USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 2
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Place of Burial (Give name of Cemetery). Oakland Cemetery- Syracuse NY
Signature and Summer ofloud
Dated at
Schwang 18
190 4/
on
place of business
of Undertaker.
18 Oferman Sweet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Youera WWW. Gardiner Age, 68.8 . 12D.
Place and Date of Death, died at 7 Thmeta Park February 2 1904. initial insuff may
Disease or Cause of Death, # Immediate,
Primary,
Duration,
3 129
Her val digiuntini Duration, 3 weeks
I certify that the above is true to the best of my knowledge and belief.
Filtmitcall
Signature and Residence § of Certifying Physiclan.
M. D.
Date of Certificate, Ich 1st 190 4.
· Give aleo street and number, if any. t Give sex of infant not named. If still-born, so state.
If a Soldler or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Fer-27
RETURN OF THE DEATH
OF
Louisa WWW. Gardiner no y ethanton Park at
Date, Felmary 2%
190
..
Filed, Jehualey 28 190 4
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honseholler in whose honse a death occurs and the oldest next of kin pf a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk. -
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts. If of a child born dead, both the birth and death shall be reported as "stillborn ". Penalty for neglect fifty dollars.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate canse of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city or town, or remove therefrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit sholl be issued until there shall have been delivered to such board a written statement, containing the fucts required by low, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- with countersign and transmit it to the elerk of the city or town for registration. Penalty for violation not exceeding fifty dollars.
BOSTONIA CONDITA.D. 1150. THINK DON
FULL NAME
Albert .... F ... Sumpter.
Registered No. 1833
Place of Death l
and Residence
South.Dept ... CityHospital ... Boston .. Mass
Date of Death.
Feb 28
.....
1904.
Age
10
years
6
... months.
15
days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
male
white
single
Maiden Name
Husband's Name
Birthplace .. Brockton Mass
Name of
Father. Frank
Birthplace
of Father ... .....
Maiden Name
of Mother.
Birthplace of Mother. So Hanson Mass
Occupation
.....
Informant
.......
Place of Burial
or removal
Mt Hope Cem Boston
Undertaker
J S Waterman & Sons
PHYSICIAN'S CERTIFICATE.
I HEREBY CERTIFY that I attended deceased during last illness,
from 1904 to 1904 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 : (
Measles 29 days
(Duration)
Contributory:{ Congenital Hydrocephalus. (Duration)
Frears.
(Signed)
John H McCollum
M.D
Feb 28
1904
.......
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recen Residents.
Usual Residence
247 Shirley St Winthrop
Filed
.......
Mar .2.
1904.
A true copy.
Attest :
ENMSlenen
Registrar.
CITY OF BOSTON. COMMONWEALTH OF MASSACHUSETTS.
RETURN OF A, DEATH-1904.
.....
WestboroMass
Grace E Howland
none
TRA
R'
PATRIBUS, SIT DEUS N
S
R
NOBIS
CITY
SI
FFICE
CIVT BOSTONIA CONDITA ADD.
.A.1822
16 30.
TA
SS.
EGIMINE
STO
N. MA
FORM C.
Commonwealth of Massachusetts.
Fel 24
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death, Feb 29 " Winthrop 190 4.
alma. Al. ElaPari Full Name of Deceased,
Maiden Name, alma. M. Sammen
If a married or divorced woman or a widow give also ( Name of Husband, Celavance, N, Calafter
Sex, témale Color, Volete Single, Married, Widowed or Divorced,
Age, 49 Years, / 6 Months, /7 Days. Occupation, 248 Shirley LT- Withrok Mass * Residence ( If out of town, ) ( also state fully. 1 248 Shiver St Vinituoj Mass. Place of Death,
Place of Birth, Al inforl 20 cars
Name and Birthplace of Father, Heures. S. Maurer
Maiden Name and Birthplace of Mother, Centerinn
Place of Burial (Give name of Cemetery), Mitford Mass Peni Grove
Dated at Aventurato mars
on 2nd March 190
Signature and place of business of Undertaker. 40 Worthint FL Nothurt
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t alma m. el aflin Age, 49Y. COM /9.D. Place and Date of Death, died at 248 Shirley St, Winthrop 29. 904 Disease or Cause - Primary, Cardiac Drapey Duration, 2 yrs. Pulmonary Dedenne
of Death, ± Immediate,
10 days
I certify that the above is true to the best of my knowledge and belief.
M. D.
Signature and Residence S of Certifying Physician. Winthrop, Mais.
Date of Certificate, Man 20 1.90%
* Give aleo street and number, if any. t Give sex of infant not named. If still-born, so state.
t If a Soldier or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF
Ulma I, Claflin 248 Shirley Sheet at
Date, Felmay 29'
190 4
Filed, March 200 190
4 .. .
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts. If of a child born dead, both the birth and death shall be reported as "stillborn ". Penalty for neglect fifty dollars.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, teu dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city or town, or remove therefrom a human body which has not been buried, nntil a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- with countersign and transmit it to the clerk of the city or town for registration. Penalty for violation not exceeding fifty dollars.
FORM C.
Commonwealth of Massachusetts.
No. ......... ......
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death, March 2"
190 4
Full Name of Deceased, Joseph William Slover Maiden Name,
¿ Is a married or divorced woman or a widow give also Name of Husband,
Sex,
Color, Dr Single, Married, Widowed or Divorced,
Age, 60 Years, 10 Months, Days. Occupation, Druggiel
* Residence ( If out of town, { [ also state fully. } 161 Shirley Street
Place of Death,
161 Shirley Street
Place of Birth,
Buckeport Manie
Penalecol
Name and Birthplace of Father,
Anech G. Slova
Drucker part me
Maiden Name and Birthplace of Mother, augusta Maria Noyes Eastport me
Place of Burial (Give name of Cemetery), Bangor Ingine
Dated at Hattrop
Summer Floych
on
March 2"
1904
Signature and place of business of Undertaker. 18 Otermin Sweet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Refah It. Stover
Age, 608.10 MIND.
Place and Date of Death,
died at
It inluogo + 6+ Shirley, er Mai 2 1904.
Primary,
Chronic BrightinHaluni Heart Disease years
Disease or Cause of Death, # Immediate,
Manic Convulcon Duration,
14 hour
I certify that the above is true to the best of my knowledge and belief.
& Johnson
M. D.
Signature and Residence S of Certifying Physician.
11
Date of Certificate,
Marche
4
190 %.
Quand
* Give also street and number, if any. t Give sex of infant not named. If still-born, so state.
[ If a Soldier or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or toum.
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF
Joseph . Slater
at 161 Shirley Sheet
Date, March 21 190
5 Filed,
190 4.
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts. If of a child born dead, both the birth and death shall be reported as "stillborn ". Penalty for neglect fifty dollars.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making sneh return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city or town, or remove therefrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth- 7 o city or town for registration. Penalty for violation not exceeding fifty dollars.
FORM C.
Commonwealth of Massachusetts.
mary
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death, "March "Y"
190 4.
Full Name of Deceased, anni Young
Maiden Name, ann Batter
= = married of divorced woman or a widow give also Name of Husband, John Young
Sex, F Color, Single, Married, Widowed or Divoreed,
Age, 7/ Years, Months, Days. Occupation,
* Residence
¿ also state fully. )
( If out of town, } Winthrop mass
Place of Death, 7) main street
Place of Birth,. Canada
Name and Birthplace of Father, George Baker
Maiden Name and Birthplace of Mother, Gether Kraker
Place of Burial (Give name of Cemetery), Ford Stills Cemetery.
Dated at Winthrop
Signature and Brunner floyd
on
March "y"
1904
place of business
of Undertaker.
Winthrop, mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
ann Juring Age, / Y. .M .............. D.
Place and Date of Death, died at
Disease or Cause of Death, # Immediate,
Primary,
Chimie Brunetti Duration,- final Year
Exhaustuni fun agitated Melancholie
Duration, 6 months
I certify that the above is true to the best of my knowledge and belief.
Char. G. Jury
Signature and Residence S of
M. D. Certifying Physician. 539 Falbor Qui.)
Date of Certificate, March 10, 1904.
· Give also street and number, if any. t Give sex of Infant not named. If still-born, so state.
{ If a Soldler or Sailor in the War of the Rebelllon, give both l'rimary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
7. 1904.
NO.
RETURN OF THE DEATH
OF
71 Mai Sheet at
Date, .. March 7" 1904.
Filed, March 8' 190
4
EXTRACTS FROM CHAPTER 29, REVISED LAWS.]
SECTION 6. Every householder in whose house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
SECTION 7. The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other anthorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts. If of a child born dead, both the birth and death shall be reported as "stillborn". Penalty for neglect fifty dollars.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate canse of death as nearly as he can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's cer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS.]
SECTION 38. No undertaker or other person shall bury a human body in a city or town, or remove therefrom a human body which has not been bnricd, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, npon receipt of such statement and certificate, shall forth- the work of the city or town for registration. Penalty for violation not exceeding fifty dollars.
FORM C.
Commonwealth of Classachusetts.
No.
RETURN OF A DEATH. To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death, March 18 " 190 4
Full Name of Deceased, Robert De Corsa Ireland
Maiden Name,
If a married or divorced woman or a Widow give also Name of Husband,
Sex, Color, 01
Single, Married, Widowed or Divorced,
Age, Years, Months, 1 Days. Occupation, Electric + Las Fullnes
* Residence ¡ also state fully. §
{ If out of town, } Winthrop mass
Place of Death, 9 miatte avenue
Place of Birth, Opeland
Name and Birthplace of Father, Robert Ireland-Oreland
Maiden Name and Birthplace of Mother,
Jane doeRe
Ireland
Place of Burial (Give name of Cemetery), ...
Main Hallaction Cemetery Lumey Mas
Dated at
place of business
on
March 19'
1904/
of Undertaker. 18Cherman@miel Winthrop mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Robert D. Ireland Age, 71 8. 4 M. /D.
Place and Date of Death,
died at
Winthrop
Man. 18
190 4.
Disease or Cause of Death, # Immediate,
Primary,
Cystitis
Duration,
2 years.
acute nephritis
Duration,
2 mos
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
of
- {
HJ Partir
M. D.
Certifying Physiclan.
Winthrop
Date of Certificate,
Mch. 19
190 4:
· Give also street and number, if any. | Give sex of infant not named. If still-born, so stute.
{ If a Boldler or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
-
Signature and Summer Glaube
No.
RETURN OF THE DEATH
Robert De Corsa Ireland at OF
Date, March 18" 1904
Filed, March 19 1904
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whose house a death occurs and the oldest next of kin of a deceased person in the city or town in which the death occurs, shall, within five days thereafter, cause notice thereof to be given to the board of health or to the town clerk.
SECTION ". 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 snch death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician shall forthwith after the death of a person whom he has attended during his last illness, at the request of an undertaker or other authorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts. If of a child born dead, both the birth and death shall be reported as "stillborn ". Penalty for neglect fifty dollars.
SECTION 11. If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as he can state the same. Penalty for refnsal or neglect, ten dollars.
SECTION 12. Every undertaker or other person who has charge of a funeral, shall forthwith obtain the physician's eer- tificate required by section 10, enter thereon the facts required by section 1, and return it to the board of health or to the clerk of the city or town in which the death occurred. The person making such return shall receive from the city or town a fee of twenty-five cents.
[EXTRACTS FROM CHAPTER 78, REVISED LAWS. ]
SECTION 38. No undertaker or other person shall bury a human body in a city or town, or remove therefrom a human body which has not been buried, until a permit from the board of health or its agent has been received. No such permit shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a physician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth-
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,
thorgrass
Sex,
Color,
White
Date of Death,
Tomar 19 mm
190 4; Age, 49 Years,
9
Months,
8 Days.
Maiden Name, § } or divorced. Mary J, Shields If married, widowed
Hidour
Husband's Name,
Ameal E Suocero
Single, Married, Widowed or Divorced,
Hid www Occupation,
Domestic
*Residence, ¿ also state fully. S
§ If out of town, }
2 Arq yla ff'
Place of Birth,
Newbury bort, mass.
*Place of Death,
2 Arayde St, Hinttror, Dass.
Name and Birthplace of Father,
Edward Shields
Derland
Maiden Name and Birthplace of Mother,. battani Gresit
Place of Interment, (Give name of Cemetery), Holy Cross, Maldau
Dated at
on
mar 19 m
1904
Signature and place of business of Undertaker. (146 Insiste of Sky
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Mary I Iroda vaso
Age,49 Y. 9 M. 8 D.
Place and Date of Death,
Primary,
Carcinoma Utéri
Duration,
2 4,25
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physiclan.
M. D.
Date of Certificate,
201
190
Y.
· 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
died' at ..
Tarelliok, Dass
Har 19" 1904.
Disease or Cause ) of Death, # Secondary,
No.
RETURN OF THE DEATH
OF May of Snodgrass
at
2 argyle Stiel
Date, March 19" 1904.
Filed, March 20" 1904.
[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 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 seeordanee 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 oceurred.
[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 anthorities. 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. 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 glassachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Date of Death, March 19 1904
Full Name of Deceased,
Charles actual Thompson
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