USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 19
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MAIDEN NAME
OF MOTHER
Frances macey or
mason
BIRTHPLACE
OF MOTHER +
Sefracombe, Eng.
OCCUPATION
INFORMANT §
Wm H. Trayes
Filed
.190
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. Il Name of cemetery.
(DURATION).
. DAYS
Contributory :
ScriviTy
(DURATION).
.. DAYS
(Signed)
William H Troyes, In:
M.D.
Jan. 20
190.6 (Address).
386 Commonwealthar. Boston
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at
Former or
Usual Residence
Place of Death ?
Days
Where was disease contracted, If not at place of death ?
PLACE OF BURIAL OR REMOVAL I
Wordtair Cometany
UNDERTAKER C.R. Bernar
DATE OF BURIAL
190 6
ADDRESS
PHYSICIAN'S CERTIFICATE
Jane Trayes.
:[4-'04-37-LM.]
· Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, January 22, 1906
Name in full, Rev Howard C. Durchaus
(If a married or divorced woman give maiden name, also name of husband.)
Sex, 2. ale Color, white,
(White, Black, Mixed, Chinese, Condition, Widower
Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 93 Years, O Months, 2 Days. Occupation,. clergyman
Residence, 12 Fremont St Winthrop Ward,
Place of Death,
Place of Birth, lington mass 1) 1 )
(State year, month and day.)
Date of Birth, Jan 22, 18/3
Name and Birthplace \ Osia Dunham, of Father,
Plymouth, Mass.
Maiden Name and Polly Carey, No. Bridgewater, Muss. Birthplace of Mother, S Minthuske Cemetery Auntuote Mars Place of Interment,
Dummer floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Jamy 22 190 6
Name and Age ?
of Deceased, Howard C.Delane
Age, 93 years.
Date and Jany 21 1906
12 FrewertSt Minutroz
Place of Death,*
Chief cause,. Brancho - primaria.
Disease - Contributing cause, Senility
Chief cause, ........ Three days
Duration 3 Contributing cause, Several years.
...
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician,
M.D.
* If an Institution, state how long an Inmate and previous residence.
.
2 1
122 .22. Rev. Howard O. Dunham
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
George Stewart-Schafer
Registered No.
Place of Death *
marittiof Mass
Date of Death
Jan 2319 1906
Age. 40 . years
.months
X
days
STATISTICAL DETAILS
SEX
MI.
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ៛ Balón mars
NAME OF
FATHER
John George Schafen
BIRTHPLACE
OF FATHER+
MAIDEN NAME
OF MOTHER
Mary Brown
BIRTHPLACE
OF MOTHER #
It. John 2. 13.
OCCUPATION Manager
INFORMANT §
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from Jan 8 1900 .... to Jan 23" 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 : Chrome Rights Inseine
(DURATION).
6 mois
Contributory :
(DURATION) DAY 8
(Signed).
3: met calf
M.D.
Jan 25 190 6 (Address)
walther In
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
Former or
Usual Residence
Buchemust
How long at
13
Days
Where was disease contracted,
unknown.
If not at place of death ?
Filed
190
Clerk
PLACE OF BURIAL OR REMOVAL II
Mount Home
DATE OF BURIAL
1/25
190€
UNDERTAKER
le R Bemuna
ADDRESS
* 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 marrled or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical dotalls. Il Name of cemetery.
Jan 2
Piace of Death ?
12 George S. Schafer
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,
SexSHELL Color,"
hete
Date of Death, Can 2,6 ª 1906; Age, 70 Years,
Months,
.Days.
Maiden Name, { If married, widowed ) Manu A. Hiwould
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Freeried Occupation,
Domestic
*Residence, { If out of town, )
¿ also state fully. 5
xa Taylor It. It ciertos, mass.
Place of Birth, Judiciar feature
*Place of Death,
Name and Birthplace of Father, Ahora.
Maiden Name and Birthplace of Mother,.
11
Place of Interment, (Give name of Cemetery),
Dated at Friultero 2 Thass Signature and
on
190L place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Many am Thuc
Age, 7 Y.
M. ..... D.
Place and Date of Death, died at
Disease or Cause of Death, # Secondary,
Cardini Catalina
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician. 28 Jucalogan
M. D.
Date of Certificate, Jan 26 1906.
· 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 Caure.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Jan 26 1906. Duration,
Primary,
No. 13
RETURN OF THE DEATH
OF
Mary a. mc thee
at
Date,
Jan 1
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 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 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 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 lie 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 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 town iu 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
[4.'04.37-LM.]
Permit No.
RETURN OF DEATH.
Winthrop BOSTON, MASS.
Date of Death,
Name in full, Charity Mayo
Jaway pos
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Female
Color Ochile
Condition, Nidomed
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 79 Years,
.Months, 25 Days. Occupation,.
Residence, Winthrop Plass
Ward,
Place of Death, 84 Lincoln Riedl
Place of Birth,. Rittery me
(State year, month and day.)
Date of Birth, aug 31"1826
Name and Birthplace ) of Father,
Henry Sargent - Kittery me
Maiden Name and ? Birthplace of Mother,
Place of Interment, Winthrop Cemetery = Hintenope Mass Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Winthrop January 26" 1906. Boston,.
Name and Age? of Deceased, Charity quayo
Age, 19 years. thus 250
Date and Jarmang 26" 1906-84 Lincoln Street
Chief cause,
Disease
Contributing cause,. analysis
Chief cause,
Contributing cause,. 3 Jours 1.
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, 6 31 metcal M.D.
* If an Institution, state how long an Ininate and previous residence.
2 1
Place of Death,* , old ige
Duration
Charity Mayo
[11.'02-37.L.M.]
Permit No.
RETURN OF DEATH. BOSTON, MASS.
Feb. 7/06
Name in full,
Date of Death, , Mary a. Grady low Glancy Javite of Iletthere (If a married or divorced woman give maiden name, also name of husband. )
Sex, Color W. Condition, MI
White, Black, Mixed, Chinese, (Single, Married, Widowed or Indian, etc.) Divorced.) Age, 57 Years, Months, ... -Days. Occupation, ..
Residence, 27 Centro It Winthrop Ward,
Place of Death, 27 Centre
(State year, month and day.)
Place of Birth, Bartow
Date of Birth,
heland
Place of Interment,
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Boston, Fely 2 190
Name and Age ) Mary a brody
of Deceased,
Date and
Place of Death,* ) Chief cause, ... apoplexy
Disease Contributing cause,
chronic Bright Disease
( Chief cause, 3 days
Duration Contributing cause, Several years
I certify that the above is true to the best of my knowledge und belief.
Name and Residence of Physician, 1
M.D.
· If an Institution, state how long an Intute and previous residence.
Age, 57 years.
lance Name and Birthplace of Father, Maurace Brennan 11 Maiden Name and Birthplace of Mother, ) Holy Grace Malden This. I Love Undertaker. 6
.Feb. 7 -15-
[4.'04.37-LM.]
» Permit No.
RETURN OF DEATH. BOSTON, MASS.
Date of Death, OJenuary 9"1906
Name in full, alexander Haggerstan
(If a married or divorced woman give maiden name, also name of husband.)
Sex, Male Color White
Condition, Widow
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
Age, 68 Years, 2 Months, 26 Days. Occupation, Every Stable
Residence,. Point Shriley -Winthrop Ward,
Place of Death, Sont Shirley Winthrop
Place of Birth, Charleston May Date of Birth,.
(State year, month and day.)
nov 13" 1837
Name and Birthplace ? of Father,
David Haggereton Yorkshire England
Maiden Name and Many am Farele-Fitchburg mass
Birthplace of Mother,
Place of Interment, Winthrop Cemetery
Summer Floyd
Undertaker.
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Svinthrop February 11' 1906
Name and Age? of Deceased, alexander Hagaestar
Age, 68 years. 2mms-
Date and February 9" 1986- Point Shirley, mars
Place of Death,* S Chief causc, Diabetes Mellitus
Disease Contributing cause, Gangrene of foot
Chief causc,
Duration - Contributing causc,. . Ten works.
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, ... M.D.
* If an Institution, state how long an Inmate and previous realdence.
Гл. 9 16
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH George, Louis Radell
FULL NAME
Place of Death *
Orlando. are, Womitrot Man
Date of Death
Det 9th
X
Age X
years.
X
months pur day
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE +
NAME OF
FATHER
ER Louis. A. Radell.
BIRTHPLACE
OF FATHER#
Fornemalle Mans
MAIDEN NAME
OF MOTHER
Mabelle . H. Rick .
BIRTHPLACE
OF MOTHER #
OCCUPATION
2
INFORMANT § Father.
€ Paris. Q. Andere
wiethick
PLACE OF BURIAL OR REMOVAL II So. Orrington, IME.
DATE OF BURIAL
JE 6 - 20
6
190.
UNDERTAKER
ADDRESS
w
PHYSICIAN'S CERTIFICATE
HEREBY CERTIFY. that I attended deceased during last illness, from 190 ... 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 :
Primary !
open forumen vvare
(DURATION).
DAYS
Contributory :
(DURATION). - DAYS
(Signed)
1219 art call
M.D.
16.95 906 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
L
How long at
Place of Death ?
Days
Where was disease contracted,
If not at place of death ?.
-
Z
Filed
.190
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.
ALL NAMES TO BE IN FULL
Registered No. ..
V el. ? 17
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,
Brico = 7- 22LEtarEN
Sex,
Heure Color
Date of Death,
190G; Age, 14 Years, ~ Months, ~ 1
.Days.
Maiden Name, { If married, widowed ) Bridget In rang kleur
or divorced.
Husband's Name,-
Single, Married, Widowed or Divorced,
Indeze Occupation,
Dozu ratée
*Residence, { If out of town, )
? also state fully. §
32 DEacon Sh' Hrutuos
Place of Birth, Airland
*Place of Death,
Heutheros
Name and Birthplace of Father, Ronald 11, Khungblue Island
Maiden Name and Birthplace of Mother, Vieru Ville 11
Dated at
on Frb 2Tun
Place of Interment, (Give name of Cemetery) Hothe iroda, Halden 1 Signature and 1906 place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Bridget Mi Carry
Age, 74 Y. M. D. Ich. 27. 1906.
Place and Date of Death,
died at Hanchop
Diarrhea
Duration, 2 cotés.
Ainility
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence of
M. D.
Certifying Physician.
Date of Certificate, 1 1906.
· Give also street and number, if any. t 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.
Primary,
Disease or Cause of Death, Secondary,
No. 18
RETURN OF THE DEATH
OF
Budget Vic Carey
at Stanthrop-
.............
Date, Feb. 27 1906
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 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 thic 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.
[4.'04-37-LM.]
. Permit No.
RETURN OF DEATH. inthe BOSTON, MASS.
no 19
Date of Death, March 6" 1906
Name in full, Daniel H. S. Look
(If a married or divorced woman give maiden name, also name of husband.)
Sex,
male
Color,
2thite
Condition,
(White, Black, Mixed, Chinese, Indian, etc.)
(Single, Married, Widowed or Divorced.)
.Age, 1 Years 3
.Months, 6 Days. Occupation,
Residence, Saint Shirley
Ward,
Place of Death, Billon Street Point Shirley
Place of Birth, Newbury peut
(State Sear, month and day.)
Date of Birth, nt, 13" 1904
Name and Birthplace of Father,
John 6, Q, Cook-attien Of, Or,
Maiden Name and Emma In, Jucharme SI albert Canada Birthplace of Mother,
Place of Interment, Elmwood Cemetery Haverhée Mass
Summer kryd
Undertaker. 180 termin Chão
PHYSICIAN'S CERTIFICATE OF THE CAUSE OF DEATH.
Dringerof March 6" Besteht,
Name and Age?
of Deceased, Daniel A. S. Cook
Age, / years .- 3-6
Date and March 6, 1906. Point Shirley, Winthrop.
Place of Death,* Chief cause, Labar Onumania.
Disease ? Contributing cause, .... Chicf cause, .. I work.
Duration Contributing cause, ..
I certify that the above is true to the best of my knowledge and belief.
Name and Residence ? of Physician, $ M.D.
* If an institution, state how long an Inmate and previous residence!
021
190 6
March 6 06 Daniel H. S. Coole
COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A DEATH-1906.
CITY OF BOSTON. 2220
FULL NAME Thomas F Hughes
Registered No.
Place of Death }
Boston
Emergency Hospital Kingston St
and Residence S
Date of Death
Mar 10
1906.
Age
55
.years .. ....
.. months days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE. .t
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
male
white
widowed
Maiden Name
Husband's Name
Pawtucket R
Birthplace
Name of Father
Thomas H
BO.S'TON.
Birthplace of Father
England
Contributory : ( (Duration)
Maiden Name
Mary Smith
Birthplace
England
(Signed)
J L Mahoney
M.D.
Mar 11 1906
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
k
Place of Burial
or removal
Providence R I
Usual Residence
Ocean View Winthrop Mass
I- or
Fileď
Mar 13
1906.
A true copy.
Attest :
Emmylenen
Registrar.
.1906,
from 1906, to 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 :
STRAR'S
PATRIO S. SIT DEL
Lobar Pneumonia 3 days
Primary (Duration) OFFICE
18
. BOSTDNIA" CONDITAA
A.182
CHYTATISR ISREGIMINE DONATA A. . MA.SS. 1830.
rs
of Mother
of Mother
Com. Traveller
Occupation
Informant
Undertaker
Lewis Jones & Son
I HEREBY CERTIFY that I attended deceased during last illness, e
0. Thomas & Hughes
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Trongs.
J. freeman
Registered No.
20
Place of Death
180Cottage are Wintherof mass
Date of Death
March 16th
Age.
50
. years
11
.months
9
.days
STATISTICAL DETAILS
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAMEt HUSBAND'S NAME t
BIRTHPLACE +
Milton Nova Scotia
NAME OF
FATHER
Samuel Freeman
BIRTHPLACE
OF FATHER+
quellona Nova Berlin
MAIDEN NAME
OF MOTHER
Charlotte freeman
BIRTHPLACE
OF MOTHER #
Caledonia nova Scotia
OCCUPATION
Salesman & Barkerchen
INFORMANT §
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from Mch. 12. 1906 to Mach. 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 :
Lobar One
(DURATION)
5
DAYS
Contributory :
(DURATION) DAY8
5
(Signed)
M.D.
Mah. 18
1906 (Address)
Minchiate, 2,000.
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
Clerk
PLACE OF BURIAL OR REMOVAL I
-
Hollington- max,
DATE OF BURIAL
/19
190€
UNDERTAKER
G. R BERENson.
ADDRESS
* 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 marrled or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. !! Name of cemetery.
20 March 16 1906 George S. Freeman
FORM C.
Commonwealth of Massachusetts.
No.
21
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,
vara
Jarak 22, Todd
Sex, Fiz uu Color,
Date of Death,
18 1906; Age, 15 Years, 11
Months, IC Days.
Maiden Name, { If married, widowed )
or divorced.
Veruk 221. Brator
Husband's Name,
Single, Married, Widowed or Divorced.
Holow Occupation,
DouEstés
*Residenee, { If out of town,
(59 Eccust It: "finitura, mass
¿ also state fully.
Boulvie 222420
.1
Place of Birth,
*Place of Death,
5ª hornet It Hisethiop neues
Name and Birthplace of Father,
Maiden Name and Birthplace of Mother,
Place of Interment, (Give name of Cemetery)
Dated at ..
Dear 181cm
190×
Signature and place of business of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Sarah m Todd
Age 13 Y. /M., OD. 190
Place and Date of Death, died at ... 59 Locust 5/ Inbrat Insufficiency Duration, jun
Primary, Disease or Canse 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.
631 metcalf
1
M. D.
Date of Certificate,
190 C
· 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 Rebel lon, give both Primary and Secondary Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
on
No. 21
RETURN OF THE DEATH
OF
Sarah M Todd
at Winthrop
Date, March 18 1906
Filed, March 31 ... 190_6. .
[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
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Mary. N. freeman
Registered No.
22
Place of Death *
,8 Cottage are Worthund Mass
Date of Death
man
25K/906
Age.
46
.years
3
months
14
days
STATISTICAL DETAILS
SEX
COLOR Mute
SINGLE, MARRIED, WIDOWED, OR DIVORCED
widow
MAIDEN
mary nickerson Fish.
HUSBAND'S NAME t
Seo. S. Freeman
BIRTHPLACE #
Duxbury mass
NAME OF
FATHER
ER Joseph. Fish
BIRTHPLACE OF FATHER# Duxbury mars
MAIDEN NAME
OF MOTHER
Charlott Prior
BIRTHPLACE
OF MOTHER #
OCCUPATION
Htmenige
INFORMANT §
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