USA > Michigan > St Joseph County > Three Rivers > Death certificates, city of Three Rivers, St. Joseph county, Michigan > Part 1
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ALLEN COUNTY PUBLIC LINNANY 3 1833 01235 1257
GENEALOGY 977.402 T41d 1907
Death certificates, city of Three Rivers, Saint Joseph county, Michigan, August 17, 1907-December 28, 1907
Copied by Allen County Public Library 2001
Allen County Public Library 900 Webster Street PO Box 2270 Fort Wayne, IN 46801-2270
AUGUST 17, 1907 TO DECEMBER 28, 1907
93-12-05-500 tks., 100 pages,
STATE OF MICHIGAN
Department of State-Division of Vital Statistics.
REGISTER OF DEATHS.
PUBLIC ACT NO. 217 OF 1897 (AMENDED, 1901).
(Township. Village, or City.)
. of THREE RIVERS, MICH.
County of ..... ST. Passer
17
1907.20
Десетви 28.
111
to
PRESERVE WITH CARE, BEGIN EACH YEAR with a new series of record numbers. This ister should be filled out at the time the Burial or Removal Permit is issued. It will serve as a basis for king the required returns to the County Clerk.
AF The Certificates of Death upon which this record is based must be mailed to the Secretary of State, sing, of the fourth day of the following month. Therefore it will be necessary to keep the Register written 'to date in order that there may be no delay in transmitting returns. Registrars should not issue permits for ths in other districts, for deaths in other States, or for disinterred bodies. Permits for the railroad transport- n of all disinterred bodies must be obtained from the State Board of Health. They cannot be issued by 1 istrars!
Mail Returns Promptly on the FOURTH (4th) Day of Each Month, and Do Not Mail them Before the Fourth
Day unless Absolutely Sure that no Deaths have Occurred.
MARGIN RESERVEDFOR : BINDING IT WRITE PLAINLY WITH UNFADING INK-THIS IS A PERMANENT RECORD. ...
PLACE OF DEATH
County cf ..
Steve
Township of
or
Village of
City of ..
31Rivera
(No. 301
Spring
.St .;
... 3 ..
.. Ward)
FULL NAME
Eli C Ridglug
PERSONAL AND STATISTICAL PARTICULARS
SEX anale
COLOR
Lelite
DATE OF BIRTH
(Month)
may.
La
(Day)
16
(Year)
1 844
AGE
... .L.3 .... years,
3
months ......
1
days
SINGLE, MARRIED.
WIDOWED, OR DIVORCED
AGE AT MARRIAGE.
NUMBER OF CHILD-
REN
( If married, age st (first) marriage
23
__ years
( Parent of 2 children, of whom / are living
BIRTHPLACE
(State or country)
Chio
NAME OF
FATHER
Lestell Ridgeley
BIRTHPLACE
OF FATHER
(State or country)
unknown
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER
(State or country)
OCCUPATION
Farmer
THE ABOVE STATED PERSONAL PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND GELIEF
(Informant) ..
Jay Ridgeley
(Address)
STATE OF MICHIGAN Department of State-Division of Vital Statistics
CERTIFICATE OF DEATH
Registered No.
40
[If dea:hoccurred in a Hospital or Institu- tion, give its NAME Instead of street and number. If away from usual residence, give "Special Informa- tion" below.]
MEDICAL CERTIFICATE OF DEATHI
DATE OF
DEATH
(Month)
aug
(Das)
(Year)
...
I HEREBY CERTIFY, That I attended deceased from aug. 15 190.7, to Cinq 17 190 .. 7, that { last saw h-+++ alive on. aug 18 190.7., and that death occurred, on the date stated above, at 8:45PM. The CAUSE OF DEATH was as follows: Cerebral
Softinc
& Softing
Contributory.
(DURATION)
DAYS
(Signed)
A.H. 6feel
.M. D.
aug 1.6190.7. (Address)
3 Rivera
SPECIAL INFORMATION only for Hospitals, Institutions, Traosients or Recent Besideats:
Former or
osnal residence
How long st
place of death!
Where mas disesse contracled, if not at place of death ?
PLACE OF BURIAL OR REMOVAL marcellus mich
DATE OF BURIAL
aug 20
.190 ...
UNDERTAKER
Elmer Walter
ADDRESS
marcellus
.
Filed
aug. 18 1907
...
James E- Bum
Registrar
-(DURATION)
17
190 ....
.
Form 36-5-
:+0,000
.
N. B .- Every Item of Information should be carefully supplied, AGE should be stated EXACTLY. PHYSICIANS should Nato CAUSE OF DEATIE In plain terms, that It may be properly classified. The "Speciat Information" for persons dying away from home should be given in every Instance.
[U. S. STANDARD CERTIFICATE OF DEATH. prepared by the Committee of the Amerienn Public Health Association aud adopted by the U. S. Census Office.]
CERTIFICATE OF DEATH.
- .)
INSTRUCTIONS TO REGISTRAR .- The registered num- ber may be Inserted In space above, if desired, for your own con- venience. It is recommended, however, that It be entered only on face of certificate, In space provided nt upper right-hand corner. It should be entered Immediately upon receipt at your office. and the date of filing in your office and your signature as registrar should be entered ut the same time on the face of the certificate in the lower right-hand corucr.
Please examine the certificate carefully before making out the permit and call the attention of the undertaker or person in charge of the disposition of the body to any omissions. If any Item cannot be obinined, the space should not be left blank nor o meaningless dash be used, but the word "Unknown" should be plainly written. Be particularly careful to see that the place of death is correctly stated. If out of your jurisdiction. do not register it, but see that It is filed with the registrar where the death occurred. It Is not necessary to give the "Speelal Infor- mation," except for deaths in institutions, etc.
Do not fail to mall all certiflentes of death filed with you to the Department of State, Lansing, Michigan, on the fourth (4th) day of the following month. Use the stamped return envelope provided for this purpose, and Include a State- meut Card, properly filled out.
1
bulmers, when duly authorized by the Secretary of Hinter lo net ux NubregIntrat, muy Inyue permita to theintelvin for donthx In villages or townships (but not In eltica). They must first have the errilitestes completely and leglidy fied ont In Ink, and must personally We all certiftestes with the registratonur before the third day of the following month without fall. The certilentes should not be numbered by the sobregistrars, bot by the registrars, who record and transipit us if originally lied with them.
DUTY OF UNDERTAKER .- It Is the duty of the undertaker or other person In charge of the final disposition of a human hody to observe the following requirements of the registration law : I. Ile must obtain a certificate of death fthis blank or any other form ever issued by the Secretary of State for this pur- pose will be satisfactory), and have It properly filled out with all of the personal und statistient particulars required by law. This part of the certitiente should preferably be signed by a rela- tive or friend of the decedent, or by some competent person acquainted with the facts. It may be signed by the undertaker or by the physician If desired.
2. The certifenie containing the above personal particulars must now be presented to the attending physician for the medi- cal certificate of cause of death. If the physician is absent, An) that the medical certificate cannot be promptly obtained, tho Incomplete certificate may be then presented to the registrar with a statement of that fact. The registrar may thereupon, In bla discretion, Issue a conditional perunit, provided the medical certificate be completed at the carllest possible moment, Hut registrare will exercise especial caution in granting such condi- tional permits to insure that the death did not result from any Infectious disease, requiring sanitury precautions, or from unlaw- ful or auspicious means. If any doubt exists, or In the case of n death without medical attendance. the registrar will refer the certificate to the Health Omfeer fif n physician) ur Coroner for Investigation and statement of cause of death. If the Henlth Omeer Is not a physician, the registrar may Insert the cause of death in dentlin occurring without medleal attendance from competent testimony over his official signature.
3. The undertaker or person In charge of the disposition of the body must nost present the rotnplete celliicate of denth, conlalolng the medical rertiliente of cause of death, to the Begleiter of the township, village or city where the death occurred, and obtain his permit for the burlul or re- moYAl of the body before any ilisposition is made of H1.
-
4. The undertaker should deliver the Registrar's turint l'ermit to the Sexton when the Interment is made, or, if the body is removed by rall or boat, the Hegletrar's firmovai Per- init must be dellvered by bhin to the agent of the transporta-
Llon company, who must attach It to the box containing the body to accompany It to destination.
DUTY OF SEXTON .- Sextons should not permit an inter- ment until n properly prepared Burini or Removal Permit is delivered by the undertaker or person In charge of the remains. A Removal Permit answers the purpose of a Burial Permit, un. less there are local regulations to the contrary.
SUGGESTIONS TO PHYSICIANS .- Physiclang are corn- estly requested to fnellitate the execution of the Inw, and especi- nlly, as far as it may be in their power, to old undertakers lo their outy of promptly obtaining a statement. of cause of death. Ilank certificates will be supplied to nll physicians in the State upon request, and may be obtained at any time from the local registrars. Physicians should have a supply of blunks on hand, and In the event of death, kindly leave the medient certificate of cause of death with the faintly of decedent, or have it ready for the undertaker so that he will not be de- layed in obtaining the permit. Compliance with this request, which will remove one of the principni difficulties of prompt registration, will be greatly appreciated.
The statement of cause of death is very Importnat for many reasons. Please be precise and defalte in making out the medi- cal certificate. If the death occurred from concer or tuber- culoxix, state what part of the body wus affected. If from septicemia, give the cause of the septicemia, especially for fe- males of childbearing nge. Never report a denth from "heart fullure;" It Is universally discredited as a statement of cause of death. If such n death was due to actual heart disease, state chut fact; or if the "heart fullure" occurred in the course of diphtheria or other disease, give the name of the disease that caused the "heart failure."
EXTRACT FROM THE REGISTRATION LAW.
Compiled Laws, 1897, $$ 4014-1020, as minended by Pubile Act No. en of 1001.
SECTION 1. The People of the State of Michigan enost, That the body of no person when death onenra in the Sinte shalt bin In. Lerred, deposited in a vanit or tant or otherwise disposed of, or removed from the township, village or etty in which the douth occurred, untti n permit for burial or removal shall have been properly Issued by the clerk of the township, villago or city In which the death occurs, who shall be tho registrar of deaths. Sec. 2 Whenever any person shall dic, the onderinker, house- holder, relative, friend, manager of Institution, sexton or other person superintending the burial of sald deceased person, shall cause a certificate of death to be filled out with all the personal and family particulars required in section three of this act, and attested by the signature of a relative or some competent per- son nequainted with the facts. The physician who attended the deceased person during his last illness shall fill out the medi- cal certificate of enuse of death. Upon the
presentation of a certificate of denth properly illled out and signed, the registrar shall Isave a permit for the burini or removal of the body nund shall Immediately record the death In the regis- ter of deaths, numbering all certilleates consecutively In the order In which they are received, beginning with No. I for the Hrst death that occurs In each year. Ja deathis from dangerous communicable diseases, burial or removal permits shall be granted by the registrar only in neeordance with the rules of the locul board of health and the Sinte Hoard of Health relating thereto. The sexton or other person having charge of the Inter- ment or linal disposition of the body shall retain the burial per- mit when presented to him by the undertaker: Provided, That when a body Is shipped the removal permit shall be presented by the undertaker or other person shipping the same to the agent of the transportation company, and shall be attached by him. with the transit perinit, to the box containing the body, to ne. company the enme to destination, and no transit permit shall be Issued or received by uny transportation company for the ship- ment of n body unless accompanied by the registrar's removal permit.
SKC. 6. An offfelal falling or refusing to perform his duty under this act, or any undertaker violating any of Its provisions, shall, upon conviction thereof, be deemed guilty of a misdemeanor. sod shall be punished by a line of not less than live dollars and not execeding one hundred dollars, or be Imprisoned in the . county jnll not creceding thirty days, or suffer both fine and Im- prisonment ut the discretion of the court. Local registrars shall Her that the provisions of this act are enforced in their juris- dietlons
Copies of the law and blank certificates of death will be supplied by the Local Registrar or by the Secretary of State.
.
Form 36-5-
.40,000
.
N. II. - Erery Item of Information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should Alale CAUSE OF DEATH In plain forms, that It may be properly cinssified. The "Speciat Information" for persons etying away from home should be given in every Instance,
[U. S. STANDARD CERTIFICATE OF DEATHI. prepared by the Committee of the Amerienn Public Health Association and adopted by the U. S. Census Office.]
CERTIFICATE OF DEATH.
1. .)
INSTRUCTIONS TO REGISTRAR .- The registered nuni- ber may be inserted in space above, il desired, for your own con. venlence. It Is recommended, however, that it be entered only on face of certifiente, In space provided nt upper right-hand corner. It should be entered Immediately upon receipt of your omec. and the date of Biling In your office and your alguature as registrar should be entered at the same time on the face of the certificate In the lower right-hand corner.
Please examine the certificate carefully before making ont the permit and call the attention of the undertaker or person in charge of the disposition of the body to any omissions. If any Item cannot be obtained, the space should not be left blank nor a meaningless dash be used, but the word "Unknown" should be plainly written. Be parileniarly careful to sec that the place of ficothi is correctly stated. Il out of your jurisdiction, do not register it, but see that It is filed with the registrar where the death occurred. It Is not necessary to give the "Special Infor- matloo," except for deaths In Institutions, etc.
Ilo not fail to mall oll certificates of death filed with you to the Department of State, Lansing, Michigan, on the fourth (4th) day of the followlog month. Use the stamped return covelope provided for this purpose, and include a State- ment Card, properly bilicd out.
INSTRUCTIONS TO SUBREGISTRARS .- Licensed em balmers, when duly authorized by the Secretary of State to aet as hubregistrars, may Issue permits to themselves for deaths la villages or townships (but not in cities). They must first have the certificates completely and legibly filled out in Ink, and must personally flic oll certificates with the registrars on or before the third day of the following month without fall. The certlilcates should not be pumbered by the subregistrars, but by the registrors, who record and transmit as It originally filed with them.
DUTY OF UNDERTAKER. - It is the duty of the undertaker or other person In charge of the final disposition of a human body to observe the following requirements of the registration law : 1. lle must obtain a rertillento of denth tthly bank or any other form ever Issued by the Secretary of State for this pur- pose will be satisfactory), and have It properly filled out with oll of the personnl and statistlen! porileulars required by law. This part of the certifleste should preferably be signed by a rela- tive or friend of the deeedent, or by some competent person acquainted with the facty. It may be signed by the undertaker or by the physician Il desired.
2. The certificate containing the above personal particulars must now be presented to the attending physician for the medl- ral certificate of cause of death. If the physician Is absent. so that the medieni certificate cannot be promptly obtained, the Incomplete certificate may be then presented to the registrar with a statement of that [net. The registrar inny thereupon, in his discretion, Issue a conditional permit, provided the medical certMeste be completed at the carliest possible moment, Hut registrars will exercise espcelal caution in granting such condi- tloual permits to lasure that the death did not result from any Infectious disease, requiring sanitary precautions, or from unlaw- ful or suspicious means. If any doubt exists, or In the case of u denth without medieni attendance the registrar will refer the certificate to the Health Officer (If n physician) or Coroner for Investigation nud statement of enuse of death. If the lenith Omeer Is not n physlelun, the registrar inny Insert the cause of death In deaths occurring without medical attendance from competent testimony over his officin] signature.
3. The undertaker or person In charge of the disposition of the body must noxt present the complete certificate of denth, cantalning the medical certificate of cause of dentli, to the Registrar of tho township, village or rity where the donth nerurred, and obtain his pormult for the barlal ar re- monval of the body before any disposition Is made of It.
4. The undertaker should deilver the Begintinr's Hin Inl l'ermit to the Sexton when the Interment Is inndle, or, If the body is removed by rail or boat, the Registrar's Removal l'or- soit must be delivered by bhp to the agent of the transporla.
flon company, who must attneh It to the box containing the body to necompany It to destination.
DUTY OF SEXTON .- Sextony should not permit nn Inter- ment until a properly prepared Burial or Removal Permit Is delivered by the undertaker er person In charge of the remains. A Removal Permit answers the purpose of a Burlal I'croit, un. Icss there are local regulations to the contrary.
SUGGESTIONS TO PHYSICIANS .- Physielans aro caro- estly requested to Ineilitate the execution of the law, and espeel- nily, ns far ns It may be In their power, to uld undertakers la their onty of promptly obtaining a statement of cause of denth. Ilank certificates will be supplied te all physicians In the State upon request, and may be obtained nt Day time frem the local registrars. Physleinns should have a supply of blunks on hund, and in the event of death, kindly leave the medienl certificato of cause of donth with the fuinlly of decedent, or Invo it ready for the undertaker so that he will not be de- Inyed In obtaining the permit. Compliance with this request, which will remove one of the principal difficultles of prompt registration, will be greatly appreciated.
The statement of cause of death is very Important for many reasons. Please be precise and definite in making out the medi- eul certificate. If the death occurred Irem rancer or tuber- culosis, state what part of the body was affected. II Irom Arpticemin, give the cause of the septicemia, especially for Ie- males ef childbearing age. Never report a denth from "henrt fullnre;" it Is universally discredited as a statement of cause of death. If such a death was due to actual heart disease, state that fact; or if the "heart foflure" occurred In the course of diphtheria or other disease, give the name of the disease that coused the " heart failure."
EXTRACT FROM THE REGISTRATION LAW.
Complied Laws, 1897, $$ 4614-4620, as amended by Public Aet No. 20 of 1901.
SECTION I. The People of the State of Michigan cnact, That the body of no person whose death occurs in the State shall be in- terred, deposited In a vault or tomb or otherwise disposed of, or removed from the township, village or city in which the death occurred, until n perinit ler burial or removal shall have been properly Issued by the clerk of the township, village or city in which the denth occurs, who shall be the registrar of deaths. Sxc. 2. Whenever any person shall die, the undertaker, house- holder. relative, friend, manager of Institution, sexton or otber person superintending the burfal of sald deceased person, shall cause a certificate of death to be filled out with all the personal and lamolly particulars required In section three of this net, and attested by the signature of a relative or some competent per- son nequainted with the Inets. The physlelan who attended the deceased persen durlug his Inst Illness shall fill out the medi- cul eertilleate of cause of denth. Upon the presentation of a certificate of death properly illled out and Aligned, the registrar sball Isque a permit for the burial or removal of the body and sball Immediately record the death In the regis- ter of deaths, numbering all certificates consecutively in the order In which they are received, beginning with No. I for the Urst death that occurs In each year. In deaths from dangerous communicable diseases, burial or removal permits shall be granted by the registrar only In necordanec with the rules of the local bourd of health und the Sinto Hoard of Health relating thereto. The sexton or other person having charge of the Inter- ment or Inal disposition of the bedy shall retain the burial per. mult when presented to him by the undertaker: Provided, Thut when a body Is shipped the removal permit shall be presented by the undertaker or other person shipping the same to the agent of the transportation company, and shall be attached by him, with the transit permit, to the box containing the body, to ne. company the samo to destination, and no transit perinit shall be lywed or received by any transportation company for the ship. nent of n body unless accompanied by the registrar's removal permit.
SEC. 0. An offleinl Inlling or refusing to perfora las duty under this act, or any undertaker violating any of Its provisions, shall, upon conviction thereal, be defined guilty of a misdemeanor, und shall be punished by a fine of not less than Ilve dollars and not execeding one hundred dollars, or be Imprisoned In the . county Jall not cxeceding thirty days, or suffer both fine and Im- prisontuent at the discretion of the court. Loent registrars shall Her that the provisions of this net nro enforced In their juris-
7
Conten of the law and blank certificates of death will be supplied by the Local Registrar or by the Secretary af State.
7
CERTIFICATE OF DEATH.
PLACE OF DEATH
County c
St Jouph
Township of.
or
Village of OF
City of ...
3 Kuver
(No ...
811 Douglas ave St. 9
Ward)
(If death occurred in a llospital or Institu- tion. give Its NAME instead of street and number. If away from usual residence, give "Special Informa- tion " below. ]
PERSONAL AND STATISTICAL PARTICULARS
SEX male
COLOR
White
DATE OF BIRTH
(Month) 12
(Das)
24
1820
AGE
84
..
.... ycars.
2
months, ..
2.8
days
SINGLE. MARRIED.
WIDOWED, OR DIVORCED
Lindound
AGE AT MARRIAGE, NUMBER OF CHILO- REN
(If married, age st (first) marriage 44 years Parent of _______ children, ol whom ....... are living
BIRTHPLACE
(State or country)
Pessoas
NAME OF
FATHER
Sam Cotterman
BIRTHPLACE
OF FATHER
(State or comatry)
Per
MAIDEN NAME
OF MOTHER
Gary Shafer
BIRTHPLACE
OF MOTHER
(State or country)
OCCUPATION 7 am es
THE ABOVE STATEO PERSONAL PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF
(Informant)
La Collver
(Address).
3 Rivera
MEDICAL CERTIFICATE OF DEATH
DATE OF
DEATH
(Month)
00
(Day)
21
190. 7
I HEREBY CERTIFY, That 1 attended deceased fram June 1 1907 to June 25 ,190.2, that I last saw h ........ alive on ....
25-
190 .. 2,
and that death occurred, on the date stated above, at
A .. M.
The CAUSE OF DEATH was as follows:
Paralysis
+ old ac
-(OUNATION)
Contributory
(DURATION)
(Signed)
Thomas A. Stammes
M. S.
aug 21. 190 .. ]. (Address) ...
3 Rivers
SPECIAL INFORMATION only for Hospitals, Imalitotions, Transients or Recent Residents:
Former or
ospal residence.
place of desib ?.
Where was disease contracted, if nol at place of death ?
PLACE OF BURIAL OR REMOVAL mooreparte
DATE OF BURIAL
Qua 23 1907
UNDERTAKER
L. a. Collier
ADDRESS
3 Rivers
Filed®
aug 22 907
James E. Bum
Registrar
adopted by the U. S. CcoRus Office.]
the Committee of the American Public Health Association aod WANTTOXIII CERTIFICATE OF DEATH. prepared by
body to necompany It to destination.
less there are loen) regulationy to the contrary. DUTY OF SEATON .- Sextons should not permit an Inter- ment untit a properly prepared Hurlal or Removal Permit Is delivered by the undertaker or person In charge of the remnias. A Removal Permit answers the purpose of n Burla! I'erinit, un- SUGGESTIONS TO PHYSICIANS .- Physiclans are coro-
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