USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 4
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Signature and Residence S Sumar S.C. Badge
- M. D.
of
483 Beo con SI
Date of Certificate, 3
190 4.
· Give aleo street and number, if any. t Givo sex of Infant not namedl. 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 town.
Agent of Board of Health.
Certifying Physician.
Duration,
No.
RETURN OF THE DEATH
OF
Infant (battrece)
3 7 Grace avenue at
Date,. March 31
190 4 .....
Filed, apie 1dl
190
.. .
[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 atterded 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 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, fintil a permit from the board of health or its agent has been received. No such permit shull be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a 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.)
Date of Death, Openie 2'
190 4.
Full Name of Deceased,
Margaret L, No Namara
woman or a Wlow give also} If a married or divorced
Maiden Name, 11 11
Oraggerly
Name of Husband, John B. M: Namara
Sex, Or
Color, Single, Married, Widowed or Divorced,
Age,
65 Years,
Months,C
-Days. Occupation,
* Residence { If out of town, } ( also state fully. )
charleston Nass
Place of Death, 2 Cottage Chence Hinteny, Mass
Place of Birth, Sneland
Name and Birthplace of Father, Michael Haggerty Theland reland
Maiden Name and Birthplace of Mother,
many Doherty.
Speland
Place of Burial (Give name of Cemetery), Holywood Bennetery (1320) Faire)
Dated at Hinthole
Signature and
on
Marie 2"
190 4
place of business of Undertaker. 50 9 52 2Karre
when BY Charlatan Dans
PHYSICIAN'S CERTIFICATE.
ORMDRIDGE, Winthroto Imperie 2
1904
'lace and Date of Death, No .. 2 Cottage avenue
Disease or Cause of Death :
Chief Cause,
Cenbral hemorrhage
DURATION.
Contributing Causet
Place where disease was contracted, if other than death,
certify that the above is true to the best of my knowledge and belief. Y a. morrison Signature of l'hysician,
Residence, No. 80 Princela
Street, .
(City or Town.)
Or Sex of Infant (not named).
If a soldier or sailor who served in the War of the Rebellion, Chief and Contributing causes must be given.
The office of Board of Health will be open for the granting of permits for burial as follows: Saturdays, 8 A. M. till 2 P.M. ; Sundays ind Holidays, 12 M. till 1 p. M. ; Other Days, from 8 A. M. till 4 P.M.
BE VERY CAREFUL TO FILL ALL BLANKS IN INK.
[OVER]
Agent of Board of Health.
Game of Deceased* Margaret I.M. Namaste posed Age, 65 Years,
Months, .. Days.
Street, Cambridge, ... . . 190
M. D.
Evet Bastano
No.
RETURN OF THE DEATH
OF
Margaret Y, NO. Namara
2 Cottage Chence
at
Date, alene 2"
190 4
Filed, aferie 2 190 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, canse 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 ocrtificate 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 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 shull 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 anantarainn and transmit it to the soul of the site no tran for anintention
Danalty for violation ant avreading fifty dollire
FORM C.
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,
190
Full Name of Deceased, Stanel of martin
Maiden Name, . "
If a married or divorced woman or a widow give also Name of Husband,.
Sex of Color,
Single, Married, Widowed or Divorced,
Age, 60 Years, Months, Days. Occupation, Dassmaker
* Residence
[ If out of town, } Neponset Mass (50 Cataw but) { also state fully. }
Place of Death, 74 Guest avenue Winthrop
Place of Birth, Bistel Deane
Name and Birthplace of Father, Robert Moulin
Maiden Name and Birthplace of Mother, Nancy Jones, - new castle me
Place of Burial (Give name of Cemetery), . Pincho Competey (Inter). mars)
Dated at Winthrop
Dummer Floyd
on
190 4
of Undertaker. 18 Herman Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Harriet y. Morton Age, 60 Y.
...
.M. .
.
.D.
Place and Date of Death, died at. Winthrop
4
190 4.
Primary,
Duration,
Duration,
2 hrs.
1
I certify that the above is true to the best of my knowledge and belief.
M.J. Partir
M. D.
Signature and Residence S of Certifying Physician.
250 Shirley Str., Hencheof
Date of Certificate,
april 5 0€.
1904
* (ive also street and number, if any. | Give sex of infant not named. If still-born, so state. { If a Soldier or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Interment in Section Juntersign and transmit to the clerk of the city or town.
rare
Winthrop Cemetery
Agent of Board of Health.
Disease or Cause of Death, } Immediate, apoplexy
Signature and place of business
Commonwealth of Classachusetts.
No.
RETURN OF THE DEATH
OF
Havier y, Marlon
at
44 lorel avenue
Date,. apare 4
1
190 4
Filed,
190 4
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honscholder in whose honse 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 S. Penalty for neglect to comply with the requirements of sections 6 and ", 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 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-
solution not exceeding fifty dollars.
FORM C.
Commonwealth of Massachusetts.
. aprq
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, ajene q "
190 4
Full Name of Deceased,
Joanna Jewkshery
Maiden Name, Joanna Haitt
If a married or divorced woman or a widow give also
Name of Husband, George St, Genkchung
Sex, Color, Single, Married, Widowed or Divorced,
Age, 19 Years, Months, 15 Days. Occupation,
* Residence ( If out of town, { ¿ also state fully. §
Mass
Place of Death, 45, Orashington avenue
Place of Birth, Walden Mass
Name and Birthplace of Father, Wathawie Hailt, Malden
Maiden Name and Birthplace of Mother, Sarah OKeagles,- Malden
Place of Burial (Give name of Cemetery), Winthrop Orginelery
Dated at Or withop
Signature and
on ajerie q"l 190 4
place of business of Undertaker. 18 Oferman Sweet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Joanna d'enRebuy Age, 79 x. 6 M. 15 D.
Place and Date of Death, died at 45 Washington Street alone 9 190 4.
Primary,
Duration,
Disease or Cause of Death, # Immediate, General Hacmorrhage
Duration,
10 days
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifylng Physician.
M. D.
Date of Certificate,
april 10
190
4.
· (r.ve also street and number, if any. | Give sex of Infant not named. If still- born, so sinte.
[ If a Soldier or Sailor in the War of the Rebellion, give both I'rimary 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
45 Washington avenue
Date,
"
190.
Filed,
190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every houscholder 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 ", f.vc 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 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 shull be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a
rent, upon receipt of such statement and certificate, shall forth-
FORM C.
apr 19
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, ajene 19 " .190
Mary Elizabeth nucle (din)
(manod) nauy
Full Name of Deceased,
Maiden Name, Mary Elizabeth Phimmy Cook
If a married or divorced { woman or a widow give also S Name of Husband,.
Sex, Color, -Single, Married, Widowed or Divorced,
Age, 60 Years, Months, - Days. Occupation, Housewife
* Residence { If out of town, } ¿ also state fully. } ..
mass
Place of Death, 4, Hashington avenue
Place of Birth, Portsmouth
new Hampshire
Name and Birthplace of Father, Thomas Cook- Smiler, England
Maiden Name and Birthplace of Mother, Permeta N. adams
Place of Burial (Give name of Cemetery),
Hintrop Genelen Drinkenof Grass
Dated at interior
Summer Floyd
ajene 20C 1904
Signature and place of business of Undertaker.
18 Overman &bcel,
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t mary E Write Age, GUY. & M. X.D.
Place and Date of Death, died at. 14 Washington com apr 19 .. 190 4.
Primary,
Disease or Cause of Death, # Immediate,
Diabetes
Duration, Indefinite
gangune f bf 8 Duration, 1 1/ 2 yos.
I certify that the above is true to the best of my knowledge and belief.
signature and Residence S of Certifying Physician. 28 Lacalago 2
M. D.
Date of Certificate, apr 21 190 4
· frive also street and number, if any. f Glvo 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.
Ayant of Board of Health.
certains
Commonwealth of Massachusetts.
No.
RETURN OF THE DEATH
OF
Mary Elizabeth Chute
HOWashington Cheme at
Date,. april 19" 190
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 oity 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 firat arrives after such death.
SECTION S. Penalty for neglect to comply with the requirements of sections 6 and ?, 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 ". l'enalty 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 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 shull be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a
Ofer 21
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, jene 21"
1904
Full Name of Deceased, tellie a. Petersen
Maiden Name, Nellie a Gavey
If a married or divorced woman or a widow give also -
Name of Husband, John B. Peterson
Sex, Color,
Single, Married, Widowed or Divorced,
Age, 34 Years, Months, Days. Occupation,
* Residence ( If out of town, { [ also state fully. }
Hiltrop Mass
Place of Death, no 15, Centre Street
Place of Birth, Onturville Pensylvania
Name and Birthplace of Father, .. Onen Garvey - Ireland
Maiden Name and Birthplace of Mother, Mary Heown- Canada
Place of Burial (Give name of Cemetery),
Dated at
Signature and
on april 221 1904
place of business of Undertaker.
18 German@heel
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Otellie a. Petersen
Age, 34. 2 M. D.
Place and Date of Death,
died at 15 Centre Street aferie 21" 190 1%. Nephritis / Pregnancy Duration, 1200- months
Primary,
Disease or Canse of Death. Immediate,
E clampsia
Duration, 1 hour
1
I certify that the above is true to the best of my knowledge and belief.
M. D.
S
Signature and Residence
4
of
Certifying Physlclan.
128 Lexington It, Si3.
Date of Certificate, 07/2/ 22
190 %
· Grive also street and number, if any. | Give sex of Infant not named. If still-born, so state. { If a Soldier or Sailor In the War of the Rebellion, give both Primary and Immediate Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
Summer Floyd
No.
RETURN OF THE DEATH
OF
etserie a. Petersen 15 Centre Street at
Date,
190 4
Filed, More 22 4 190 ..
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder in whosc 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 snch 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 shull be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a
anch statement and certificate, shall forth-
L
11
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, panie 21
180 4
Full Name of Deceased, Suite Com enfant (Petersen)
Maiden Name,
If a married or divorced woman or a widow give also Name of Husband,
Sex,
Color,
Single, Married, Widowed or Divorced,
Age, Years,
Months, r Days. Occupation,
* Residence { If out of town, } [ also state fully. }
no 15 bentre Sheel
Place of Death, no 15 Centre Street
Minitrop
Place of Birth, no15 Centre Stre Amitrop Name and Birthplace of Father, John P. Rterson Sweden
Maiden Name and Birthplace of Mother,
nellie a Sancy Mirisville Pa
Place of Burial (Give name of Cemetery), Hordlawn Cemetery
Dated at Winthrop
. Signature and Summer Ferd.
on
Marie 22 190 %
place of business of Undertaker. 18 OferinQuest
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age,
Y.
.M.
D.
Place and Date of Death, died at at Monstruos No 15 Centre Street pt, 190 %.
Disease or Cause of Death, # Immediate,
Primary,
Duration,
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.
128 Lexington Pl., E Boston
Date of Certificate, april 22 190%.
· (s. ve also street and number, if any. | 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 toun.
Agent of Board of Health.
No.
RETURN OF THE DEATH
OF Stielom Petersen -
at
15 Centre Street
Date,. ajerie 21" 1904
Filed, apgrie 22 190 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 oceurs, shall, within five days thereafter, canse 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 S. Penalty for neglect to comply with the requirements of seetions 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.
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