
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence Edward to years M. D.
of Certifying Physician.
#12 vient the Monthof
Date of Certificate,
allauch 23
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. Stou 22
I
No. 13
RETURN OF THE DEATH
OF Dusan Elizabeth Clark at Seassam Oenue
Date, March 22
190 ___.
Filed, March 23 1901.
[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 or 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.
Danalty for violation not exceeding fifty dollars.
FORM C.
Commonwealth of glassachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Threejes. Payson Floyd
1
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex,
Color,
Date of Death, march 24 1901; Age, 60 Years, 5 Months, 11 Days.
Maiden Name, { married, w or divorced.
Husband's Name,
-
-
Single, Married, Widowed or Divorced, Occupation,
*Residence, { If out of town, )
Northrop mass
¿ also state fully.
Place of Birth,
north Chelsea
*Place of Death,
10 goenst Street
Name and Birthplace of Father, David Floyd Chelsea
Maiden Name and Birthplace of Mother,
Sally . Linkeshiny Chelsea
Place of Interment, (Give name of Cemetery),
Winthrop benecent
Dated at.
Stinthrop
Summer Cloud
on
march 24
190 /
Signature and place of business of Undertaker.
Winthrop mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Phillipa Passere landAge, 60 Y. 5 M. " D.
Place and Date of Death,
died March 24 190 ;. Tehoping Cerebral racmariages Duration, / noreste-
Disease or Cause - Primary,
of Death, ¿ Secondary,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
21 irustivos
Date of Certificate, Marci 27 190/.
· 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.
Duration, Sc Johnson. M. D.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
No. 14
RETURN OF THE DEATH
OF Phillips Payen Floyd To goener Street
Date, March 24 " 1901.
Filed, March 25
190 __.
[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 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 eity 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 liis vessel first arrives after suel death.
SECTION 8. Penalty for neglect to comply with the requirements of seetions 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 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 seetion 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 city or town or removed therefrom, until a permit therefor shall have been received from the proper anthorities. No sneh 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 sueh 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.
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,
Thomas Henry Clark
Sex,
Color,
Date of Death,
March 31
190/ ; Age, 22 Years,
9 Months,
5 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name, ..
Single, Married, Widowed or Divorced.
Occupation,
Clerk
*Residence, { If out of town, )
also state fully!}
Winthrop Mass
Place of Birth,
Somerville Mass
*Place of Death,
29 Sargent Street
Name and Birthplace of Father,
Edward I. Clark-Cambridge
Maiden Name and Birthplace of Mother, Cynthia . Harding-Chatham
Place of Interment, (Give name of Cemetery), Sinto 10 Cemetery
Dated at Winthrop
Summer Floyd
on
Marie 1"
190 /
Signature and
place of business
of Undertaker.
Hinttrop Mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Thomas Henry Clarke
Age, 22Y. 9 .M. S.D.
Place and Date of Death,
died at.
March 31"1900-37 Sargent R1 550.
Disease or Cause | Primary,
of Death, #
Secondary,
Thethicio Pulmonalis
Duration,
24/ 200
Duration,
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, 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. 15
RETURN OF THE DEATH
OF Thomas Ofensy Clarke 27 Sargent Shell
Winthrop mask at
Date, March 31
1901
Filed, Cyferie 1" 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 perinit 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.
1.11 ===
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, /
Caleb Blanding Smith
Sex,
Color,
Date of Death,
ajerie 4
190 ) ; Age, +1 + Years,
~ Months,
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
1
Single, Married, Widowed or Divorced, Occupation, Engineer
*Residence, { If out of town, )
? also state fully.
Winthrop Nase
Place of Birth,
Putney Vermont
*Place of Death,
22 Centre street
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Nordea Cemetery
Dated at
Minthajo
Summer Floyd
on
alene 5
190 /
Signature aud place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age,
Y ..
.. MI . .. ......
.D.
Place and Date of Death, died at.
190 ·
Duration,
3 cups
Disease or Cause | Primary,
of Death, ;
Secondary,
Gastro Duodenites
Duration, 1 werk
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician. 40 Princeton St Sarl Basta
M. D.
Date of Certificate,
april
4
190 /.
· Give also street and number, if any. | Givo 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
2
No. 16
RETURN OF THE DEATH
OF Caleb Harding Smith 22 Gente Sheel at
Date,
1901.
Filed, ajeril 5 190_/_
[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 oceurs, 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 liis vessel first arrives after snch 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 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 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 city or town or removed therefrom, until a permit tlicrefor 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.
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,
Flanche Elizabeth Ford
Sex,
Color,
22
Date of Death,
ajerie 6
190/; Age, .. 13
.Years,
6
Months, 2 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Occupation, ---
*Residence, { If out of town, )
Winthrop Mass
¿ also state fully. ) -..
Place of Birth, West Somerville Mass
*Place of Death,
75 Lincoln Street Winthrop, Mass
Name and Birthplace of Father,. Haller &, Lord =Alesmich Mass
Maiden Name and Birthplace of Mother, ... Dennie W, Robbins=Burlington
Place of Interment, (Give name of Cemetery),
Winthrop Cemetery
Summer Floyd
Date Winthrop
on
alenie y"
190 /
Signature and
place of business
of Undertaker.
Printhat Wasa
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Blanche Elisabeth Lord
Age, 3 8. 6 M. 2 D.
Place and Date of Death,
died at.
Mintluogo
Mene 6 "
190/.
Disease or Cause
of Death, #
Secondary,
Primary,
Pneumonia
Duration,
10 days
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
M. J. Soule
M. D.
of
Certifying Physician.
Date of Certificate,
april
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.
aparato
No. 17 4
RETURN OF THE DEATH
OF Blanche 6 . Lord
at
175. Lincoln & hel
Date, ajerie 6"
190_/
Filed, ajerie y 190_/ _.
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death ocenrs, 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 sneh 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 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 seetion 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 issued until a written statement, as required by law, has been furnished, with a physician's certificate of the cause of death. When sueli 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.
FORM C.
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
Name,
Thomas 6, John
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Sex, Color,
Date of Death,
Mene 14 '
.190/; Age,// Years,
5
Months,
5 Days.
Maiden Name, { If married, widowed )
or divorced.
4
/
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
bareenter
*Residence, { If out of town, )
¿ also state fully. 3
Northrop mass :-
Place of Birth,
new Brunswick
*Place of Death,
35 Marshall
wall Street
Name and Birthplace of Father,
andrew Solution-Scotland
Maiden Name and Birthplace of Mother, ...
ann Spencer- Cheland
Winthrop Cemetery
Place of Interment, (Give name of Cemetery),.
Bummer Floyd
Dated at
on
Marie 15"
190 /
Signature and
place of business
of Undertaker.
Winthrop mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t OThomas to Johnston Age, 71 x. 5 M. 5D.
Place and Date of Death,
died at.
Minitrop No 3.5 Marshall &1- april 14"1901
Disease or Cause
of Death, #
Secondary,
Tuberculosis
Duration,
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
6 1. Soule
M. D.
of
Certifying Physician.
Winthrop Man
Date of Certificate,
april 16
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.
Primary,
No. 18
RETURN OF THE DEATH
Thomas 6. Johnson at 35 Marchace os need
Date, ajerie 14
1901
Filed, ajerie 15
190 __
[EXTRACTS FROM CHAPTER 444, ACTS OF 1897.]
SECTION 6. Every householder in whose house a death oeeurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of au 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 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 faets.
SECTION 11. In ease 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 obtaiu the physiciau's certifieate 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 towu 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 suchi 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 certifieate 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.
5
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
William addison Kenediessex, Im
.Color,
Date of Death,
ajene 19" 1901; Age, 79 Years,
Months, o
24 Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Clergy man
*Residence, { If out of town, )
¿ also state fully. 3
Winthrop Mass
Place of Birth, OTego n.y.
*Place of Death,
no i myrtle Chenne
William Benedic Ofuntile WU
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