USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 1
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COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
60
/
Registered No.
years
months
days
STATISTICAL, DETAIL
SEX male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widower
MAIDEN NAME +
HUSBAND'S NAME f
BIRTHPLACE #
Marrmachi 8:21 Prince Edward Island
NAME OF FATHER Thomas Cochran
BIRTHPLACE OF FATHER Į Unknow
1
MAIDEN NAME OF MOTHER Unknown
BIRTHPLACE OF MOTHER # Undonown.
OCCUPATION Common Laborer abarer
INFORMANT § Mrs. m. G. Ganger
PLACE OF BURIAL OR REMOVAL !! DATE OF BURIAL nostrings hel ms ford Jan. 3, 0 6
UNDERTAKER ADDRESS I. Q. Steinbeck 80 Middlesex ff
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. 190 .... to 190. .,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows : Primary :
.. DAYS
Contributory
.(DURATION) ... ... DAYS (Signed) NO Mich Mich Enerom Jun2 1906 (Address) 219 Curtech
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or
al Resid
4.59 Chelmsford dag
Days
Where was disease contracted, if not at place of death ?. .
Lawell Moss
Filed Jan 3 196 Eduard Robbins
Town
Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details. Name of cemetry.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
William
Place of Death *
Date of Death
RETURN OF A DEATH ST. Cochrane north Chelmsford January 1, '05.
Age.
80
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Comma & Blood 1000
Place of Death * North
Uchelmsford
Date of Death
2 Jan 8 h 1906
Age.
37
years
10
months
14 days
STATISTICAL DETAIL
SEX
Female
COLOR While
SINGLE, MARRIED, WIDOWED, OR DIVORCED married
MAIDEN NAME +
Emma
Hapton
HUSBAND'S NAME + Edgar Wo Ybord
BIRTHPLACE # Dunstable Mass
NAME OF FATHER Peter Hp. Vahton
BIRTHPLACE OF FATHER Dunstable Mass
MAIDEN NAME OF MOTHER Achoah y: Manchester
BIRTHPLACE OF MOTHER Norway Maine
OCCUPATION
youse kular.
INFORMANT § Etta M. Hunter,
PLACE OF BURIAL OR REMOVAL !! curtis melig
DATE OF BURIAL Jan, 12 .... 190.6.
UNDERTAKER Thomas a. Green
ADDRESS Carlisle Drives.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness
.. 190 6. that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Pneumonia
(DURATION) 6 DAYS
Contributory
.(DURATION). DAYS
(Signed)
JE Varney
M. D.
Jucy 1/ 190 6 (Address) North Chelundan)
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence . Place of Death ?. Days
How long at
Where was disease contracted, if not at place of death ?.
Filed Jan. 11 1906 Edward & Robbing
Vom Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
+ In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
|| Name of cemetry.
61
CITY OF LOWELL
Registered No.
2
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Place of Death *
Date of Death
RETURN OF A DEATH Michael Harrington no Chemsford Jan 20, 1906
Age ... 64
CITY 62 OF LOWELL
3
Registered No.
.. years.
montlis
days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OB DIVORCED
MAIDEN NAME t
HUSBAND'S NAME f
BIRTHPLACE #
Ireland
NAME OF FATHER Michael Harington
BIRTHPLACE OF FATHER Į Ireland
MAIDEN NAME OF MOTHER
Julia Haning ton
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION In Moulder
INFORMANT § John & Harrington
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. 190 .... to 190.
that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows : Primary : acute Bronchitis
DAYS
Contributory
(Signed)
Quan Portão
M. D.
face 20 1906 (Address) 253 Cuerine 5 %
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence . Place of Death ?.. . Days
How long at
Where was disease contracted, if not at place of death ?.
Filed Jan. 20 190 6 Edward & Jobbing
Clerk.
PLACE OF BURIAL OR REMOVAL !I St Patricks
DATE OF BURIAL Jan 22 0 6
UNDERTAKER ADDRESS I Denmet to Johann
*City or Town, street and number, if any. If death occurs away from USUAL, RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number. + In case of married or divorced woman, or widow. # State or Country ; also city, town or county, if known. (9 Naine and address of person giving statistical details. Save of cemetry .
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
A
.. (DURATION). .DAYS
COMMONWEALTH OF MASSACHUSETTS
6.3
RETURN OF A DEATH
FULL NAME
Place of Death *
Chelmsford place
Date of Death.
High- 3-19060
Age ..
74
years.
months
.days
STATISTICAL DETAILS
SEX Male
COLOR,
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME 1
HUSBAND'S NAME +
BIRTHPLACE # Boston.
NAME OF FATHER Social Pyjama.
BIRTHPLACE OF FATHER# Chelineford
MAIDEN NAME
OF MOTHER
Sophironia Flagg
BIRTHPLACE OF MOTHER# Littleton.
OCCUPATION Havner.
INFORMANT §
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last
illness, from.
190.
426. 3 1906,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Cardiac paralysis
· (DURATION) per minute
Contributory :
Senile defination.
( DURATION ). DAYS
(Signed) ..
Umara toward M.D.
feb. 4 1906 (Address) Chelmsford
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death ?.
.Days
Where was disease contracted, If not at place of death ?
Filed Freb. 5 1906 Sohard Ir Polling
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclai Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
... .... 190.1./ ..
UNDERTAKER
6
ADDRESS
.Registered No.
4
-
١
L
-
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL.
STATISTICAL DETAIL
SEX finale
COLOR
White
SINGLE, MARRIED, WIDOWED, OR/ DIVORCED Smile
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Lawell Mars
NAME OF FATHER asa Wetherbee
BIRTHPLACE OF FATHER # Harvard Mans
MAIDEN NAME OF MOTHER Pally Park
BIRTHPLACE OF MOTHER # Harvard Man
OCCUPATION
INFORMANT § Salahna Hetthe
PLACE OF BURIAL OR REMOVAL I im, Lawell Mars
DATE OF BURIAL
Fre 9 .10.6
ADDRESS
1
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jan. 20, 1906 to Feb. 7 .. 190.6. .. that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows : Primary : Venite Exhaustion
Indefinite
.(DURATION). DAYS
Contributory
.. (DURATION). . . DAYS
(Signed)
Burnham& Penner
M. D.
Fib 8, 1906 (Address) Lowell Mass.
.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence. Place of Death ? Days
How long at
Where was disease contracted, if not at place of death ?.
Filed
Feb. 9 190
.. 190%.
6 Edward J. Robbing
Tom
Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
+ In case of married or divorced woman, or widow. # State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
UNDERTAKER tamm Wormbeck So Middagen
CITY OF LOWELL
64
RETURN OF A DEATH
FULL NAME
Ellen & Dbetterbec
Registered No ..
5
Place of Death *
Forth Chelmsford Mars
Date of Death
Feb 7" 1906
Age 73
years.
6
months
days
COMMONWEALTH OF MASSACHUSETTS
A
65
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Benjamin Osgood Robbins Registered No.
6
Place of Death *
South Chelmsford
Date of Death
February 11, 1906.
Age 68
8
. years ..
.. months.
11
.days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # South Chelmsford
NAME OF
FATHER
Jannes Adams Robbins
BIRTHPLACEV OF FATHER# South Chelmsford
MAIDEN NAME
OF MOTHER
Alzina Fletcher
BIRTHPLACE
OF MOTHER#
Westford
OCCUPATION
Farmer
INFORMANT § Charles Q. Collins
PLACE OF, BURIAL OR REMOVAL II Hart Pond am. So. Chelmsford
DATE OF BURIAL
Feb. 14, 1906.
UNDERTAKER D. P. Byjam
ADDRESS
South
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190 torfeb. 11, 1906, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary: Ofthisis Pulmonalis
(DURATION). OAYS
Contributory :
?.......... ( OURATION) .. DAYS
(Signed) ..
M.D.
Tick. 13,1906 (Address) Clubesfond, Mano.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Former or
Usual Residence
.Place of Death ?
.Days
Where was disease contracted,
If not at place of death ?
Filed
Feb. 14
1904.
Edward & Robbing
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If in a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
66
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death
174
9, 1906 Age 56 years
months
days
STATISTICAL DETAIL
SEX COLOR female that
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Canal
MAIDEN NAME +
mary
HUSBAND'S NAME +
James Bugles
BIRTHPLACE ±
Queland
NAME OF FATHER Verena Carroll
BIRTHPLACE OF FATHER Į
Wieland
MAIDEN NAME OF MOTHER
not krumm
BIRTHPLACE OF MOTHER #
Uneland
OCCUPATION at Home
INFORMANT § Von. Stilleams N. Yugler
PLACE OF BURIAL OR REMOVAL ¡l
DATE OF BURIAL
.... 190
UNDERTAKER -
ADDRESS
faced t: Nuwel Tme 324 margit Ut -
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. July 12 1906 to Jebay 17 190. 6 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Pren money
Contributory
(DURATION). DAYS
(signed) .
M. D.
July 18
.. 190€. (Address).
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
How long at
Former or Usual Residence. Place of Death ?. . Days
Where was disease contracted, if not at place of death ?.
Filed Feb. 19 506 Edward J. Robbins
Clerk.
.City or Town, street and number, if any. If death occurs away from USUAL, If in a RESIDENCE, give facts called for under " Special Information.' Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
Il Name of cemetry.
6
.. (DURATION) .. AYS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
CITY OF LOWELL
Registered No ... Mary malese Vatnet worth While ford
-
COMMONWEALTH OF MASSACHUSETTS
67
Nomell
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
( hms banet gay Dodge
Registered No.
50
Place of l
Death * S
Month Chelmsford Mall
Date of ¿
Feb. 24.
.1906
Death
S
Residence
North Chelmsford
4
Age 64
.. years ..
.. months.
.days
STATISTICAL DETAILS
SEX
COLOR
CINOSLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t
gay
HUSBAND'S NAME 1
Daniel : 2. Rouge
BIRTHPLACE # nurhual NH
NAME OF
FATHER
Ziba gay
BIRTHPLACE
OF FATHER#
Deering N.H.
MAIDEN NAME
OF MOTHER
Mary Kennedy.
BIRTHPLACE
OF MOTHER#
Ireland
OCCUPATION
At home
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
Cemented mb Auburn Feb 28ch
DATE OF BURIAL
Cambridge min
190.6
UNDERTAKER
ADDRESS
Lowell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Delay 18 1906 to Fly 24 906
that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Pneumonia
(DURATION) Seven DAYS
Contributory :
sucral jems
.(DURATION).
. DAY8
(Signed).
JE Varney
.M.D.
July 24 190 6 (Address).
Hent Chehunden.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
. years ..
months. days
Where was disease contracted,
If not at place of death ?
Filed
teh 26
1906
Edward & Rafting
Clerk
Toun.
* City or town, street and number, If any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
68
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death
months
days
STATISTICAL DETAIL
SEX mal that
-SINGLE, MARRIED, WIDOWEDNOR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ± Inland
NAME OF FATHER
m: Lillian
BIRTHPLACE OF FATHER İ
Inland
MAIDEN NAME OF MOTHER
Same
BIRTHPLACE OF MOTHER +
Unland
OCCUPATION Ofnature
INFORMANT Brotheren Jaw Having to
DATE OF BURIAL
..
... 190
ADDRESS
UNDERTAKER
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from 904 to 726 25 1906 .. that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF HEATII was of follows :
Primary :
(Pulmonary
Jaberculosis.
2 years
... (DURATION) .. DAVS
Contributory
.. (VURATION) ...
. . DAYS
(Signed) .. Amasa toward .. Feb 2.6 1906 (Address) Clubretard.
4
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
How long at
Former or Usual Residence . Place of Death ?. Days
Where was disease contracted, if not at place of death ?..
Filed
Firb. 27 IN 6 Edward J. Roblox
Clerk.
"City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
11 Name of cemetry.
CITY OF LOWELL
CSillia
9
Registered No ..
.Age ... 42 years
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
PLACE OF BURIAL OR REMOVAL I Ture
r
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Henry & Perham
Registered No ..
Place of )
Death *
Datonal Florida
Date of l
Feb. 25
Death
5
.1906
Residence
Chelmsford Mass Age.
Age
62
.years.
3
9
.months
.days
STATISTICAL DETAILS
SEX
COLOR
Zale White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
married
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Chelmsford
NAME OF
FATHER
David Perham
Perham
BIRTHPLACE
OF FATHER#
Chelmsford
MAIDEN NAME
OF MOTHER
Elentheria I. Haite
BIRTHPLACE
OF MOTHER #
Section Vermont
OCCUPATION
Vinegar In/gr.
INFORMANT §
Walter Perham
PLACE OF BURIAL OR REMOVAL !! Forefathers Cemetery Chelelord mais.
DATE OF BURIAL
mar 2 1906
UNDERTAKER 2. a jemback
ADDRESS
Lowell Masz
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last
illness, from ..
190 ..
190 ... that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
: acute Villon atrophy of Liver
. (DURATION).
DAYS
Contributory :
(DURATION)
.. DAY8
(Signed) J. a. Van Valzah
M.D.
90- (Add
Datona Florida.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months. days
Where was disease contracted, If not at place of death ?.
Filed
Mar. 2, 1906
Edward . Batting
Town
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special information." If in a Hospital or institution, give its NAME instead of street and number. t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalis. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
69
Chelmsford
(CITY OR TOWN.) 010
د
..
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
City of Lowel, 70
RETURN OF A DEATH
FULL NAME
Eugene H. S. Dutton
.. Registered No.
334
Place of Death *
Lowell Men Markt, Lowell Mais
Date of Death.
Mar. 4. 1906
.Age
61
years ..
10
8
months
.days
STATISTICAL DETAILS
SEX
m.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
no Chelmsford
NAME OF
FATHER
Parker Dultou
BIRTHPLACE
OF FATHER#
no Chelmsford
MAIDEN NAME
OF MOTHER
Lucretia De Clare
BIRTHPLACE
OF MOTHER#
new London
OCCUPATION
INFORMANT § Chas, H. Dutton
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
mar 6
6
190.
UNDERTAKER
8.a. Hembech
ADDRESS
midalux SA
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. mar 2 190 6 to mar 4 1906 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : -
Primary :
Labai neumonia
... (DURATION) ..
DAYS
Contributory :
-
(DURATION).
DAYS
(Signed)
Fredenich Binchliffe
M.D.
may 4 ,90
.1906 (Ad
.(Address).
Lowell Gym Wordt,
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
no Chelmsford,
How long at
.Place of Death ?.
-
.. Days
Where was disease contracted,
If not at place of death ?
Filed.
Mar. 6 1906 Girard Madman
City
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under " Special Information." If In a Hospital or Institution, give Its NAME Instead of streot and number.
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
COMMONWEALTH OF MASSACHUSETTS
71
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
lanet
Mc quade
Registered No.
12
Death * S
Residence
north Chelmsford mas Age.
25
.. years.
7
.. months.
.. days
STATISTICAL DETAILS
SEX Female
COLOR why
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME 1
Janet morning.
HUSBAND'S NAME T John mc quade
BIRTHPLACE #
Scotland
NAME OF FATHER matthew morning
BIRTHPLACE OF FATHER Scotland
MAIDEN NAME OF MOTHER Margaret Dickson
BIRTHPLACE
OF MOTHER ±
Scotland
OCCUPATION at home
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL II Riverside Cemetery
DATE OF BURIAL
march 7, 90. 6
UNDERTAKER
ADDRESS
P.M. Young to 33 Prescott of
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 1905 illness, from January 1905 ToMet &. 1906, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Pulmonary tuberculosis
14 monte
(DURATION) ..
DAYS
Contributory :
(Signed)
JE Janney
.(DURATION) .DAYS
Meh 5 1906 (Address) Horth Cheluizen.
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at
Place of Death ?
.years.
months days
Where was disease contracted, If not at place of death ?.
Filed
mar. 6.
1906 Edward & Robbing
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Place of )
Forth Chelmsford Mass
Date of l
march
4
190 C
Death S
COMMONWEALTH OF MASSACHUSETTS
CITY 72 OF LOWELL
RETURN OF A DEATH
Registered No .. 13
months days
STATISTICAL DETAIL
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OTT DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Cheland
NAME OF FATHER Patrus O'Steil
BIRTHPLACE OF FATHER Į
Unland
MAIDEN NAME OF MOTHER
nut kunu
BIRTHPLACE OF MOTHER #
Inland
OCCUPATION
Sabores
INFORMANT § Mary O til type
PLACE OF BURIAL OR REMOVAL [I
DATE OF BURIAL of Tateurs cuenta query March 7
1 UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last ness, Ivey 19 1906 to the 5th 190 6 that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
viltica
(DURATION) 18 DAYS
Contributory
.... (DURATION). . DAYS
(Signed)
nech 50
,6 (Addre
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence .
How long at
Place of Death ?. . Days
Where was disease contracted, if not at place of death ?..
Filed Mar. 6 1906 Edward ). Raffin
Vorm Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL If in a RESIDENCE, give facts called for under " Special Information.' Hospital or Institution, give its NAME instead of street and number.
+ In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
Il Name of cemetry.
-
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
alves
Place of Death *
Church street Ball Chilamfad
Date of Death Brauch 50% 1906
Age 5.5 Years.
ALL NAMES TO BE IN FULL.
M. D.
73
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME John
Roberts
Registered No.
14
Place of Death *
South Chelmsford mass
Date of Death.
March 5th 1906 Age >9 years 14
.. months.
11
.days
STATISTICAL DETAILS
SEX
male White
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Andover, N. 26.
NAME OF
FATHER
Johnathan Roberts
BIRTHPLACE
OF FATHERİ
Andover Dr. Ho.
MAIDEN NAME OF MOTHER Elizabeth Smith
BIRTHPLACE OF MOTHER # Andover 2. Hp
OCCUPATION Farmer
INFORMANT §
Carrie A. Super.
PLACE OF BURIAL OR REMOVAL I
Edson
howell
em.
DATE OF BURIAL
Tar 1 1906.
UNDERTAKER
Daniel PB.
am
ADDRESS
So Chelmsford,
mass
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from fan-15 190 Sto Mech- 5= 1900, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Huile Dementia
. (DURATION).
DAY8
Contributory :
(Signed)
myslegpu-
.M.D.
(DURATION).
DAYS
Mich-5- 1900
Mitford
SPECIAL INFORMATION only for Hospitals, Institutlons, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death ?.
Days
Where was disease contracted, If not at place of death ?
Filed
Mar. 6 1906 Eduard . Bobbing
Town
Clerk
* Clty or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If in a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. li Name of cemetery.
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