The volume, 1893–1896
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Disease or Cause of Death
(Primary and Secondary), {
Duration of Sickness,
If rtShlmT1 °!'.nili0,w,' t If a Soldier who served in the War of the Rebellion,
f 11 Other than W lute, (if.) Mulatto. (I.) Indian. If ofother Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. September, 1892.-5,000.
O-V f
f Public Statutes, Chapter 32, « amended by Acts of iSSS , Chapter 306 ; Acts of i8Sg, Chapter »*.]
t . . . . „ , a. - person during his last illness shall, when requested, forthwith furnish for registration, a
Section 3. A P1^1™ attC" 1 1 Uef the name of the deceased, his age, the disease of which he died, the duration of
certificate stating. to the best of h„ „ aforesaid, he shall be punished by a
h„ last sickness, and the date of h,s hecease. If ^ wh„ „,„a in w„ of „« rebellion, the physician shall give
ittV^e^C-She ieondary or immediate cause o, death a, nearly a, he can state the same. If a physician refuse, o, neglect, to
make such certificate he shall forfeit U “ ^ ‘ of a deceased person
unliHi^ hasNrecebod°aljpcnnit so to 'J? fie^ssued undHhere^riaMn^^livered^tl^uchTst^d^i^a^^t'or'clerk^as^the'case
purpose, the chairman of the board kf health or any y^"**** . Jd Ca,e of death bv violence the medical examiner shall,
?t^r^I^r™4=fac.ory stat'emen, ami certificate are delivered to the board of health or to its agent, the boan
if requested, make tne same, wuc . , , reaistrar for registration. The person to whom the permit is sc
“ -I Z S'rl:id":, .0 the mannered cause of the death, a, the
SI” or regisb " may re,ui,e. Any person violating any of the provision, of this see, ion shall be punished by a fine no, exceed, ng fifty
dollars. «
physicians certificate.
Name and Age of Deceased,
Daie and Place of Death, - I died a{ f
I Disease or Cauto of Death, - J „/ /
’ - •2W" * (X>
1 c"‘ify ,h‘“ *» v - - _
r-— — ^ - -*
*0r Sex of Infant (not
named).
ff /Df ?
Date af Cerifcate^^^,^ £ ^
[May, 1888.]
j
[Arts of j 888, Chapter JoS.]
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows: — Section j. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
SECTION 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign an 1 trrnsmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. \_Approved May 4, 1888.
— ' -
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased*
Date and Place of Death, -
Disease or Cause of Death, -
('OJLeCAAfLs Duration of Sick
Hp
'fdijMlf,
I certify that the above is true, to the best of my knowledge and belief.
a ~ ~ ~
Name and Residence of Certifying Physician , ttCn'. ^
Date of Certificate, Cfa/Cfi..
r
[May, 1888.]
*Or Sex of Infant (not named).
[Acts of 1888, Chapter Jo6.~]
Section I. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows: — Section j. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section y. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make tire same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [. Approved May 4, 1888.
RETURN OF A DEATH
To the Clerk of the Town in which the Death
[. Public Statutes, Chapter 32, as amended by Acts of 18SS, Chapter 306 ; Acts of iSsq, Chapter 234. \
Section , A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a
eszsssz? *. — «. *. w «*.«*-, *. *«. ***z
secondary or rmmedia.e cause of dea.h as nearly a, he can state the sanre. If a phystenrn refuses or neglect, to
, p y he treasurer the sum of ten dollars for the use of the town in which he resides.
ma 'section 5 ' No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such ci y o
f the citv or town clerk No such permit shall be issued until there has been delivered to such board, or agent or clerk as the case
m^be a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
may be, a sausiac y , , . th of this chanter, or in lieu thereof a certificate as hereinafter provided. If there is
of the attending P P™, 1 “/certiSte of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the
S of le ^board or4al2 or any physician employed by a city or town for the purpose shall, upon request of said boar ,
* nt nr clerk make such certificate as is required of the attending physician ; and in case of death by violence the medical examl"er ’
‘ ° este 1 make the same When such satisfactory statement and certificate are delivered to the board of health or to its agent, the oar
and transmit th/ same to the clerk or registrar for registration. The person to whom the permit is so
• ° v, 11 thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding y
dollars. . . '•
A
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased*
Date and Place of Death , -
Disrate or Sause of , Death, -
Age,/'
$L-
'y yjr&t eC /. / 7 ]%f3'
Duration of Sickness
I certify that the above Is true, to the best of my knowledge and belief.
Name and ResideTtce of Certifying Pftysician, p3.
Date of Certificate, Z^-
*Or Sex of Infant (not named).
-*re
[Ed. — 10 M — Oct. 9, 1889.]
[May, 1888.J
[Acts of 1888, Chapter Jo6.]
SrrrTON i Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
l6CtS Section' 2 t0 Section ^0?^ hap ter, prohibiting thi burial or removal of a human body until a proper certificate is furnished is
« Jet 1 S! iSfS 'o’regi,:™ »"y"q«i.e An, vioU.ing »n, of .he p,ovi„o„. of .hi,
section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 18&X.
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Ph
GO
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CO
»o
* If a Married Woman or Widow, f If a Sdldier who served in the War of the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. Nov. 1890—5,000.
[Acts of 1888, Chap. 30G.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AN© THE BURIAL AND REMOVAL OF
BODIES OF DECEASED 'PERSONS.
Be it enacted, etc., as follows t
Section 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for
registration certain facts relating to deceased persons, is amended so as to read as follows : — Section 3. A physician who has
attended a person during his last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the
best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of his last
sickness, and the date of his decease, If a physician neglects or refuses to make a certificate, as aforesaid, lie shall be pun-
ished by a fine not exceeding fifty dollars. , , , , ,
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is fur-
nished, is amended so as to read as follows : — Section 5. No undertaker, sexton or other person shall bury in a city or town
or remove therefrom the body of a deceased person until he has received a permit so to do from tho board of^ liealUi jir ^its
phys
enough for the puiq
upon request of i
livcred'tcTthe board of health or to its agent, ‘the board or agent shall forthwith countersign and transmit the same to the clerk
or registrar for registration. The person to whom the permit is so given shall thereafter furnish for registration any other
information as to the deceased or to- the manner and cause of the death, as the clerk or registrar may require. Any person
violating any of the provisions of this section shall be punished by a flue not exceeding fifty dollars. [_ Approved Man 4, IbbS.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
/_■. n lk 1
Name and age of deceased
Date and place of death:
Disease or cause of death :
-nyc ' •J'-’ "
((/ / ^9 £ ^ ft (ft*..0*. .4. /•
Age ■■■■> yrs '• • • • -^nios i ays.
Duration of disease:*-
RETURN OF A DEATH.
To the Clerk of the Town, in which the Death occurred.
\
J
* I f :i Married Woman or Widow. $ If a Soldier who served in/lhe War of the Rebellion,
t If other than While. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. J
Plate. Ed. September, 1892. — 5,U00.
Zu* si&'Lcr. 2, if V?v,
i "V ^
[Public Statutes , Chapter jaflar amendeJWy ^ite ofiSSS \ Chapter fob ; Ads of iS8g, Chapter 224 .]
Section 3. A physician who has attended>ja person daring Ik? last illness shall, when requested, forthwith furnish for registration, a
certificate stating, to the best of his knowledge and belj^VtWe natagbf the decked, ,hij^ge, the disease of which he died, the duration of
his last sickness, and the date of his decease. If a phyyi&^rmileclfebr ^eftisk te makfe^-eertificate, as aforesaid, he shall be punished by a
fine not exceeding fifty dollars. In case the deceased \/is a soldier or a sailor who^rved in the war of the rebellion, the physician shall give
both the primary and the secondary or immediate cause of death as nearly as he'*can state the same. If a physician refuses or neglects to
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or
town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case
may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the
purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board
agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shal
if requested, make the same When such satisfactory statement and certificate are delivered to the board of health or to its agent, the boa
or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is
given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty
dollars.
-71
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased*
Date and Place of Death , -
Disease or Cause of Death, -
Jiio. XftdC+y
Age, ' U?
died at
of
O^u, , £jfi /8?J.
Duration of _ Sickness &
I certify that the above is true, to the best of my knowledge and belief.
and Reside7ice of Certf^ing Physician , obi
In.
Date of Certificate,
*Or Bex of Infant (not named).
[Acts of 1888, Chapter 306.]
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
, * ' 1 O o r V *-*^*«-*^ tv a kVgldUUUUU V- v_ 1 LCUU
acts relating to deceased persons, is amended so as to read as follows: — Section 3. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : Section 3. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [. Approved May 4, 1888.
CO «5 <ffi (4
‘f • f \
[Public Statutes, Chapter 32, as amended by’ Acts of 18SS, Chapter 306 ; Acts of iSSg, Chapter 224^
Section t A physician who has {attended a person dMng his last illness shall, when requested, forthwith furnish for registration, a
certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died the duration of
his last sickness and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished oy a
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give
both the primary0 and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he re»i es.
Section c No undertaker, sextoi or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do ffom the board of health or its duly appointed agent, or, if there is no board of health in such city or
town from the city or town clerk. No puch permit shall be issued until there has been delivered to such board, or agent or clerk as the case
mav be a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
of the attending physician, if any, asreqfiredby section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there »
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reason,, early enough for the
purpose the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said uoard,
Unt or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall
lTreauested make the same. When sufch satisfactory statement and certificate are delivered to the board of health or to its agent, the board
or a-ent shill forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so
ffiven shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty
dollars.
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased*
Date and Place of Death, -
disease or Cause of Death, -
I certify that the above is true, to the best of my knowledge and belief.
ame and Residence of Certifying Physician, ....
*0r Sex of Infant (not named).
Date of Certificate,
[May, 1888.]
[Arts of 1888, Chapter jo6.]
Section i Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows : - J. A physician who has attended a person during h.s
L illne shaVXn requested forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the decetd,’ his age, die dise’ase of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars. .
S™ 2 Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate rs furn shed is
amendeYso as to read as follows : - Section 5 No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body If a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or if there 1 is n
loir A of health in s!ch city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board or a-ent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
an? Lilted together vdti the certificate of the attending physician, if any, as required by section three of this chapter, or in then _ hereof
a certificate^ t hSfer provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any phyMaaii ^emp oye . y
town for the purpose shall upon request of said board, agent or clerk, make such certificate as is required of the attending ptysi >
section shall be punished by a fine not exceeding fifty dollars. [. Approved May 4, 18SS.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
1 1. Name of Father
* If a Married Woman or Widow. } If a Soldier who served in the War of the Rebellion,
t If other than White. (SI.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. J
Plate, lid. September, 1892. — 5, out).
\_Public Statutes , Chapter 33, as amended by Acts of /SSS, Chapter 306 ; Acts of i88g, Chapter 324 .]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a
certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of
his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give
both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or
town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case
may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for t
purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said boar
agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall
if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board
or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so
given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty
dollars.
PHYSICIAN’S CERTIFICATE.
Lt. /OtPruddS^ Ase’ - ••
, ' ,. .
died at. ZJ ^ y tM* <J±jL l.Z Z i&9 3 ■
/.fz^zA./Z-
of .
vie and Age of Deceased,*
r te and Place of Death, t -
sense or Cause of Death, -
{Primary and Secondary. )\
fpation of Sickness,
f / certify that the above is true , to the best of m» knowledge and belief n / *
[ „ r. -• / X^-- ZZ ZZacAP
pat tire and Residence of Certifying Physician, f
Date of Certificate,
•^A
i8q
)r Sex of Infant (not named), ll stillborn so state.
t If child died immediately after birth so state. % If a soldier or sailor who served in the War of the Rebellion .
Plate. Ed. May, 1893. — 5,000.
^srai^sa£^!!?^f^« ^”«ssr*5s^s*^^: s^.o4?ss?,,,^ “r ^ssrsffissts
-S~i|p 5S5aH^^S*lE^^
sSfe^5rrtrs“;:ss
physician employed by ad tv or towiffor tl reasons- early enough for the3 purpose the Chairman of^tfp i*® atte“d'u» Physician
* If a Married Woman or Widow. J If a Soldier who served in the War of th^tebellion.
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. J
Plate. Ed. September, 1892.-0,000.
[• Public Statutes , Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of i88g, Chapter 224.^
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a
certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration ol
his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give
both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person1
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or:
town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case:
may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate 1
of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the
purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board,,
agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall*
if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board
or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so
given shall thereafter furnish for registration any other information's to The deceased ^or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty
dollars.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
♦It is very desirable to be informed of the duration of the disease.
UNDERTAKER’S RETURN— Boston.
Maiden named
Married, single, or widow of wife of
Age^ years, ^..mos.,^.#ays. Residence,
n l / street and\ S/s/v. s
ce of death (*£*,£*),
'lace of birth,
Mime of father
ward
l i^/^O Occupation,
^^fc^/Alaiden name of mother,
irthplace of father^^^ .*/£. r^<C. J$?Birthplace of mother ^Tr
T„ .4. s/ry^
Place of interment, t /K ^ v - —
* If a married woman or a widow. t Give the name of the burial ground.
Signature of Undertaker :
T
To the Clerk of the Town in which the Death occurred,
* I f a Married Woman or Widow. J If a Soldier who served in the War of the Rebellion.
1 If other than While. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 1R9S. — 5,000.
[A****** CKa„ter32, a, <,»»« Act, of 1838, <*0*800; AasoflSSS, Carter 224; AC.CJ '1893,
Sect.os 3. A physician who ha, attended a person ‘'"™S riS
tration, a certificate stating, to the best ot Ins d ^ and a physician who has attended at a birth of a child dyin;
died, the duration of Ins last sickness, and the date of Ins dec , , P forthwith furnish for registration a certificate
immediately thereafter, or at the birth of : « n stillborn child ,sk bom dc;ul“ If a physician neg
stating to the best oi his knowledge and belief the -act , statement therein he shall be punished by a fine not exceedm:
lects or refuses to make a certificate as aforesaid, or makes a f.. . - the rebellion, the physician shall give bot
fifty dollars. In case the deceased was a soldier or a s* or w served n the ; physPicfan refuses or neglect
the primary and the secondary or immediate cause of dc- ‘ A dollars for the use of the town in which he resides,
to make such certificate he shall forfeit to the treasurer tl e ™ , ‘ t remove therefrom a human body until li
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove ^ ^ bQard Qf healtb in such cit
has received a permit so to do from the board of u tl” bas beeu delivered to such board, or agent o
or town, from the city or town clerk. No such permit shall be issued until there. has .been a .e, ^ to be returned an
clerk, as the case maybe, a satisfactory written statement conta o jeouired^y section three of this chapter, or in lie
recorded, together with the certificate of the attendin0 physician, ‘X’--1 f tbe certificate of the attending physic ia
thereof a certificate as hereinafter provided. If there is no attend., g phj s c an, " 11 “«a^"aQ of the board of health or an
cannot be obtained, for good and sufficient reasons, , early < enough foi 1 ?db^.d a„cnt or cierk, make such certificate as i
physician employed by a city or town for the purpose shall, up q ‘ , exarnincr shall, if requested, make the same
required of the attending physician ; and in case of death by vlole^eb^®.d“ f h altb “ t0 its a„ent, the board or agent shall fort!
When such satisfactory statement and certificate are del vei ed to the permit is so give
with countersign and transmit the same to the clerk ?r^»lht^aaf the’deceased' or to the manner and cause of the death, as tli
S o?^^ provisions of this section shall be punished by a fine not exceec
ing fifty dollars.
If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and secondary
cause of death. See Chap. 224, Acts of 1889.
PHYSICIAN’S CERTIFICATE.
1-
flame and Age of Deceased *
• ’//.
Dale and Place of Death, -
died at
Disease or Cause of Death, -
of l
lie Age,
Cfu£ /
JjdlD MpVru
Duration of Sickness
/
:
I certify that the above is true , to the best of my knowledge and belief.
aitie a fid Residefice of Certifying Physician , .
Date of Certificate,
’Iff
[May, 1888.]
*0r Sex of Infant (not named),
[Arts of j 888 , Chapter po6.~\
Section i Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows : - Section j. A physician who has attended a person dunng h,
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief thence
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. ph>sicia g
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars d
Section 2 Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished,
amended as to read as follows : - Section ]. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or 1 ere 1
tatVof h“.^ city o, town, from the ci.y'o, town clack. No ,uch pencil .kail
board or anent or clerk as the case may be, a satisfactory written statement containing the facts required b) this chapter to be retu
and recorded together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu . her
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or gi
section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4 , 1888.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred
SECTION 3- A ,%>»»» who h» omnileS M>™ *“•». . de«,„tl,'Ws ™ ,he disease of which he died, the duration of
„ physician who has attended a person dunn0 » d ’hi the di3ease of which he died, the duration of
certificate stating, to the best of his knowledge and behd, d e ^thc^ ^ ^ & as aforcsaid, be shall be punished by a
bis last sickness, and the date of his decease. I fa ™ » sailor ^ ^ -n the vvar of the rebellion, the physician shall give
fine not exceeding fifty dollars. In case the dec used wa ^ ^ ^ he can state the saine. If a physician refuses or neglects to
both the primary and the secondary or lmmcc la ^ ^ tgn dollars for the use of the town in which he resides.
make such certificate he shall forfeit to the teas ^ shaU b in a city 0r town or remove therefrom the body of a deceased person
Section 5. No undertaker, sexton or o ier 1 Qr its dul appointed agent, or, if there is no board of health in such city or
until he has received a permit so to do from t e oan ^ until there has been delivered to such board, or agent or clerk as the case
town, from the city or town clerk. No sue P<-™ uired by this chapter to be returned and recorded, together with the certifica e
may be,* satisfactory written statement containing *efactsreq, ‘ ^ ^ thereof a certificate as hereinafter provided. If there is
of the attending physician, if any, as require, >\ sec 10 cannot be obtained, for good and sufficient reasons, early enough for the
no attending physician, or if the certificate of the at ed b a city or town for the purpose shall, upon request of said board
purpose, the chairman of the board of health or any phy» P ' ^ . and in case of death by violence the medical examiner shall
agent or clerk, make such certificate as is 'required ^of J certificate are delivered to the board of health or to its agent, the board
if requested, make the same. When such satisfactory state d ^ ^ for reg;stration. The person to whom the permit is so
or agent shall forthwith countersign and transmi « : sai ^ ^ tQ ^ deceased Qr to the manner and cause of the death, as the
s: zagrz ^ — °f tws section shai1 be punished by a fine not g y
dollars.
If the deceased was a soldier or sailor who served in the war of the rebellion, give both the primary and secondary
cause of death. See Chap. 224, Acts of 1889.
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased*
Date and Place of Death , -
Disease or Cause of Death, -
Q./r££iLt^.. Age, d *V''
=(7fj •'k — <n‘ *
died at / / CS/}yiyyiAAsJ'~>. ~ / ..^dAAcUAAd. NiAjALf. S .
of )fMymtaDfH,Mkural!on ¥ Siehtesl wyetfa
Name and Residence of Certifying Physician,
1 certify that the above is true, to the best of my knowledge and belief.
idem , Jfa (priz/ess ji~ ) / , y Lyi ]p
Date of Certificate,
♦Or Sex of Infant (not named).
j8 f $
[Ed. — 10 M — Oct. 9, 1889.]
[May, 1888.]
SECTION I. Section three of chapter thirty-two of the Tuhlic Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to rea 1 as follows: — Section j. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certifcate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : - — Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
:
■■
* |fa Married Woman or Widow. J If a Soldier who served m ihe War of ftie llebellion.
i l t othei tbaii \\ liitc. (M.) Mulatto. (I.) Indian. If of other llaccs, specify what.
[Be very particular to fill all Blanks.]
Hate. Ed. September, 1892. — 5,000.
- "Mh' ^o.,
S^KK. 3. A p*™» '"'» '” -«** V3S ri.“.r«4 ’» age, i di.ea.a of which I. died, «. *»*» .
certificate stating, to the best of his hno^le ge anc ’ or refuses to make a certificate, as aforesaid, he shall be punished »/
his last sickness, and the date of his decease. If a physic , who served in the war of the rebellion, the physician shall giv, fc
fine not exceeding fifty dollars. In case the decea^ was a^eror ^ ^ ^ ^ ^ ^ If a physician refuses or neglects
both the primary and the secondary or lmme ia e “ donars for the use of the town in which he resides,
make such certificate he shall forfeit to the treasurer the sum of ^ ^ ^ or town or remove therefrom the body of a deceased perse! *
Section 5. No undertaker, sexton or other p ' duly appointed agent, or, if there is no board of health in such city ■
until he has received a permit so to do from the board of he ^ ^ ^ been delivered t0 such board, or agent or clerks as the ca .
town, from the city or town clerk. No such 1“ ^ d , this chapter to be returned and recorded, together with the certifica
a satisfactory written statement containing he - —
may be
of the attending physician, if any
tement containing the facts re^re. - ^ ^ thereof a certificate as hereinafter provided. If there
, as required by section three of this chpter or in leu early en0ttgh for t
ee 01 this cr13.ptv.rj ur m * t . i f of f
purpose, the chairman of the board of health °r^ -f nftpmH J Dhvsician; and in case of death by violence the medical examiner sha
1th or any physician employed oy a u. r r the medical examiner sha
agent or clerk, make such certificate as is required of the attending physiaan^ an m ^ case o of health or t0 its agent, the boa
^requested, make the same. When such satisfactory statement and certificate are del. ^ nprson t<} whom the permit is
if requested, make the same. When such satisfactory sta *“lerk Qr registrar for registration. The person to whom the permit is
or agent shall forthwith countersign and transmit e sa < {o ^ deceased or to the manner and cause of the death, as t
given shall thereafter furnish for registration any o “ i)ro‘visions of this section shall be punished by a fine not exceeding fi
clerk or registrar may require,
dollars.
Any person violating any
[Acts of 1888, Chapter J06.]
Section I. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows: — Section 3. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 3. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board <7f health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
(Disease or Cause of Death,
\ (Primary anil Secondary}, J
fi. 'Duration of Sickness, .
\_Public Statutes , Chapter 33, as amended by Acts 0/ /SSS, Chapter 306 ; Acts of /SSg, Chapter 334.]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, s
certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration a
his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall gi
both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town m which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased pc
until he has received a permit so to do from the board of health or its duly appointed agent, or, if '.here is no board of health in such cn_
town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the ca»i
may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the
purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board,
agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall,
if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board
cr agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so
given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding fifty
dollars.
r
y /
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased*
me and Place of Death, - I died at
t m
'rWU
s*
hsease or Cause of Death, - of ‘ -4 ? IdstP'PL t ^ Duration of Sickness
/ cetlify that the above is true, to the best of my knowledge and belief.
Tame and Residence of Certify nig Physician, ffn frT^f 7f~tuse// <c\.
Date of Certificate, (Cffiy / (y
fifM
♦Or Bex of Infant (not named).
[Acts of /8SS, Chapter J0<5.]
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows: — Section j. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section p. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to w'hom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [ Approved j\[ay 4, 1S88.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
* I f a Married Woman or Widow. J If n Soldier who served in the War of the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. September, 1892.— a, 000.
/
//
”C
, c amended bv Acts of iSSS, Chapter 306 ; Acts of iSSg, Chapter 224 .]
\_PubUc Statutes, Chapter 32, . ulness shall when requested, forthwith furnish for registration, a
SECTION 3- A physician who has attendee ^P«son ‘ ^ ^ deceasedf his age, the disease of which he died, the duration of ,
certificate stating, to the best of his knowle g J neglectS or refuses to make a certificate, as aforesaid, he shall be punished by a
his last sickness, and the date of his decease If a physicia * in the war of the rebellion, the physician shall give
fine not exceeding fifty dollars. In case the as be can state the same. If a physician refuses or neglects to
both the primary and the secondary or immedia dol,ars for the use of tbe town in which he resides.
make such certificate he shall forfeit to the treasurer a city or town or remove therefrom the body of a deceased person
SECTION 5- No undertaker, sexton or other person sha 11 7 ^ J d agent> or> if there is no board of health in such city or
until he has received a permit so to do from the boar : o t^re has been delivered to such board, or agent or clerk, as the case
town, from the city or town clerk. No such by this chapter to be returned and recorded, together with the certificate
may be, a satisfactory written statement contaimn0 ^ ^ or in Ueu thereof a certificate as hereinafter provided. If there is
of the attending physician, if any, as required y sec 10 . cannot be obtained, for good and sufficient reasons, early enough for the
no attending physician, or if the certificate of the • mg by & dty Qr town for the purpose shall, upon request of said board
purpose, the chairman of the board of heal V V 7 P Y y and in case of death by violence the medical examiner shal ,
agent or clerk, make such certificate as ,s required of the atten g P to the board of health or to its agent, the boar,
/requested, make the same. When such registrar for registration. The person to whom the permit
or agent shall forthwith countersign and transmit the same ^ ^ or tQ tbe manner and cause of the death, a-
^ of the provisions of this section shall be punished by a fine not exceedn |
dollars. * _ sf.C
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased,*
Date and Place of Death, -
Disease or Cause of Death, -
gADAAtNlr
jk w /y?u
3-
. Duration of Sickness /
firaj / /u_, dN/ia iy
I certify that the above is true, to the best of my knowledge and belief.
bu
Physician, df ^ ^
^ Date of Certificate,- f let? I 3 '
a'f Jc and Residence of Certifying
8D
' • 3*
2^C
ispj
[May, 1888.]
*Or Sex of Infant (not named).
[Acts of 1888, Chapter J06.]
Section I. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows: — Section 3. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 3. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No sujh permit shall be issued until there has been delivered to such
hoard, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4, 1888.
RETURN OFX DEATH.
To the Clerk of the Town in which the Death occurred,
* If a Married Woman or Widow. J If a Soldier who served in the War of the Rebellion.
1 If other than While. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. J
Plate. Ed. September, 1892. — 5,000.
IPublic Statutes, Chapter 32, as amended by Acts of 1888, Chapter 30b ; Acts of 1889, Chapter 224.-]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a
certificate stat ng, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died the durahon of
his last sickness ^nd the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician sha gn e
tal “he prim,,, a., 1, he «e=onda,y o, immediate cause of death a, .early as he ca. state the same. » "
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in nhich he res' les’
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city o,
t , , • . t lerk No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case.
^yLe ^"satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificat|
of the attending physician, if any, as require!} by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. I ^ there is
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the
purpose the chairman of the board of health or any physician employed by a city or town for the purpose shad, upon request of said board
Lent or clerk make such certificate as is required of the attending physician; and m case of death by violence the medical examiner sh j
if requested make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board
or a vent shall forthwith countersign and transmit the same to the clerk or registrar for registration. 1 he person to whom the ^perm.t is , so
given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as
Lrk or registrar may require. Any person violating any of the provisions of this section shall be punished by a tme not exceeding . y
dollars.
PHYSICIAN’S CERTIFICATE
Vatne and Age of Deceased*
Od l e and Place of Death, -
Oisease or Cause of Death, -
I certify that the above is true, to the best of my knowledge and belief.
*0r Sex of Infant (not named).
[May, 1888.]
[Acts of 1 888, Chapter 306. ~\
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows 1- — Section 3. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, , a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 3. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4 , 1888.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
CO
CO
* 1 f a Married Woman or Widow. } If a Soldier who served in the War of the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to till all Blanks.]
Plate. Ed. September, 1S92. — 5.000.
,, hv Acts of jSSS, Chapter jo6 ; Acts of iSSg, Chapter 224.']
[ Public Statutes. Chapter 32. as amended by A f ^ ^ ^ requestedi forthwith furnish for registration, a
agent or clerk, make Uisfactory statement and certificate are dell whom the permit is so
dollars- .^*vzy&&r ' 'y"
PHYSICIAN’S CERTIFICATE.
)
[Ac/s of iSSS, Chapter jod.]
Section i . Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows : - Section 3. A physician who has attended a person during his
last illness shall when requested, forthwith burnish for registration, a certificate stating, to the best of his knowledge and belief, the
“eS his age, L di.ehe of which he .lied, ihe dorado,, of his las. sickness, and , he date of h,s decease. If a phys.c.n n.g-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty do ars. . , . , , •
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furm ,
amended so as to read as follows : — Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent or if there is no
board of heaUh in sich city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be return
and rto ded together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certlf.clte as ^hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any ^
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as ,s required of the attending physician, and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to' the clerk or gi
?or Z Station. The person to whom the permit is so given shall thereafter furnish for registration any other u.formation as o tne d
ceased or to the manner and cause of the death, as the clerk or regis-rar may require Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, iSSS.
RETURN OF A DEATH.
To the Clerk of the TowlfThi which the Death occurred.
0. Place of Death
* ] f a Married Woman or Widow. J I f a Soldier who sctrCnid in the War ol the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. September, 1892. — 5.900.
inu, aw** <****■ “ f» "ifr*'!on’ a
section 3. A[ - -£s,"
certificate slating, to tfie best o us ^ If a iifivsician neglects or refuses to ma .e a cer ■ tebellion, the physician shall give
rr- r.r tir- rr,
Section 5- No oneler.aker, seston or othen* ^ ^ ^ (Wy appointed agent, or, f th'"'- “ „ clett, „, the ease
until he has received a permit so to < o ro be lssaed until there has been de t\ ere< 0 ’ together with the certificate
town, from the city or town clerk. Iso facts required hy this chapter to be returned and rec provided. If there is
may be, a satiifaC^^ section three of this chapter or m heji it mo a sufficient reasons, early enough for the
of the attending physician, it any, t attending physician cannot be obtai-ea, g ,. request of siul uoas#,
no attending phy.tcian, or * «- =« W * <* “ — * TlZ o”nt 1 e m dial «— **
V5Z shin foa-thwith countersign
given shall thereafter furnish for ^ ^ vlolating any of the provisions/of this jecto
clerk or registrar may require. * > I tfsj
dollars. '
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased *
Dale and Place of Death, -
died at
Disease on Cause of Dteatli, - of .e^^f ePjt e.
Age, - ft S ^c{/L
1 88 (J. £
Duration of Sickness
I certify that the above is true, to the best of my knowledge and belief.
Name and Residence of Certifying Physician , nr * f.
Date of Certificate,
1 88
*Or Sex of Infant (not named).
[May, 1888.]
[Acts of 1888, Chapter 306 .]
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows: — Section 3. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 3. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4, 1888.
RETTJ H N OF DEATH.
To the Clerk of the Towjr'm which the Death occuiTed.
* I f :i Married Woman or Widow, t If a Soldier who served in the War of the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. J
Plate. Ed. September, 1892. — 5,000.
- J^P
ryp('nAX$'~? ireT^op
[ Public Statutes, Chapter J2, as amended by Acts oj tSSS, Chapter pots ; Acts of iSSp, Citapter asp."]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, :
certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration ot
his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a
fine not exceeding fifty dollars. Ip case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give
both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased persoi
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such cite
town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the c
may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certifi ■
of the attending physician, if any, 4s required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If the •<
no attending physician, or if the ceftificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough ft
purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said bo.
agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner sh
if requested, make the same. Whbn such satisfactory statement and certificate are delivered to tile board of health or to its agent, the bo
or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit i-
given shall thereafter furnish for fegistration any other information as to the deceased or to the manner and cause of the death, as
clerk or registrar may require. Any person violating anvofUie- provisions of this section shall be punished by a fine not exceeding In ■
nnfQ) VJ)
' ti±n f
yw 0 f
PHYSICIAN’S CERTIFICATE.
[Arts of 1 8SS , Chapter Jo6.~\
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows t —Section 3. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 3. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. Nd such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, / S8S .
[fill out with ink].
ate of Death, . . .
Name,
(Maiden Name), . .
(Name of Husband),
Sex, and whether single,
Married, or Widowed,
Color, ....
Age,
Residence, . . .
Occupation, . .
Place of Birth, .
Name of Father,
Name of Mother,
(Maiden Name).
0.</ ; /J~S3
Birthplace of Father, .
Birthplace of Mother,
Signature of Undertaker or other person makini
/J
-V
UndcHokv,-.
*’3
iT
PHYSICIAN’S CERTIFICATE.
Name of Deceased ',
Date and Place of Death ,
Disease or Cause of Death ,
Duration of Sickness,
I certify the above is true, to the best of my knowledge and belie
Date of Certificate,
- i89 3
Physician.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Same and age of decease i
Date and place of a (3
— *-*-
Disease or cause of aeath :
Age .
Duration of disease :*
Name and residence |
of physician. J
<£r T.
I certify that the above is true, to the lest of my knowledge and belief ,
\yC(r^>
M. D.
•It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting; of permits for burial, as follows: — Saturdays, 9 A. M. till
2 P.M.; Sundays, 10 A. M. till 12 M.; Holidays, from lO A. M. till 12 M.; other days, from 9 A.M. till 5 P. IVf .
UNDERTAKER’S RETURN.— Bestow
do ' 189 <3 . Name,
Date of deaf
Maiden name*
^kmdeeU- single, or widow of
Color/?^* Age, /years, ^ mos.,^ days. Residence,
Place of death (6lnTmb“nrdJ[? .
Place of birth,
Q^Xq - ^
Ses,.^,
wife— of\
Name of father, py/sw*
ward O
Occupation, < —
Maiden name of nuitTrrfi^p ^Ho1
cpL
3r,
Birthplace of fat Birthpjjicc of moth.£'/^4~*^^'
Place of interment,!
* If a married woman or a widow. t Give the name of the burial ground.
£77?
Signature of Undertaker :
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
(
.Disease or Cause of Death
\ (Primary and Secondary), {
G. Duration of Sickness,
\_Public Statutes, Chapter 32, as amended by Acts of /SSS, Chapter 30b ; Acts of /SSg, Chapter 224."]
Section * A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a
certificate statin-, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of
his last sickness, "and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give
both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to
nmke such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section e No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or
town from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case
mav be a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for e
purpose the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board,
a-ent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall
i /"requested make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board
or a-ent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so
given shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as tin
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceeding
dollars. /
jName and Age of Deceased ,*
'Date and Place of Death, f -
Disease or Cause of Death, -
(Primary and Secondary.) f
Duration of Sickness,
I certify that the above is true, Jo the best of my knowledge an^fbelief.
Signature and Residence of Certifying Physician
9
Yfli
^I‘t (llot If stillborn so state. | If child died immediately after birth so state// } If a solder or sailor who served in the War of the Rebellion
' Plate. Ed. May, 1893. — 5,000.
[Public Statutes, Chapter 32 as amended by Acts oj 1SS8, Chapter 30G ; Ads of 1889, Chapter 224; Acts of 1893, Chapter 263.']
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which lie
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
to make such certificate lie shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is
required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same.
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall fortli-
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
ing fifty dollars.
OD
M
P
c3
PQ
o
o
©
o'
03
Pi
>»
U :
0 ■
>
Q
w
X Public Statute*, Chapter 32, as amended by Acts of /SSS, Chapter 30b; Acts of iSSg, Chapter «*.]
/ , . . , has attLed a person during his last illness shall, when requested, forthwith furnish for registration, a
SECTION 3- A physician who has alien. I ,w«.«d. his a<?e. the disease of which he died, the duration of
l“ , au ' w the name of the deceased, his age, the disease of which he died, the duration of
certificate stating, to the best of his know e ge ant net,lects or refUses to make a certificate, as aforesaid, he shall be punished by a
his last sickness, and the date of his decease. P • j? -i who served ;n the war of the rebellion, the physician shall give
fine not exceeding fifty dollars. In case the ^ as nearly as he can state the same. If a physician refuses or neglects to
both the primary and the secondary or immediate ca^ of de‘ * as ^ ^ ^ ^ ^ ^ ;n which he resides.
make such certificate he shall forfeit to the treasurer le s therefrom the body of a deceased person
Section 5. No undertake,, sexton o, brnym * ^ ^ u „„ bo„d ot health In such city o,
until he ha. received a permit so to do ,r“‘ 1 ' mta ,Le ha. been delivered to such board, or agent or clerk, as the case
town, from the city or town clerk, ho such pe returned and recorded, together with the certificate
may be, a satisfactory written statement con taming h f * ^ ^ thereof a certificate as hereinafter provided. If there k
of the attending physician, if any, as require >> sec < vsician cannot be obtained, for good and sufficient reasons, early enough for th
no attending physician or ly physidan employed by a city or town for the purpose shall, upon request of said boarf
purpose, the chairman of the board of heatth 1 - di h ysician ; and in case of death by violence the medical examiner shah,
agent or clerk, make such Cert^^“Jhr2Wact statement and certificate are delivered to the board of health or to its agent, the boar..
dollars. . (
.1/
PHYSICIAN’S CERTIFICATE.
[Acts of 1888, Chapter jo6 .]
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows : — Section j. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid^he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section j. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4, 1888.
Duration of disease
1 certify that the above is true^o the best of my knowledge and belief \
Name and residence 1
j . /fTr.tZ-.?..
/
of physician.
M. D.
♦It is very desirable to be informed of the duration of the disease.
The office of the Board of Health will be open for the granting of permits for burial, as follows: — Saturdays, 9 A. M. till
2 P. >1.; Sundays, 10 A. M. till 12 M.; Holidays, from lO A. M. till 12 M.; other days, from 9 A.M. till 5 P. M.
UNDERTAKER’S RETURN./
;^</.-.i89 J. Name,
^mos., C^day s. Residence, O * A j' lliM..
Married, single, o
*y) 23v!
Color, /y Age,^^ears^mos.,r .-..aays.
Place of death ■■***&
Place of birth, (Aa^lAbw:^. Occupation, ,4&£qa^Q^.
Name of father, . AyV.. j Maiden name of mother, CLLxY. Y. . . . /o T
fi/J Birthplace of mother,^. .
/ Qu. Y4 . .
Birthplace of father,
Place of interment, t
* If a married woman or a widow. t Clive the name of I e burial gro
Sl/hr:.
Signature of Undertaker :
* ] f a Married Woman or Widow. f If a Soldier who served in the War of the Rebellion.
( if other than White. (M.) Mulatto. (I.) Indian. If of other Races, Specify what.
[Be very particular to fill all Blanks. J
[. Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224 .]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a
certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of
his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punished by a
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give
both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city or
town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or clerk, as the case
may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
of the attending physician, if any, as required by section three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is
no attending physician, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, early enough for the
purpose, the chairman of the board of health or any physician employed by a city or town for the purpose shall, upon request of said board,
agent or clerk, make such certificate as is required of the attending physician ; and in case of death by violence the medical examiner shall,
if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board,
cr agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so
given shall thereafter furnish for registration any other information a^to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this sectiop-^Jaall Ire punished by a fine not exceeding fifty
dollars. 1 ~ -
•/
0
PHYSICIAN’S CERTIFICATE.
[Arts of 1888, Chapter J06.]
Section I. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows:- — Section j. A physician who his attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4 , 1888.
PHYSICIAN’S CERTIFICATE OF THE CAUSE OF DEATH.
Somerville,
Xame of Deceased, ^ ^
Place and Bate of Death: Died at (
iso 3
Disease or Cause of Death
/If a Soldier who served Id the War of the Rebellion, both \
^thc primary and secondary causes of death must be given./
Duration of Disease ,t
Age, S&Yrs., Mos., Days
, £^189 3
U1 UCOlll UIUOI UO giv till*/ . .
fZA-v^A: iuj/Czr
1 certify that the above is true, to the best of my knowledge and belief,
Signature of Physician,
Residence,
Date of
Death .
UNJJUK'I'Akkkk kkiUKN.
}S. ' /„// A.-
1 89 $. Mame,^f J... ■ ..r:^c. ' 1 ‘
yMame of j*
Husband, j rr. :
Maiden Maine, *
Sex, C Color, t / }} Single, Married Widowed,
Age, (eg Yrs., Mos., — - Days. Residence, glA
^ . (jno.j istreet.; f (lown or City and State.)
Place of Death (SNumbe"d), thA <Aj - Ward
Occupation,
Maine of
Father.
Birthplace
of Father.
A*
Place of Birth,
Maiden Marne ) 7
of Mother. j ,
Birthplace
Place of Interment,
l ^^Jjl life
V4Ar c .£ c //<*
((/emttery.) (1
‘Ot x'Of. of Mother. 1 ^C^aJL f>'CH*.'6'C.
*t ^
(Town or City and State.)
* If a Married woman or a Widow. t If other than White, (A) African, (M) Mulatto, (I) Indian; If of other races, specify what.
Signature of Undertaker,
Residence, 0 ^ —
(No.)
(Street.)
(Town or City.)
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred
* 1 f a Married Woman or Widow, t If a Soldier who served in tile War of the Rebellion.
I If other than White. (M.) Mulatto. (I.) Indian. If of olliei' Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. September, 1892.— o,0oi).
[ Public Statutes , Chapter 32, as amended by Acts of sSSS, Chapter 306 ; Acts of /.STi}), Chapter 22p.]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for registration, a
certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he died, the duration of
his last sickness, and the date of his decease.' If a physician neglects or refuses to make a certificate, as aforesaid, he shall be nunished by a
fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of tie rebellion, the physician shall give
both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to
make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in whS:h he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the body of a deceased person
until he has received a permit so to do from tjhe board of health or its duly appointed agent, or, if there ^ no board of health in such city or
town, from the city or town clerk. No such 'permit shall be issued until there has been delivered to such ooard, or agent or clerk, as the case
may be, a satisfactory written statement containing the facts required by this chapter to be returned and recorded, together with the certificate
of the attending physician, if any, asrequiredby section three of this chapter, or in lieu thereof a certificate's hereinafter provided. If there is
no attending physician, or if the certificate oflhe attending physician cannot be obtained, for good and sufficient reasons, early enough for the
purpose, the chairman of the board of healtl^ or any physician employed by a city or town for the purpose shall, upon request of said board,
agent or clerk, make such certificate as is required of the attending physician ; and in case of death by Violence the medical examiner shall,
if requested, make the same. When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board
or agent shall forthwith countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so
given shall thereafter furnish for registration any other information as to the deceased or to the mar 1
clerk or registrar may require. Any person violating any of the provisions of this section shall be pm
dollars. j ^
ner and cause of the death, as the
■fished by a fine not exceeding fifty
PHYSICIAN’S CERTIFICATE.
* Or Sex of Infant (not named). If stillborn so state. f If child died immediately after birth so state. f If a soldituwr sailor who served in the War of t lie Rebellion-
Plate. Ed. May, 1893. — 5,000.
[Public Statutes, Chapter 32, as amended by Ads of IS SS, Chapter 306; Acts of 1SS9, Chapter 224 ; Acts of 1893, Chapter 263. J
Section 3 A physician who has attended a person during his last illness shall, when requested,
t 'HM) iiinrv and the secondary or immediate cause of death as nearly as lie can state the same. If a physician refuses or ncg
thereof a certificate as hereinafter provided. If there is no attending physician or .^e fe ‘tih°ate of the 5
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the J
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, _mahe sucn cert. fa
required of the attendin'* physician; and in case of death by violence the medical examiner shall, if requested, mane tne same
When such satisfactory” statement and certificate are delivered to the board of health or to its agent, t - h< ‘
with countersign and transmit the same to the clerk or registrar for registration The Person to whom l the pe mnt ^ »
w.-ai thereafter furnish for registration any other information as to the deceased or to the mannei and cause or tne aeatn, as wie
:SS or° regis trarmayrequi re. Any person violating any of the provisions of this section shall be punished by a fane not exceed-
ing fifty dollars.
' 1 1 ;i Married Woman or Widow. J li a Soldier wlio served in ilie War oi liie Uebeliiou.
( If other than White. (M.) Mulatto. (I.) Indian. If of other Knees, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 1893. — 5,000.
[Public Statutes, Chapter 32, as amended by Acts of 1S8S, Chapter 306; Acts of!8S9, Chapter 224; Acts oflS93, Chapter 263. ]
f Physician who has attended a person during his last illness shall, when requested, forthwith furnish for re<d«-
th’ A rtificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of whiclThe
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dvhnr
SST °[ “ *fe,blrth ft*” "‘I. Wh» reqSJted, Sh L r^Stll .
‘ f»to ^he best of bls knowledge and belief the fact that such a child died after birth or was born dead If a physician ne°-’
flftv SeTn°r I a ?ertlica,te as at°resaid, or makes a false statement therein, he shall be punished by a fine not exceedin'*
fty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion the physician shall <rive hr.th
|;°Prird ^ sf°ndaly « -immediate cause of death as nearly as he can state the . fame If a
Srmrw certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides. °
& pcriON o. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human borlv until ho
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such oitv
th°m the °lty °v5 t0Wn c-leik‘ No Sllch Permifc shall be issued until there has been delivered to such board or a-'ent or
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
lecorded, together with the certificate of the attending physician, if any, as required by section three of this chanter or in li n
cSno. bVoSS “ tbere ls, "» *“«■«“”« PMW». or If The of ISSj ph “ic£
nSior obtame<k for »ood and sufficient reasons, early enough for the purpose, the chairman of the board of health or anv
rermired ofThi0 a C1ity °r-tOWn fo.r.the PurPOse shall, upon request of said board, agent or clerk, make such certificate as is
When such ^ ia?rm" Ph/Slcian5 and 111 case of death by violence the medical examiner shall, if requested, make the same
With eon nr ®a*lsfact°17' statement and certificate are delivered to the board of health or to its agent, the board or a «ent shall forth ’
sTv rS a transmit the same to the clerk or registrar for registration. The person to whom the perm" tisso Sen
: furmsh for registration any other information as to the deceased or to the manner and cause of the death as the
ing fifty dollars m3y reqlUre- Any Persou violating any of the provisions of this section shall be punished by a fine not exceed-
[Acts of 1888, Chapter Jo6.~\
Section I. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows : — Section j. A physician who has attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section p. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if thwre is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [ Approved May 4, 1888.
Extract from Section 2 of Chapter1 306 of jjje Legislative Spfcf of 1888.
No undertaker, sexton, or other person shall bury in a city or town, or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly
appointed agent, or if there is no board of health in such city or town, from the city or town clerk.
No such permit shall be issued until there has been delivered to such board, or agent, or clerk, as the
case may be, a satisfactory written statement containing the facts required by this chapter to be re-
turned and recorded, together with the certificate of the attending physician, if any, as required by sec-
tion three of this chapter, or in lieu thereof a certificate as hereinafter provided. If there is no at-
tending physician, or if the certificate of the attending physician can not be obtained, for good and
sufficient reasons, early enough for the purpose, the chairman of the board of health, or any physician
employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such
certificate as is required of the attending physician ; and in case of death by violence, the medical
examiner shall, if requested, make the same. When such satisfactory statement and certificate are de-
livered to the board of health or its agent, the board or agent shall forthwith countersign and transmit
the same to the clerk or register for registration. The person to whom the permit is so given shall
thereafter furnish for registration any other information as to the deceased or to the manner and cause
of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars.
O' onimontur.'illh of ,i$ns6!ubusctfs.
* 1 f a Married Woman or Widow. } li a Soldier wlio served in the War of the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
(Be very particular to All all Blanks.]
Plate. Ed. May, 1893.-5,000.
A.
[Public Statutes, Chapter 32. as amended by Acts of 1SSS , Chapter 306 ; Acts of 1S89, Chapter 224; Acts of 1S93, Chapter 263.']
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
has received a permit so to do from the board of health or Its duly appointed agent, or, if there is no board of health in such city
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is
required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same.
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth-
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
ing fifty dollars.
PHYSICIAN'S CERTIFICATE
[Acts of 188S , Chapter 306. ]
facts delating to d attending physicians to furnish for reg{#tration certain
last illness shall, when requested forthwith furnish Jor rli tS n ~ rf ? 3' A PhyS,C,an Wh° haS attended a P*™" during his
of the deceased, his age, the disease rf ^hichTe did the Eon h" t , f ** °fhis k”ow1^ “d the name
iect~r° s a,;e a rmr-r^ he *Ln be decease- if a »**
amended so as to ^ °f a h™ *** until a proper certificate is furnished, is
body of a deceased person until he has received a permit so to dTfromTl eV^ bUry & C'ty °f .t0Wn °r remove therefrom the
board of health in such city or town, from the city or town clerh N 1 h ° ^ °r ^ dU'y aPPointed agent, °r, if there is no
board, or agent or clerk as the case Zv hP a T SUCh P6rmlt ShaU be isSUed untiI there has been delivered to such
and recorded, together with the certificate of the attend^ nh™" ‘ " ®tfatement containmg the facts required by this chapter to be returned
a certificate as hereinafter provLed.' If there * ^ thre? °f th» chaPter> « - lieu thereof
for good and sufficient reasons, early enough for the numose ?thp ~h ' ’ ' r 6 Certl lCate °f the attending physician can not be obtained,
town for the purpose shall, upon request of LTboard T? 1 t T t °f health °f Ph>'sician employed by a city or
in case of deathby violent Te meS 1%’ "tT* “ is of the Ending physician; and
delivered to the board of health or to its agent the board or 'n f ^ ^ *ame' ^hen sucb satisfactory statement and certificate are
for registration. The person “ "ho^h^mU^ 1^™^!^^ «» **»= «- •>>= clerk or register
ceased or to the manner and cause of the Heath s ° t t urntsh for registration any other information as to the de-
sertion shall he punished hy a fmeVi 1^1, mg' ^ * ** * <*
t I f jJtheTthaVwhTte11 J lf ;l,?°‘dTiei.who sei ve‘i "> Wo of the Rebellion,
oilier than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 1893. — 5,000.
[ Public Statutes, Chapter 32 as amended b
SSS, Chapter 306; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
stating to the best of his knowledge and belief the fact t c statement therein he shall be punished by a fine not exceeding
iects or refuses to make a certificate as af°resaid, or ma wlio served in the war of the rebellion, the physician shall give both
fifty dollars. In case the deceased was a soldier or a sai state tbe game_ jf a physician refuses or neglects
the primary and the secondary or immediate cause of di.ath a ? ^ tbe use Qf the town in which he resides,
to make such certificate he shall forfeit to the treasurer the su . t or rem0Ve therefrom a human body until he
Section 5. No undertaker, sexton or other Person shall bury m a ^or tm or icmove tjere ^ <>f in>such dty
has received a permit so to do from the boai d of healtti or its ffi iJSUed until there has been delivered to such board, or agent or
or town, from the city or town clerk. No such permit shall be g uired by this chapter to be returned and
clerk, as the case may be, a satisfactory written statement conta » iredqbv section three of this chapter, or in lieu
recorded, together with the certificate of the P^sician, l ^ 7- « or }f {[e certificate of the attending physician
thereof a certificate as hereinafter provided. If theie is no atten g p y ’ cbairman of the board of health or any
cannot be obtained, for good and sufficient reasons, eaily < e°ou»h fc ? s?dd board a<mnt or clerk, make such certificate as is
physician employed by a city or tovvn for the purpose shall, up 1 lne‘c|ical examiner shall, if requested, make the same.
required of the attending physician ; and in case of death by « e i mec tQ Ug a<rent’ the board or agent shall forth-
jps:
violating0 any1 of the^ro visions of this section shall be punished by a fine not exceed-
ing fifty dollars.
PHYSICIAN’S CERTIFICATE.
lame and Age of Deceased*
late and Place of Death, -
lisease or Cause of Death, -
died at SdJ
» V Age, oQ/dpiQ / ')?Vb 2d$ch
tflff ~j2 / y r> . - j f AIM.
A /? / ?_ / '
Duration of Sickness < CO'UXa^, *efLi. u. i^ct/ku ,f£^ ~
^ /^X-pLt 'X _<C52sl-^-
I certify 'that the above is true, to th'e best of my knowledge and belief.
a me and Residence of Certifying Physician, r^~i ^ CfLffAL. / O \dj HOlI. i~ $ 'i'
Date of Certificate, Qe^h^- 4- / i8^S-
<r ~
•Or Sex of Infant (not named).
[May, 1S88.]
[Acts of j88S, 'Chapter po6.~\
Section i. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain
facts relating to deceased persons, is amended so as to read as follows : — Section j. A physician^vho h is attended a person during his
last illness shall, when requested, forthwith furnish for registration, a certificate stating, to the best of his knowledge and belief, the name
of the deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his decease. If a physician neg-
lects or refuses to make a certificate, as aforesaid, he shall be punished by a fine not exceeding fifty dollars.
Section 2. Section five of said chapter, prohibiting the burial or removal of a human body until a proper certificate is furnished, is
amended so as to read as follows : — Section 3. No undertaker, sexton or other person shall bury in a city or town or remove therefrom the
body of a deceased person until he has received a permit so to do from the board of health or its duly appointed agent, or, if there is no
board of health in such city or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such
board, or agent or clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned
and recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu thereof
a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician can not be obtained,
for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any physician employed by a city or
town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is required of the attending physician; and
in case of death by violence the medical examiner shall, if requested, make the same. When such satisfactory statement and certificate are
delivered to the board of health or to its agent, the board or agent shall forthwith countersign and transmit the same to the clerk or register
for registration. The person to whom the permit is so given shall thereafter furnish for registration any other information as to the de-
ceased or to the manner and cause of the death, as the clerk or registrar may require. Any person violating any of the provisions of this
section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
Tame of Deceased,*
nge of Deceased,
Dale and Place of Death,
Disease or Cause of Death
Cambridge , vP 18
aged 3 years, ./ months y. / P days,
died al tfym-f, (J * / 3
fZy*
C^cJtjPe^r f
of
The Duration of Sickness was ftrey-r" 's'-c: ; ' y
Duration of Sickness,
I certify that the above is true, to the best of my knowledge and belief-
Name and Residence of Certifying Physician , ....
*Or Sex of Infant (not named)
A physician who has attended a person during his last illness sh 11 vhen requested, forthwith
furnish for registration, a certificate stating, to the best of his knowledge and belief, the name of the
deceased, his age, the disease of which he died, the duration of his last sickness, and the date of his
decease. If a physician neglects or refuses to make a certificate, as aforesaid, he shall be punishe d
by a fine not exceeding fifty dollars.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
10. Place of Birth,
•* If a Married Woman or Widow. | If a Soldier who served in the \Va i' of the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to till all Blanks. 1
Plate. Ed. May, 1883. — 5,000.
-<-T
[Public Statutes, Chapter 32, as amended by Acts of 18SS, Chapter 30G ; Acts of 18S9, Chapter 224; Acts of 1893, Chaptei 2 33. ]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his ^Se» the of ^ Mch e
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at biith of : a i c l
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration certificat
stating to the best of his knowledge and belief the fact that such a child died after birth or was bom dead. II a physic _ e
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he Shall be punished by a fine not exceedm.
frffy dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall bi\e bot.
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or nea
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in whidine resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body untU he
h^-eceived a permit so to do frota the board of health or its duly appointed agent, or, if there is no board of heaith in suchmt}
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such boaid, or a„eiit or
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as reqmred by section three of thm chapter, or m 1 cu
thereof a certificate as hereinafter! provided. If there is no attending physician, or if the certificate of the attending physician
cannot be obtained, for good andlsufficient reasons, early enough for the purpose, the chairman of the boaid h..ntp ^
physician employed by a city or tdwn for the purpose shall, upon request ot said board, agent or clerk, make ®"ch ™ l
required of the attending physiciai ; and in case of death by violence the medical examiner shall,
When such satisfactory statement and certificate are delivered to the board of health or to its agem, the board or a^ent slia -
with countersign and transmit the same to the clerk or registrar for registration. The person to whom tne permit is so gi e
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as t e
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished J
ing fifty dollars. j ■ l ( ,
PHYSICIAN’S CERTIFICATE.
9U
ne and Age of Deceased *
•©
; pa/e and Place of Death, t -
i
Disease or Cause of Death, -
{Primary and Secondary.) J
duration of Sickness ,
— ■ Age, C 6
died at (dSArL Zj2l.1L.i89 3 .
of m
khif Sn flet ^
Signature and Residence of Certifying Physician ,
f '
I certify that the /hove is true , to me best of my knowledge and belief.
^aie °f Ceri'ficate> - ^dftyvib^L vt/'A /l? " r8g S .
Or Sex of Infant (not named). If stillborn so state. f If child died immediately after birth so state. J. If a soldier or sailor who served in the War of the Rebellion .
Plate. Ed. May, 1893. — 5,000.
♦
\ Public. Statutes, Chapter 32, as amended by Acts of 1SSS, Chapter 30G ; Acts of 18S9, Chapter 224 ; Acts of 1S93, Chapter 2 G 3.]
Suction 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which lie
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent oi
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in liei
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physiciar
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or auj
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as h
required of the attending physician; and in case of death by violence the medical examiner shall, if requested, make the same
When such satisfactory statement and certificate are delivered to the board of health orto its agent, theboard or agent shall forth
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so give)
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as th
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed
ing fifty dollars.
RETURN of a death.
To the Clerk of the Town in which the Death occurre
/ Disease or Cause of Death
\ (Primary and Secondary),!
Duration of Sickness,
* If a Married Woman or Widow. J If a Soldier who served in the Warol ihe ItcbuiUou.
t If other than White, (M.) Mulatto. (X.) Indian. If of other kaces, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 1893.-5,000.
[Public Statutes, Chapter 32, as amended by Acts of 1S88, Chapter 306; Acts of 18S9, Chapter 224; Acts of 1S93, Chapter 263.]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration a certificate statin0' to the best of his knowledge and belief, the name of the deceased, his age, the disease of ^ Inch 1 c
died the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying
immediately thereafter or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
statin <>■ to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
th/primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or nealects
SSSSe shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5 No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human boc^ until he
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such ^ city
or town from thecitv or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or
clerk as the case maybe, a satisfactory written statement containing the facts required by this chapter to be returned and
£&&<&£ wKec.rtiOc.te J the attending physician if a, requl^d by »e three' K'S °ph siS
thereof a certificate as hereinafter provided. If there is no attending physician, or if tbe certificate of the ’ a,
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the cha rman *he J
physician employed by a city or town for the purpose shall, upon request of said board, agent °r f
remiired of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same.
When such satisfactory statement and certificate are delivered to the board of health or to^^e^-tbe board ora^e°tsh^11 f
witli countersign and transmit the same to the clerk or registrar for registration The Person to whom the perm t S
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed
ing fifty dollars.
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased*
Date and Place of Death f -
Disease or Cause of Death, -
(Primary and Secondary .)^
Duration of Sickness ,
lAAj
Age, d (p fJfQAAL>
died at / f OP Z dfiADstP'fo JqJ/ d 6* / 8 (? 3 .
of
I certify that the above is true , to the best of my knowledge and belief.
Signature and Residence of Certifying Physician £
Date of Certificate
* Ur Sex of Infant (not named). If stillborn so state.
I If child died immediately after birth so state. J If a soldier or sailor who served in the War of the Rebellion.
Plate. Ed. May, 1893. — 5,000.
rP“T Tzl::zci^:zss‘^‘::soa: **«**• ***“*> **«»»■ «~«*i
tration, a certificate stating, to the best of his knowledge and ' belief^the^am8 Wl,'Cn rc(luested> forthwith furnish for regis-
(hed, the duration of liis last sickness, and the date of his decc^i V 1 -°-f theIde9easedI his age, the disease of which he
immediately thereafter, or at the birth of a stillborn child sha^whe m, SThT T,ho.h,a® attende(l !lt a birth of a child dying
fthe be.st of bis knowledge and belief the fact that such - ch Id d mV ' * fl,ru!sh for registration a certificate,
lects or lefuses to make a certificate as aforesaid or miw o of * cl,c^ after birth or was born dead. If a physician ne^.
lifiy dollars. In case the deceased was a soldier or a sailor wlm^ w- ? therein, be shall be punished by a fine not exceed in%
the primary and the secondary or immediate cause of death ocn ^ec 1,1 ^be war of the rebellion, the physician shall °dve both
to make such certificate he shall forfeit ^ the same. If a physician refuses o'netdecS
Section 5. No undertaker, sexton or other person shVil hn ° *?f1,ars {or the use of tbe town in which he resides,
has received a permit so to do from the board of health or its dulv inti • ' ? ->r t0VV11 or remove therefrom a human body until lie
or town, from the city or town clerk X,rdV' appointed agent, or, if there is no board of health in such citv
clerk, as the case may he, a "“l'1 tJ!ere has bce" delivered to such board, or a" ent oV
recorded, together with the certificate of the attending physician^ ami rn^ r^>Ki] b-yr tllis chapter to be returned and
thereof a certificate as hereinafter provided. If thmTisno attend - .re<*aired by section three of this chapter, or in lieu
cannot be obtained, for good and sufiieient reaso ns e-rlv enoiS w vllT ’ °r+lf th,e ccrtif,cate <>[ the attending physician
physician employed by a city or town for the iiilrw® S f the PurP°su> t]>e chairman of the board of health or anv
required of the attending physician™ nd in ca^ h UI,?n, reQuest of said board, agent or clerk, make such certificate as is
^fhcoUCf sa.tisfact°ry Statement and certificate ire sha11’ if requested, make the same.
rrilSSS~
may req"ire- any Of the %£%-££
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
* 1 f a Married Woman or Widow. { If a Soldier who served in Iho'War of the Rebellion
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
(Be very particular to fill all Blanks.]
riate. Ed. May, 1893. — 5,000.
[. Public Statutes,
Chapter 32 as amended by Acts oj 1888, Chapter 306; Acts of 1S89, Chapter 224; Acts of 1893, Chapter 263.-]
Section 3. A physician who has attended a person during liis last illness shall, when requested, forthwith furnish for regis-
te stating to the best of his knowledge and belief, the name of the deceased, his age, the disease of which h-
of hlS last SlP.knftSS. nnrl tha rlato • : * . , P \ 7. 7 . . L‘
tration, a certificate
died, the duration of his last sickness, and the date of his decease
ry1 ,v;,y;' — Tf'"'*.'':00.’ uilt; 'laLC ^ uecease; and a physician who has attended at a birth of a child dvin r
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate’
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician ne°--
fiftv rtnibfr- USCTn°rfla a certl&cate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceedin’®'
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
the primaiy and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses orne<dects
1 WT.nv - Vn!fe ,'etS ,la forff fc to the, treasurer the sum of ten dollars for the use of the town in which he resides. °
oec.iion N<? undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
or town from S° “? C ° fr®m the ^oard of hea1^ or Sts duly appointed agent, or, if there is no board of health in such city
«« r,°“ ie y 7’ t0Wn P.lePk\ No su.ch Permlt sha11 be issued until there has been delivered to such board, or agent or
vicm-Hon w c7i -7 7’ a S7«fa5t017 v7ntten statement containing the facts required by this chapter to be returned and
twlnla’ 1 T?lt ,1 the. certificate of the attending physician, if any, as required by section three of this chapter, or in lieu
cannotfbe ohPdn^f herel“after Provided. If there is no attending physician, or if the certificate of the attending physician
nhvskdmi ll *8 - ^ an* suffl°ie“* masons, early enough for the purpose, the chairman of the board of health or any
rermb^H nf fhi r l7 or.town ff°r.the Purpose shall, upon request of said board, agent or clerk, make such certificate as is
When7!7h 7 " Ph/Slclan 5 and in case of death by violence the medical examiner shall, if requested, make the same. ]
with ^ 1 ^ sa.tlsfact,°7 statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth-7,
slmd tl7r7?ftSlf f an- wnsmlt thf same to the clerk or registrar for registration. The person to whom the permit is so given
7:7 tk ,reaf tfr furmsh for registration any other information as to the deceased or to the manner and-eause of the death, as the
P fif?l^f7iStrar may requlre- Auy person violating any of the provisionsof this section shall be punished by a fine not exceed-
ing nny dollars. ^ 'f
PHYSICIAN’S CERTIFICATE.
Name and Age of Deceased \*
Date and Place of Death , t -
Disease or Cause of Death, - of // l
{Primary and Secondary .) J
Duration of Sickness, - -
I certify that the above is true, to the best of m y knowledge and belief.
Ifcigvit/u re and Residence of Certifying Physician,
Date of Certificate, *0 fidf?. “ x ^ t&9 3
* Or Sex of Infant (not named). 1 1 stillborn so state.
1 If child died immediately after birth so state.
Plate. Ed. May, 1893. — 5,000.
J. If a soldier or sailor who served in the War of the Rebellion.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred,
If a M arried Woman or Widow. J If a Soldier who served in the War of the Rebellion,
t If other thau While. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 189.". — 5,000.
-f
[Public Statutes, Chapter 32, as amended by Acts of 1SSS, Chapter 30G ; Acts of 1889, Chapter 221 ; Acts of 1893, Chapter 263.]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health In such city j
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as lequired by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is
required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same..
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth ■
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so give
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as t1 j
clerk or registrar may require. Any person violating, aKvoajahe provisions of this section shall be punished by a fine not excer f
ing fifty dollars. J I
PHYSICIAN’S CERTIFICATE.
/ certify that the above jy true, to the beyt of my knowledge and belief.
Signature and Residence of Certifying I*Jtysiciany
vmtcc: 7 . dcsiA - 2?zm, Mm,
Date rf Certificate, _ (Qc'f 7^
i89 3 •
Sex of Infant (not named). If stillborn so state.
I If child died immediately after birth so state. { If a soldier or sailor who served in the War of the Rebellion
Plate. Ed. May, 1893. — 5,000.
I Public Statutes, Chapter 32, as amended by Ads of 1SSS, Chapter 30G ; Acts of 1SS9, Chapter 224 ; Acts of 1893, Chapter 263.]
Section 3. A physician who lias attended a person during his las,t illness shall, when requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the nanfl%pf the deceased, his age, the disease of which he
died, the duration of his last sickness, and the date of his decease; and a phyfirlan who has attended at a birth of a child dying
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physiciau shall give both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city
or town, from the city or town clerk. No such permit shall be issued until there lias been delivered to such board, or agent or
, clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as lequired by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is
required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same.
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth-
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
ing fifty dollai's.
‘ ] f a Married Woman or Widow. J If a Soldier who served in the War of the Rebellion.
| If Other lhau While. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Bo very particular to fill all Blanks.]
Plate. Ed. May. 1893. — 5,000.
.2 (z/9 totem
W
[Pub lie Statutes, Chapter 32, as amended by Acts of 18SS, Chapter 30G ; Acts of 1889, Chapter 224 ; Ads of 1893, Chapter 26,
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for re®
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dyi
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certifica
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician m
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine notexceedi
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give be
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglei
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body ntyd
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health ir,
or town, from the city or town clerk. No such permit shall be issued until there lias been delivered to such board, or ^
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be return |
recorded, together with the certificate of the attending physician, if any, as lequired by section three of this chapter, or in
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physi'
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or .
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as
required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the sar
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall fori
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so giv
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as 1
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exce<
ing fifty dollars.
_
\ime ami Age of Deceased,*
PHYSICIAN’S CERTIFICATE.
'tale anil Place of Death, f -
*' is*" or Cause of Death,
^ rYy anil Secondary.) ^
r m of Sickness,
. iii
*&9 J •
mature and Residence of Certifying Physician ,
$
*»
■
I certify that the above is true , to the best of my knowledge and belief.
Date of Certificate,
(ScA-/^
i893
Or Sex of Infant (not named;. 1 1 stillborn so state.
f If child died immediately after birth so state.
Plate. Ed. May, 1893. — 5,000.
J If a soldier or sailor who served in the War of the Rebellion*
[ rnhlic Statutes, Chapter 32, as amended by Acts of 18S8, Chapter 306 ; Acts of 1889, Chapter 224 ; Acts of 1S93, Chapter 263.]
Section 3. A physician who has attended a person during his last illness sliarfj \Vheh requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sextou or other person shall bury in a city or town or remove therefrom a human body until lie
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any
physician employed by a city or town for tire purpose shall, upon request of said board, agent or clerk, make such certificate as is
required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same.
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth-
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
ing fifty dollars.
■ I f a Mari n il Woman or Widow. } li a Soldier who served m the War id the liebelliou.
f If other than White. (M.) Mulatto. (I.) Indian. If of other ltaces, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 1893.-5,000.
, f 18S9 chapter 224 ; Acts of 1893, Chapter 263.]
-rrr
ss»
SSSf-^seW;^
the primary and the secondary forfdt t0 the treasurer the su & city or town or y?“0^®V« no board of health in such city
has received a P®rm^ ®° ^j0wnclerk. No such permit shall be n<r the facts required by this cl lap ^ chapter, or in lien
No such permit shall facts required * or in lien
thereof a certificate as h n sPuffl|ient reasons, ea^/11(fi request of said board, agent br ' r > requested, make the fl
cannot be obtained, f or .^ci the purpose shali, upon r q medical examiner shall, . £ <1 agent shall
physician employed by a city or tow case o£ death ^y violence lIie heaithorto its agent, the noar ^ is p,
isi^l^^issssisss^^ :
ing fifty dollars. r /
R ETT
PHYSICIANS CERTIFICATE.
/ certify that the above is true , to the best of my knowledge and belief.
*nd Residence of Certifying Physician, H, f edjtf
Date of Certificate , .. IL ~ i8g / .
C rf
«int (noi named). If stillborn so state. | If child died TnlTftediately after birth so state. f If a soldier or sailor who served in the War of the Rebellion-
^ Plate. E4. May, 1893. — 5,000.
[Public Statutes, Chapter 32 as amended by Acts oj 1SSS, Chapter 300; Acts of 2880, Chapin 222, Ails leA l
Section 3. A pl.ysidta who to. Mi a person d°rb>. tUtol SES'to
tration, a certificate stating, to the best of J11® . and a physician who has attended at a birth of a child dying
died, the duration of his last sickness, and the date of his d > ' ) fortliwith furnish for registration a certificate,
immediately thereafter, or at the .birth of a ■ Jllbon dead! If a physician nog-
stating to the best of Ins knowledge and belief the fact that such a ch Q thc|.eit)i lie shan be punished by a fine notcxceeding
lects or refuses to make a certificate as afoiesa d, ‘ dlor who' served in the war of the rebellion, the physician shall give both
fifty dollars. In case the deceased was a soldier or a £,„!?, _ J! ° „rlv ,,s ,.e can state the same. If a physician refuses or neglects
the primary and the secondary or immediate cause of > ‘ A ‘ . (i0u.u s "for the use of the town in which he resides,
to make such certificate he shall forfeit to the tome ^the Nuin ot tc \i ■ I rcm0ve therefrom a human body until he
Section 5. No undertaker, sexton or other person shall bu y in a city 01 town or amuv hoard of ht,aith in such city
has received a permit so to do from the board of health or its c u y ^ £ j delivered to such board, or agent or
or town, from the city or town clerk. No such permit shall be issued until ^g^J“('by thjs chaptcr to be returned and
clerk, as the case maybe, a satisfactory written statement co . => reeuired by section three of this chapter, or in lieu
recorded, together with the certificate of the attending musician or if the certificate of the attending physician
thereof a certificate as hereinafter provided. If there ,s no attend,! £ ;s/the chalrman of the board of health or any
cannot be obtained, for good and sufficient reasons, ea}1y e°°’1»h f ° t ■ „ board, agent or clerk, make such certificate as is
physician employed by a city or town for the purpose shall, ° Jal examiner shall, if requested, make the same,
required of the attending physician ; and in case of death by v lolence .the - c - board or agent shall forth-
When such satisfactory statement and certificate are delr whom the permit is so given
with countersign and transmit the same to the clerk r ^ - ^ » d eCeased or to the manner and cause of the death, as the
of this section shall be punished by a fine not exceed-
ing fifty dollars.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred,
ll :i Married Woniau or Widow. | ff a Soldier who served m the War ol the kebeiliou.
1 If oilier than White. (M.) Mulatto. (I.) Indian. If of other Uaces, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 1893.-5,000.
, , , 7 ooo chapter 224 ; Acts of 1893, Chapter 266
w ha ids of 1888, Chapter 306 ; Acts of 1889, Chapt , furnish for reg
recorded, together with the cerun If there 1S no attending pnj the chairman ?* Such certificate
•sfassst sJssrJSf «V“ -sa 4. -s-s ,*
clerk, as the the attending or if the certificate or or
recorded, together -n after provided. If there is n - +ke purpose, the chairm , ave such certificate 1
thereof a certificate Efficient reasons, early enough for the^ agent w derk.^e^^ ^ gg
cannot be obtained, £ or town for the purpose y11’ up?”,p!1^e the medical examiner shall, if : fi ^ agent shall fo
clerk or registrar may require. Any p
ing fifty dollars. _
PHYSICIANS CERTIFICATE.
' and A-e °f Deceased* | Cil CMrtfA . ,.
and Place of Death; f - j died at... fifty. /%» / '
ease or Cause of Death ,
( Primary and Secondary.)*
'.ration of Sickness,
°f
I certify that the above is true , A; the best of my knowledge and belief.
Age,
Qfure and Residence of
&£
.189 d>
d Certifying Physician, C f’/^L<^lf fj ff f fA f) \
/:^C) " *- l-CTL C S</Cw)f’/£ & y/ "™
Dale of Certificate, (Qp^/- '2—fo. ^ -
r0f,‘‘U“t(n^me<i)- lfit,“b0rnS0^C- t Ifa soldier or sailor who served in tteVVarof the
Rebellion
[ Public Statutes, Chapter 32 as amended by Acts oj 1S8S, Chapter 306 ; Acts of 1889, Chapter 224 ; Acts of 1893, Chapter 263. ]
Section 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration, a certiticate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which lie
died, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
stating to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove therefrom a human body until he
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or
clerk, as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded, together with the certificate of the attending physician, if any, as required by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the attending physician
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health or any
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate as is
required of the attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same.
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the board or agent shall forth-
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceed-
ing fifty dollars.
* ] f a Married Woman or Widow. } If a Soldier who served in the War of the Rebellion,
t If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
(Be very particular to fill all Blanks.]
Plate. Ed. May, 1893.-5,000. Q
l Public Statutes, Chapter 32 as amended by
Section 3. A physician who has a
tration, a certificate stating, to the best
died, the duration of his last sickness* a
immediately thereafter, or at the birth
stating to the best of his knowledge a; id
iects or refuses to make a certificate
fifty dollars. In case the deceased w
FlSSS, Chapter 300; Acts of 1889, Chapter 224; Acts of 1893, Chapter 203]
nCfSpn during his last illness shall S which^he
attended0 at a birth of a child dying
rSSMEttSt suc^a child died after birth or was born oeau.
ssahl, or u l¥lA both
' '—or a sailor whored m-the '^^Ln refuses or neglects
fifty dollars: In case the deceased 'y as nearly as he can state the same. If a physician ref uses or neglects
the primary and the secondary - or dollars for the use of the
to make such certificate he shall forfeit .to le • 1L^ , ,, bury in a city or town or remove t
wimsmimmm
ing fifty dollars.
PHYSICIAN’S CERTIFICATE.
Name a ' Age of Deceased,
Date and Place of Death fi
y (Primary and Secondary.) j
Duration of Sickness,
27aC-
I certify that the afiove is i>yifi to rtf e best of my knowledge and be fief.
t ig nature and Residence of Certifying Physician , £/
Date of Certificate, * j8q 3 .
\ T x aa
■ Sex of Infant (not named). If stillborn so state. J If child died immediately after birth so state. I If a soldier or sailor who served in the War of the Rebellion
Plate. Ed. May, 1893. — 5,000.
[ Public Statutes, Chapter 32, as amended by Ads oflSSS, Chapter 30G ; Acts of 1SS9, Chapter 224; Acts of 1893, Chapter 263.
, . i j «ii.. . _ "u ^ -f l-i txti f fnrru’oK VP tri y
Section 3 A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-4
Ue stating, to the best of his knowledge and belief, the name of the deceased, his age the disease of which he
- , . , & . . , n ^ i . l . J C 1,!™ r* i oin-n U'llA Kfl <2 « 1 1 PTlfl Ol'l fl.f, fl. hi Pt.h Ol ZL CllllCl (1Y1112
tration, a certificate stating, to the best or Ins Knowledge ana Denei, me name oi uieuew»cu, ^ .r To
died the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dyin0
immediately thereafter, or at the birth of a stillborn child, shall, when requested
statin" to the best of his knowledge and belief the fact that such a child died alter birth or w as born dead. If a phyacian ne^
iccts or refuses to make a certificate as aforesaid, or makes a false statement therein, lie shall be punished by a fine not exceed.n
fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall toi\ e both
the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects
lo h„ shall forfeit to the Insurer the sum of ten dollars for the use of ih. town in nn.il l.e
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove tlieiefrom a human body mntil he
has received a permit so to do from the hoard of health or its duly appointed agent, or, if there is no board of health In such cit}
or town from the city or town clerk. No such permit shall be issued until there has been delivered to such board, or agent or
clerk as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned and
recorded together with the certificate of the attending physician, if any, as lequired by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or it the certificate of the .^of ‘w t h *0- anv
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the boaid of health o. any
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such ceituicate as i
Sired of tile attending physician ; and in case of death by violence the medical examiner shall, if requested, make the same.
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the boai d or agent sha for t -
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the pernnt is so «iven
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any of the provisions of this section shall be punished by a fine not exceei -
ing fifty dollars.
RETURN OF A DEATH.
To the Clerk of the Town in which the Death occurred.
■ If a Married Woman or Widow. J If a Soldier who served in the War of the Rebellion,
f It other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.]
Plate. Ed. May, 189S. — 5,000.
[. Public Statutes, Chapter 32, as amended by Acts of 18SS, Chapter 30G; Acts of 1889, Chapter 221; Acts of 1893, Chapter 263.]
Suction 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis-
tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of y hich he
died the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dj ,
immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate,
statin" to the best of his knowledge and belief the fact that such a child died after birth or was born dead. If a physician neg-
lects or refuses to make a certificate as aforesaid, or makes a false statement therein, he shall be punished by a fine not exceeding
fifty dollars In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both
th/primarv and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neBlects
to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the 1 "ZV™! ‘him bmJv unti' he
Section 5. No undertaker, sexton or other person shall bury in a city or town or remove tlieiefrom a human body uuti he
has received a permit so to do from the board of health or its duly appointed agent, or, if there is no board of health in such city
or town, from the city or town clerk. No such permit shall be issued until there has been delivered to such boaid, °r
clerk as the case may be, a satisfactory written statement containing the facts required by this chapter to be returned a d
recorded, to"ether with the certificate of the attending physician, if any, as lequired by section three of this chapter, or in lieu
thereof a certificate as hereinafter provided. If there is no attending physician, or if the certificate of the : attend ing PhJ Rician
cannot be obtained, for good and sufficient reasons, early enough for the purpose, the chairman of the board of health o. an j
physician employed by a city or town for the purpose shall, upon request of said board, agent or clerk, make such certificate a^is
required of the attending physician ; and in case of death by violence the medical examiner shall, if requested make the same.
When such satisfactory statement and certificate are delivered to the board of health or to its agent, the boaid or agent shall forth-
with countersign and transmit the same to the clerk or registrar for registration. The person to whom the permit is so given
shall thereafter furnish for registration any other information as to the deceased or to the manner and cause of the death, as the
clerk or registrar may require. Any person violating any qf^ejifo^iou^ c^liia.sQctpm shall be punished by a fine not exceed-
ing fifty dollars. '> }•' y ^ f/n
[I ' o
PHYSICIAN’S CERTIFICATE.
' and Ag' of Deceased, • j kit*** (f J ff . 'ffceyt
find Place of Death f - died at -yf /
-se or Cause of Death, - 0f
'rimary ami Secondary.) j
tion of Sickness,
Ag‘> /*fA ///r/jc^j
2— ,, y.
7 certify that the above is truest o tfefest of my knowledge anil belief
re and Residence of Certifying Physician,
of i n fam (not named ) . I f stillborn
so state. f If child died immediately after birth sn ciotA t if „ t j- ,
Plate. Ed. May, 1893 — 6,000. ’ a soldier or sadorwho served in the War of the Rebellion-
ss§i!l^
MMMB
mrnmmmsmM
clerk or registrar may require. Any person
ing fifty dollars.
RETURN OF A DEATH.
To the Clerk of the Town in whicli the Death occurred,
• 1 f a Married Woman or Widow. J II a Soldier who served m the War of the iiebcliiou.
f If other than White. (M.) Mulatto. (I.) Indian. If of other ltaces, specify what.
[Be very particular to All all Blanks.]
Plate. Ed. May, 1893.-5,000.
Sfction 3 A physician who has attended a person during his last illness shall, \ M , u: , »,,. rHc»»<A of which
OEOIlU-iN O. a , . v:,, TmArnlorlo-P STlfi
Section 3 A physician who has attended a person during liis last lUnesssnai^^ IjjjHj his ^ge> the disease of which he,
tration, a certificate stating, to the best of Ins * ^T5dgf8 “cewe ^and a physician who has attended at a birth of a chiid dying
died the duration of his last sickness, and the date of his deceas e ■, ai u i i > forthwith furnish for registration a certificate,
immediately thereafter, or at the birth of a stillborn child shall .when or was born dead. If a physician neg-
stating to the best of his knowledge and belief tbe fact that sue ch M therein) be shall be punished by a fine not exceeding
loots or refuses to make a certificate as aforesaid, or makes a fal t t „ of therebeUion, the physician shall give both
fifty dollars. In case the deceased was a soldier or a sailor who s state the same. If a physician refuses or neglects
the primary and the secondary or immediate cause of dea;t l a^ar‘y a , ,, for tbe use of the town in which he resides,
to ma™ such certificate he shall forfeit to the treasurer ^of to ^Dan reaove therefrom a human body until he
Section 5 No undertaker, sexton or other person shall . Z j no-ent or if there is no board of health in such city
has received a permit so to do from the board of health or 1*™%*%* delivered to such board, or agent or
or town from the city or town clerk. No such permit shall be issued unh ,)y th,s chapter to be returned and
clerk as the case may be, a satisfactory written statement con tap nn^ e ^ q S(;ction three of this chapter, or in lieu
recorded, together with the certificate of the attending p lay X’ sicjaa or if the certificate of the attending physician
thereof a certificate as hereinafter provided. If there is no attending chiiirman of the board of health or any
cannot be obtained, for good and sufficient «“ons, eai y „ reauest of said board, agent or clerk make such ^certificate as iThe text goes on. The rest is in the file.