USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 18
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[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 suchi 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
FORM C.
Commonwealth of Classachusetfs.
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,
Sex, FREM Color,
Date of Death,
190 G; Age, 22 Years,
4 Months, Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced, Ifichour Occupation, Vozurate.
*Residence, ¿ also state fully. )
{ If out of town, {
* 91 Thirteen St.
Place of Birth,
*Place of Death,
Finestras Ticaso.
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother, Mary A. M Ecauled 1, 11 11
Place of Interment, (Give name of Cemetery),
Dated at
on
190.
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Caliaring? Hunter
Age 2.2 x. 4 M.
. .... D.
Place and Date of Death,
died at.
multiple renntis
Duration,
5 mains
1906 -.
Primary,
Disease or Cause
of Death, #
Secondary,
Duration,
I certify that the above is true to the best of my knowledge and belief.
(2)me/ call
M. D.
Signature and Residence of Certifying Physiclan.
1 mithora
Date of Certificate, 190 .
· Give also street nnd number, if any. | Give sex of Infant not named. If still-born, 80 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. 1
RETURN OF THE DEATH
OF
Catherine W. Hunter
at
Date, far, 1
190 1
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 sneh a death, give notice thereof to the board of health or to the clerk of the city or town in which the death ocenrred.
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 snel 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 ean state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the faets 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 anthorities. No sueh 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 eountersign and transmit the same to the clerk of the city or town for registration.
[4.'04-37.LM.]
- Permit No. .........
RETURN OF DEATH. BOSTON, MASS.
Date of Death, ..
Sommary 3" 1906
Name in full, May 6, Oreither
Samuel W. Keith
(If a married or divorced woman give maiden name, also name of husband.)
Sex,
Ofemale
Color
White
Condition,
(Single, Married, Widowed or Divorced.)
Age, 55 Years, / Months, 9 Days.
Minthur Ofighlands
Ward, Residence,.
Place of Death, 33 Jen ete avenue
Nov 27 "1850 (State year, month and day.)
Place of Birth, Grafton Mass Date of Birth,
Name and Birthplace ? of Father, Maiden Name and Birthplace of Mother,
seleh 2, adame Grafton mars
ann Dresser Pomfret Connecticut
Place of Interment, Grafton Mass
SummerFloyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
of Deceased, 5 Mary E. Keith Boston,. Jany. 5 190.12.
Name and Age ?
Age, S5 years.
Date and Ichny, 5/06, Winthrop Maso,
Place of Death,*
Chief cause, .... Cerebral Harmonhage
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 ? of Physician, Thomas Eligout M.D.
* If an institution, state how long an Inmate and previous residence.
21
.....
Widowed
(White, Black, Mixed, Chinese, Indian, etc.) Occupation,.
au. 3
Mary E. Keith
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1906.
CITY OF BOSTON.
FULL NAME John L Mackay
Registered No.
120
Place of Death
Boston Mass General Hospital
and Residence S
Date of Death
Jan 5
1906.
Age
41
.. years
5
months . days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
male
white married
Maiden Name ......
Husband's Name
Birthplace
Lake Ainslie
Name of
Hector
Father
Birthplace
Scotland
of Father
Maiden Name
Margaret Campbell
of Mother
Birthplace of Mother
Scotland
Occupation Builder
Informant.
Place of Burial Woodlawn Everett or removal
Usual Residence
18 Pleasant St Winthropkas ;
Undertaker Lewis Jones & Son
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1906, to .. 1906, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
ST
RAR'S
UT
ATRIBE S. SIT DECO Primary ( Durafon )
Gen Peritonitis 3 days
FFICE
.182
. MASS.
6 days (Duration)
(Signed) ... H Clark
.M.D.
Jan .... 6. 1906
........... SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
...
Jiadn ... 8.
1906.
A true copy.
Attest :
Registrar.
VITATIS RE CONDITAA) ISREGIMINHE DONATA A. 1830.
BO.S'TO
Contributory : Acute Appendicitis
A
U
John L. Mackay
Lano
COMMONWEALTH OF MASSACHUSETTS
City of Newton
RETURN OF A DEATH Florence Paul Grant
Registered No.
Place of Death *
Fort Banks, Wruthop, mass
Date of Death
January 6, 1906
Age
36
. years.
months
days
STATISTICAL DETAILS
SEX
49
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
m
MAIDEN NAME Ť
Florence H. Paul
HUSBAND'S NAME +
Homer B. Grant
BIRTHPLACE #
Norton Centre, mars.
NAME OF
FATHER
Luther Paul
BIRTHPLACE
OF FATHER+
-Foton Centre. Mas
MAIDEN NAME
OF MOTHER
Ellen D, Briggs
BIRTHPLACE
OF MOTHER #
Leiturate, mass.
OCCUPATION
· Housewife
INFORMANT § Lucken 4. Paul
657 Proglatan La Robe
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
fanii,906
UNDERTAKER
E. M. Pytt
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last illness, from Dans Pan. 6 S .190 to 190.0., that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Maplexy
(DURATION)
1
DAYS
Contributory :
(DURATION). . DAYS
(Signed)
M.D.
6
190.66 (Address)
3) Fait Paupe
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death ?
Days
Where was disease contracted, If not at place of death ?
Filed
190
City
Clerk
* City or town, street and number, if any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give its NAME instead of street and number,
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. || Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
AND
LIEF
UNIGA
630. INC
ANTUM
TOWN
N SES A CITY 167
ORPORATED
FULL NAME
Medical Examiners in case of a person of supposed death by violence must certify to City Clerk name and residence, if known, otherwise a description of such person, as full as may be, with cause and manner of death. Revised Laws, Chap. 24, Sect. 8.
DESCRIPTION.
Nationality Sex
Age.
Height .
Weight
Complexion
Hair
Eyes
Nose ..
Face.
Teeth
Clothing, etc ..
Physicians and Undertakers must furnish information required by the City Clerk. Revised Laws, Chap. 78, Sect. 38. Cremation is not allowed within forty-eight hours after death, unless in case of contagious or infectious disease, nor in any event without proper medical certificate and permit from Board of Health. Revised Laws, Chap. 78, Sect. 38.
Burial or Removal of a human body without permit of the Board of Health is unlawful, and such permit cannot issue until all facts required are furnished. Revised Laws, Chap. 78, Sect. 39.
No person in charge of a CEMETERY or BURIAL GROUND shall allow a human body to be buried therein, or such body or ashes thereof to be removed without permit, nor the ashes of a human body to be buried without permit and certificate of Medical Examiner prerequisite to cremation. Revised Laws, Chap. 78, Sect. 40.
No Undertaker shall bury the ashes of a human body without a certificate from the person in charge of the Crematory that the burial permit and certificate of the Medical Examiner has been duly presented. Revised Laws, Chap. 78, Sect. 41.
A PHYSICIAN shall forthwith, after the death of a person whom he has attended during his last illness, at the request of an Under_ taker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate, stating to the best of his knowledge and belief the name of the deceased, his supposed age, the disease of which he died, the duration of his last illness, and the date of his death. Revised Laws, Chap. 29, Sect. 10.
No common carrier or other person shall convey or cause to be conveyed, through or from any city or town in this Commonwealth, the body of any person who has died of small pox, scarlet fever, diphtheria or typhus fever until such body has been so encased and prepared as to preclude any danger of contagion or infection by its transportation; and no city or town clerk shall give a permit for the removal of such body until he has received from the Board of Health of the city * * or clerk or agent of the Board of Health in which the death occurred a certificate stating the cause of death, and that said body has been prepared in the manner prescribed in this section, which certificate shall be delivered to the agent or person who receives the body. Whoever violates the provisions of this section shall forfeit not more than twenty-five dollars. Revised Laws, Chap. 78, Sect. 43.
Extract from Regulations : Board of Health, City of Newton.
RULE 24. Any person having charge of the body of a person who has died of cholera, yellow fever, small pox, varioloid, diphtheria, membranous croup, scarlet fever, typhus fever or measles shall cause such body to be washed in a solution of corrosive sublimate (2 drachms to 1 gallon of water) wrapped in a sheet saturated with a solution of corrosive sublimate, same strength, and immediately placed in a tightly sealed coffin, and the body shall be buried in accordance with the following instructions : no public conveyance shall be used unless the same shall be afterwards disinfected under the direction of the Board of Health; if placed in a receiving tomb the body shall be enclosed in a metallic casket and hermetically sealed ; no draperies shall be used; every undertaker or person acting as such shall immediately notify the Board of Health upon receiving notice of a death from any of the above diseases, and it shall be his duty to see that the instructions of the Board of Health are complied with.
Within return countersigned and approved this
day of 190
Agent Board of Health.
3
6
[4-'04-37-LM.]
Permit No.
RETURN OF DEATH. BOOTON, MASS.
Date of Death,
January 9" 1906
Name in full, annie Salle Bronne
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female Color, White Condition, Didon
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age,. 62 Years, 9 Months, 11 Days.
Residence, Grett Mass
Ward,
Place of Death, .. Beacon Villa Sanitariam
(State year, month and day.)
Place of Birth, Portland me
Date of Birth, War 29" 1843
Name and Birthplace ) Unknown
of Father,
Otaviet E. Hardy-Deering Me
Maiden Name and
Birthplace of Mother, S Portland me, Evergreen Cemetery Place of Interment,
Summer Houd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop January 9" 1906.
Name and Age ?
of Deceased, Anne Belle Browne
Age, 62 years. 9mollas
Date and Place of Death,* Bencon Viven, Weuthof Mann
Chief cause, .... Heart viene one
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 ? of Physician, A. B. Norman M.D.
* If an Institution, state how long an inmate and previous residence.
021
Occupation,
multimen
Jan . 4 4
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Name in full,
Date of Death, .. Julia Coburn Polisen
January 10"190%
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Ofemale Color Othile-
Condition, Widowed
(Single, Married, Widowed or Divorced.)
Age 89 Years, 5 Months, /0 Days.
Residence,
Ward,
Siren Street Point Shirley
Place of Death, 11
(State year, month And day.)
Place of Birth, Hudson et, Of, Date of Birth,.
Name and Birthplace ) Unknown
of Father, Maiden Name and Birthplace of Mother, Place of Interment, Mand antund (Cremation !! Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE GAUSE OF DEATH.
Printtrop Boston, January 10' 1906.
Name and Age ? of Deceased,
2
Age,
years.
Date and
Place of Death,* Chief cause,
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 ? of Physician, 5 M.D.
* If an institution, state how long an Inmate and previous residence.
21
(White, Black, Mixed, Chinese, Indian, etc.)" Occupation,
Julia Coburn Robinson
2
1
1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
3
FULL NAME
Place of )
Death *
Death S
Residence
Age
86
.years.
months.
.days
STATISTICAL DETAILS
SEX
Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widerved
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE + Rox Bury, Mars
NAME OF
FATHER
BIRTHPLACE OF FATHER$ marble head. Mars.
MAIDEN NAME
OF MOTHER
BIRTHPLACE OF MOTHER
Joanna. Hillã
Portmouth, A. M.
OCCUPATION
INFORMANT § Charles N. Miller.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Dec 4/
1903 ... to Jan 10 1906, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Senile Dementia.
Contributory :
Expanding Im. Diferen.
(DURATION) .......... DAY8
(Signed)
Edward H. Weswall
M.D.
.190
.(Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Place of Death ? years. ....
months
.... days
Where was disease contracted, If not at place of death ?
Filed Jan 12 .1906.
Wendy Clerk
* City or town, street and number, If any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, glve Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
* State or country [ also city, town or county, If known.
§ Name and address of person giving statistical details.
11 Name of cemetery.
PLACE OF BURIAL OR REMOVAL II
Hultsof man.
DATE OF BURIAL
UNDERTAKER
Ger. H. Robbins
ADDRESS
......
190.
Registered No.
Date of l
Jan 10
190
6
ALL NAMES TO BE IN FULL
(DURATION ).
DAYS
1 James de Saber Jam 10 , 1907
[4-'04.37-LM.]
Permit No.
RETURN OF DEATH.
Drintrump
BOSTON, MASS.
Date of Death,
Yamany 14.1906
Name in full, Jennie Shaman
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female
Color, White Condition, Didomed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 1 Years,
8 Months,
Days.
Occupation,
Residence,
Ward,
Place of Death, 24 Read Sheel
Place of Birth, Scotland
(State year, month and day.)
Name and Birthplace ? Unknown
Unknow
of Father, Maiden Name and Birthplace of Mother, Place of Interment, Free files Cemetery West Toplay Summer Floyd
Undertaker 18 HermanShell
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Hantrop Jamany Boston,
Name and Age )
of Deceased, Dennie Shammin
Age, 51 years. 8820-7ds
Date and January 14" 1906-24 Read Street
Place of Death,* S
Chief cause, Double Precumona.
Disease Contributing cause,
Cardiaca- failure.
Chief cause,
14 days
Duration Contributing cause .......
I certify that the above is true to the best of my knowledge and belief. Name and Residence ? of Physician, 5
O. EJohnson
M.D.
* If an Institution, state how long an Inmate and previous residence.
021
Date of Birth,
amary 10" 1905.
Demue
Shannon
$[4.'04-37-LM.]
Permit No.
RETURN OF DEATH.
Crinthispo
BOSTON, MASS.
Name in full, Grace Regina Word Date of Death, ...
(If a married or divorced woman give maiden name, also name of husband.)
Sex, GFemale Color Arhite
Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 4 Years, .. 4 Months,
Days.
Occupation,
Residence,. Stinttop Mass Ward .~
Place of Death, Belcher & hel
¿State year, month and day.)
Place of Birth,
tanthof Mass Date of Birth, Defet 14"1901
Name and Birthplace ? of Father,
alexander Wood-Q, E, Deland
Maiden Name and addie Mc Callum- E. deland
Birthplace of Mother,
Place of Interment, Winthrop Cemetery
SummerFloyd
Undertaker. 18 Oferman Cheel
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop January 15- 1906.
Boston,
Name and Age ? of Deceased, Grace Regina Word
Age, 4 years. 4 mm
Date and Zamiany IH"1906-Metcalf Otosfeitae
Place of Death,*
Chief cause, · menphi citis Disease
Contributing cause, Conical abscess
Chief cause, 4 days
Duration
Contributing cause,
3 weeks
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, 315 Milcay M.D.
* If an Institution, state how long an Inmate and previous residence.
January 14 " 1906
Grace Regina Word
.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Charles the illis.
.Registered No.
Place of Death *
58 Bowdoin te. Whetherh. Suat
Date of Death
Jan 16 1 1906
Age
13
bars.
7
.months
21
.days
STATISTICAL DETAILS
SEX Male
COLOR
SINGLE, MARRIED, WIDOWELOR .DIVORCED
Widower
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACE #
Sydney, the
NAME OF
FATHER
Williane Ellis
BIRTHPLACE
OF FATHER$
·Pigdney. Lue
MAIDEN NAME
OF MOTHER
Phoebe Tutelle.
BIRTHPLACE
OF MOTHER +
OCCUPATION Retired
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 1905 ... to Dec. 6 Jan 16 1906 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows Primary : Carcinoma of Liver
(DURATION) .OAY
Contributory :
(DURATION). DAY
(Signed)
Um. a. Ham
M.D
Jan. 16 1906 (Address) 1799 Dorchester ance. Das
SPECIAL INFORMATION only for Hospitais, institutions, Transients or Recent Residents.
Former or Usual Residence Place of Death ? Day
How long at
Where was disease contracted, If not at place of death ?
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL I
Jul: Hotie
DATE OF BURIAL
Jan 19 1906
ADDRESS
. Clty or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital o Institution, give Its NAME instead of street and number.
t in case of married or divorced woman, or widow.
1 State or country; also city, town or county, If known. § Name and address of person giving statistical details,
UNDERTAKER 8.73 Role Here 124 Derchus & 1 Name of cemetery.
Chas. IN: Ellis.
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,
Jardínau
Sex,
mala Color
Ethete
1
Date of Death,
Fare 18h
1906; Age, 4 2 Years,
.Months, ............ Days.
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,~
Single, Married, Widowed or Divorced, maneed „.Occupation,‘
*Residence, { If out of town, ) ¿ also state fully. Coral Avy En wrest, Billow Voltage)
Place of Birth, England
*Place of Death,
Name and Birthplace of Father,
Sua land 11
Maiden Name and Birthplace of Mother, protein
Place of Interment, (Give name of Cemetery),
Last Poston Uru
Dated at
on
190
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Ferdinand Builtin
Age,- 2. Y. .. M. - D.
Place and Date of Death,
died at. Conalto Cuentavs. 190 .
Verocell. Hew- discas. Duration,
Duration, In tanter
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
A.t.C.
Certifying Physician.
Date of Certificate, minstmon Jan. 5.8/06. 190
· Give also street and number, if any. t 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.
M. D.
Disease or Cause
of Death, #
Secondary,
Primary,
7
No. ... 9
RETURN OF THE DEATH
Ferdinand Grafton OF
at
.......
Date, Javi . 18
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 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 sueli death.
SECTION 8. Penalty for ueglect 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, teu dollars.
SECTION 12. Any person haying charge of the fuuereal rites preliminary to the intermeut 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 elerk' of the city or town in which the death occurred. 1
[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 sueli 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. Wheu 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
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Sance Traces!
Registered No.
................
Place of Death *
Date of Death
fare 18 1906
Age
96
years
6
mont
.. months.
19
days
STATISTICAL DETAILS
SEX
Female
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
.
Zvlálow
MAIDEN NAME +
HUSBAND'S NAME Ť
Sohn, Trayco
| HEREBY CERTIFY that I attended deceased during last
illness, from.
Jan. 6
1906 to
Jan. 18
1906,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Cardiac Thrombosis inThe
BIRTHPLACE +
Barnstaple Deconstric County potable pulmonary contolisty.
England
NAME OF
FATHER
Henderson- John Brooke
BIRTHPLACE
OF FATHER+
Barnstable, Eing.
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