USA > Massachusetts > Suffolk County > Winthrop > Town of Winthrop : Record of Deaths 1904-1906 > Part 7
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24
Registrar.
....
Somerville Mass
RAR
'S
ATRIBUS, SIT DEUS N
OB
CITY
OFFICE
BOSTONIA CONDITA AD.
A.1822
B 16 30. SREGIMINE DONATA 55.
T
V
MA
with countorgien
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, Ung. 3, .190 Y.
Dorothy Louisa Mitchell
If a married or divorced - Maiden Name,
woman or a widow give also
Name of Husband,
Sex, Color, Single, Married, Widowed or Divorced, ...
Hours
Age, 22 Years, ... Months, Days. Occupation,
* Residence ( If out of town, } [ also state fully. ) .
Huittrop mass
Place of Death,
# 1
orange
Place of Birth,
2 Garland It. Hanitudy # 1 William & Mitchell, Hruthrop
Name and Birthplace of Father.
Maiden Name and Birthplace of Mother,
Marine a. White Portsmouth, Va.
Winthrop Cemetery
Place of Burial (Give name of Cemetery), ....
Dated at Winthrop
Dummes Floyd.
on aug. 4. ... 190
place of business of Undertaker.
Hrultrap mass
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Disease or Cause of Death, }
Primary,
Immediate,
Freannitim
Duration,
I certify that the above is true to the best of my knowledge and belief.
Edward 7. Gage
M. D.
Signature and Residence S of Certifying Physician. 131 Cent ative
Date of Certificate,
Camy 4
1904.
· Give alao 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.
Ghos R Gardum
Agent of Board of Health.
22 hours
Dorothy Louisa Mitchell Age,
Y. M. .D.
died at.
#1 Bowdown St
Immature Infant
Duration,
190
Signature and
3
Full Name of Deceased,.
No.
RETURN OF THE DEATH
OF Dorothy L Mitchell
at 1 Oakland & heel
Date, august 3
1904
Filed, august 5 190 4
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every honscholder 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 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 anthorized person or of any member of the family of the deceased, furnish for registration a certificate setting forth the required facts.
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 hnman 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 ian'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 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, august 5" Full Name of Deceased, Christina
1904
Maiden Name, Christina Rose
If a married or divorced woman or a widow give also
Name of Husband, auchin a. Griss
Sex, Color, -Single, Married, Widowed or Divorced,
Age, 43 Years, 4 Months, 10 Days. Occupation,
* Residence { If out of town, ) { also state fully. )
Court Road
Hintenof Mass
Place of Death,
bord Road Winthrop Mass
Place of Birth, bambudge mass
Name and Birthplace of Father, Robech Ross, Scotland
Maiden Name and Birthplace of Mother, Katherine Dryle-9 & Seland
Place of Burial (Give name of Cemetery)
Rural Genety
New Bedford
Dated at Or anthrop
Summer Floyd
on august 6" 1904
Signature and place of business of Undertaker. 18Osterman & wel
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Christina Bliss
Age, 40 8. 4 M. 10.D.
Place and Date of Death, died at Com Prad august 5' .190 4
Carcinoma Ttivi
Duration,
30 monites
Caramenna Piteri
Duration,
3 0 minutes
I certify that the above is true to the best of my knowledge and belief.
I.E. Saison
M. D.
Signature and Residence S of
CertifyIng Physlclan.
Date of Certificate, (August 6 1904.
Mass
· Give also street and number, if any. | Give sex of infant not nained. 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.
Chao R Gardner
Agent of Board of Health.
- Primary,
Disease or Cause of Death, ± Immediate,
No.
RETURN OF THE DEATH
OF
Christina Ilies
1
at
bout Road
Date, august
190 4
Filed, august 8" 190
4
[EXTRACTS FROM CHAPTER 29, REVISED LAWS.]
SECTION 6. Every honscholder in whose house a death ocenrs and the oldest next of kin of a deceased person in the eity or town in which the death occurs, shall, within five days thereafter, eause 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 notiee of the death of any person under his charge to the board of health or to the elerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for negleet 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.
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 eanse of death as nearly as he ean 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- tifieate required by seetion 10, enter thereon the faets required by seetion 1, and return it to the board of health or to the clerk of the eity or town in which the death occurred. The person making such return shall receive from the eity 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 eity, 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 husician's certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth-
NOR
8 :
1738
CHELSEA
REVERE 1871
COMMONWEALTH OF MASSACHUSETTS
aug
REVERE.
(CITY OR TOWN.)
Registered No.
Place of l #2 Beach Road, Winthrop
Date of l
aug.
11
190 46
Death S
/ 11 months
4
.days
STATISTICAL DETAILS
SEX Male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
-MAIDEN NAME T
HUSBAND'S NAME +
BIRTHPLACE+ Medford. Mas
NAME OF
FATHER
James Q. Host
BIRTHPLACE
OF FATHER+
Maine
MAIDEN NAME
OF MOTHER
Charlott . He Sutach
BIRTHPLACE
OF MOTHER+
Baston
OCCUPATION Bookkeeper
INFORMANT §
Sister
PLACE OF BURIAL OR REMOVAL Il
Woodlawn Cemetery
DATE OF BURIAL
Cinq 14 1
190.4.
UNDERTAKER
Walter J. White.
ADDRESS 968 Bundway Kevere
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. July 28 1904 to aug. 10 .190.5%, 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 : Pulmonary Tuberculosis
Que yes
. (DURATION)
TODAY'S
Contributory :
(Signed)
Trainand Cautious
M.D.
aug. 13 1901 (Address) 68) Withuch Par
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years ..
. months days
Where was disease contracted,
If not at place of death ?
Filed
190.
Clerk
Cluq 29, 1904
* City of 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.
ELSEA 184
FULL NAME
RETURN OF A DEATH Charles Oliver Frost
Death * S
Residence
#2 Beach Road Winthro Age
47
.. years
(DURATION) .. DAYS
aug 11"1.904. auquel 29-1904
FORM C.
Commonwealth of Massachusetts.
aug 17
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,. auquel 17 190 4.
Full Name of Deceased,
Comma b, butter
If a married or divorced woman or a widow give also
Sex, Color,
Age, 45 Years, 10
* Residence { If out of town, } [ also state fully. ]
D interro 10 Mass
Place of Death, 22 Dashing Ton Avenue
Place of Birth, Provincetem Mass
Name and Birthplace of Father, Haskell D. Odiggine=Orleans Wase
Maiden Name and Birthplace of Mother, Busan Sole=Freeport me
Place of Burial (Give name of Cemetery) Winthrop Cerveteri
Dated at Henttrop
Summer Ofloyd
0
on
august 18" 1904
Signature and place of business of Undertaker. 18 Sterman Sweet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Comma L, butter Age, 45 Y. 10 M. 13 D.
Place and Date of Death, died at Winthrop, august 17" 1904.
Disease or Cause of Death, Immediate,
Primary,
Chronic Iritualitil repelentes Duration,
3 yrs
deveria Interstitial repelentes Duration,
3 yrs
I certify that the above is true to the best of my knowledge and belief.
signature and Residence S of Certifying Physician.
I.& Johnson
M. D.
Date of Certificate, 19 190%.
· Give also street and number, if any. | Give sex of Infant not nained. If still-born, 80 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.
Charles 12 Barchece ..... Agent of Board of Health.
Maiden Name,
Name of Husband, Edward, et. butter
Single, Married, Widowed or Divorced,.
Months, /3 Days. Occupation,
-
No.
RETURN OF THE DEATH
OF Emma b, butter
at
22 Nachington Que
Date, -. august 17
190 4
Filed, ..... august 19 190 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.
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 shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a windows certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth-
FORM C.
aug 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, auquel 19'
190 4
Full Name of Deceased, Clarence Belcher
Maiden Name,
-
If a married or divorced woman or a widow give also Name of Husband,
Sex, 21
Color, Single, Married, Widowed or Divorced, .. Age, Years, Months, 6 Days. Occupation,
* Residence ( If out of town, } It interop naes
{ also state fully. [ ...
Place of Death, 70, Pauline Steel
Place of Birth, Winthrope mass
Name and Birthplace of Father, arnold J. Belcher (Winthrop)
Maiden Name and Birthplace of Mother, Eliza Do. mc menuie (Charlotte tym)
D.E.d
Place of Burial (Give name of Cemetery), Hinthop Cemetery (Winthrop)
Dated at Winthrop
Summer floyd
on aug 30
190 4
of Undertaker. 18, Odermar Sheet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
Disease or Cause of Death, # Immediate,
Clarence Belcher Age, Y. N. 6 D.
died at 70 Pauline Street
aug19 "
190 4.
Meningitis
Duration,
6 days
Duration,
I certify that the above is true to the best of my knowledge and belief.
signature and Residence § of
M. D.
Certifying Physiclan.
Date of Certificate,
190
4
· Give also street and number, if any. f Glve 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 Canse.
Countersign and transmit to the clerk of the city or town.
Chacha R Barche
Agent of Board of Health.
Primary,
Signature and
place of business
Commonwealth of Classachusetts
No.
RETURN OF THE DEATH
OF Clarence
Selcher
70 Pauline Sweet
at
Date,.
auquel 19 1904
Filed, august 28 190 20
[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 elerk of the city or town within the Commonwealth at which his vessel first arrives after such death.
SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. A physician 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 refnsal or negleet, 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 bnry 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
1. af and certificate shall forth-
FORM C.
Commonwealth of Classachusetts.
Ошло 20
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,. august 20'
190 4
Full Name of Deceased.
{ TOMATEN Or divorced ! woman or a widow give also
Name of Husband,
Sex, In Color, -Single, Married, Widowed , Divorced,
Age, 49 Months, .Days. Occupation, Salesman
* Residence ( If out of town, } { also state fully. §
Winthrop Mass
Place of Death, 7 Somerset Ovenue
Place of Birth, milton DO Or,
Name and Birthplace of Father, Lorenzo Hayes- Rochester & OV,
Maiden Name and Birthplace of Mother, Martha Leighton milton NOT
Place of Burial (Give name of Cemetery) Rochester Camely 2 CX
Dated at Winthrop
Signature and
DummerFloyd
on august 22 190
4
place of business
of Undertaker.
18Overmine Street
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death,
died at.
Disease or Cause ) Primary, of Death, } Immediate,
Gred Odayes Age, 119%. Cua 20 190 Y. , Duration,
........... D.
Duration,
1 yr
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physiclan. august 22 190 4.
M. D.
Date of Certificate,
* Give also street and number, if any. | Give sex of infant not named. If still-born, so state.
If a Soldier or Ssilor in the War of the Rebellion, give both Primary and Iinmediato Cause.
Countersign and transmit to the clerk of the city or town.
Agent of Board of Health.
...
Maiden Name,
Fred Hayes Hayes
No.
RETURN OF THE DEATH
OF
Gred Hayes
at
Date, -. august 20 190
Filed, august 22 190
[EXTRACTS FROM CHAPTER 29, REVISED LAWS. ]
SECTION 6. Every householder 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, 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 certificate setting forth the required facts.
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 shall be issued until there shall have been delivered to such board a written statement, containing the facts required by law, with a Lutande certificate of the cause of death. The Board of Health or agent, upon receipt of such statement and certificate, shall forth-
cavIT
BOSTONIA CONDITAD. 1330.
CITY OF BOSTON. COMMONWEALTH OF MASSACHUSETTS.
CITY O RETURN OF A DEATH-1904. BOSTO
FULL NAME Eliza Heald
Registered No .. .7.01.9
Place of Death ¿ and Residence S
B.o.s.t.o.n
Mass. Hom. Hospital
Date of Death
Aug 21
1904.
Age
70
. years.
7
months
5
days.
STATISTICAL DETAILS.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
female
white
widowed
Maiden Name
Stubbs
Husband's Name
William Heald
Isle of Jersey Gr.
Birthplace.
....
Name of Father. Thomas
Birthplace
of Father
England
Maiden Name
of Mother
Annie Sherwood
Birthplace
of Mother
England
Occupation none
Informant
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 : (
Cerebral Embolism
(Duration)
B. 2 weeks & 2 days
Contributory : (Duration)
(Signed)
Wm O Mann
A.D
Aug 21
1904
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
or removal
Worcester Mass
Undertaker
Horace R Crane & Co
Usual Residence
12 Underhill St Winthrop
Filed
Aug .... 24
1904.
A true copy.
Attest :
ENMGlenen
Registrar.
Place of Burial
AR' PATRIBUS, SIT DEUS 'S
CITY R
OBI
OFFICE
BOSTONIA
A).1822
CONDITA AD.
B CISP
1830. REGIMINE DONATA A
MASS.
T ON.
physician's certificate of the cause
FORM C.
Commonwealth of Massachusetts,
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, august 21'
190 4
Full Name of Deceased,
Lilly May Standing
Maiden Name,
If a married or divorced woman or a Widow give also } Name of Husband,
Sex,
Color,
Single, Married, Widowed or Divorced,
Age, 2 Years, 7 Months, / 3 Days. Occupation,
* Residence ( If out of town, } [ also state fully.
Stinttrop mass
Place of Death,
Saint Shirley (Safte avenue Camp
Place of Birth, East Dalton Mass
Name and Birthplace of Father, Ferdinand , Otarding Prospect
Maiden Name and Birthplace of Mother, Sybil a, Thechy que,
Place of Burial (Give name of Cemetery), Winthrop Quetery Menthope mass
Dated at
Summer Floyd
on august 221904
Signature and place of business of Undertaker. 18 Oferman Sheet
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Lilly May Harding Age, 2 x. y M. /3D.
Place and Date of Death, died at Point Stilen drafts are inguer 21 190 4.
Disease or Cause of Death.+ Immediate,
Primary,
Entero Colitis
Duration,
2 coke.
Duration,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
H.l. Carter
M. D.
Certifying Physician.
Winthrop Beach
Date of Certificate,
aug. 22d
1904
· five aleo 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 town.
Charla K Gardner
Agent of Board of Health.
aug2/
No. ..............
No.
RETURN OF THE DEATH
OF
Lilly May Harding Tafta Chenve PrShirley at
Date, -. august 21" 1904.
Filed, auquel 23" 1904
[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, 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 affer 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.
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.