USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 1
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Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15 | Part 16 | Part 17 | Part 18 | Part 19 | Part 20 | Part 21 | Part 22 | Part 23 | Part 24 | Part 25 | Part 26 | Part 27 | Part 28 | Part 29 | Part 30 | Part 31 | Part 32 | Part 33 | Part 34 | Part 35 | Part 36 | Part 37
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Engine
7
Place of }
Centre S. Chelmsford
Death * S
Residence
Centre S. Chelmsford
Age.
60
... years ..
-
5
.months .. .... .. days
STATISTICAL DETAILS
SEX
-) hale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Divorced
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE #
HEbron ?I. H.
NAME OF
FATHER
HEgakich Herrin
BIRTHPLACE OF FATHER# Habron n. H.
MAIDEN NAME
OF MOTHER
Ruth Durgun
BIRTHPLACE
OF MOTHER #
Buxton me
OCCUPATION
Painter
INFORMANT § Miro Martha Knowles
PLACE OF BURIAL OR REMOVAL I
1. im Ridge Cem. Chelmsford
DATE OF BURIAL
Jan 8
.....
199.0 ..
UNDERTAKER
Malin Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
.490 ... 10 190 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 :
Tecido
by Prison
. (DURATION) .. DAYS
Contributory :
.(DURATION).
. DAYS
(Signed) W Meigs MS. Medical Examiner MD.
un. 7, 1900 (Address) ..
160 Themmack h.
-
SPECIAL INFORMATION only for Hospitais, 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
Jan 7, 1980 devardy Proting
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.
160 Chelmsford (CITY OR TOWN.)
1
.Registered No ..
Date of l
7
Death
1
.....
٢
COMMONWEALTH OF MASSACHUSETTS
161
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME (Adeband)
Harald
Piace of l
Middlesex County Training Lehul
Death * S
Residence
237 Riken
11 Samuel Mi Age 10
.. years ..
.months ..
.days
STATISTICAL DETAILS
SEX male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Jawell Mars
NAME OF FATHER Charles Harrand)
BIRTHPLACE OF FATHER#
Obanada
MAIDEN NAME OF MOTHER Beatrice albert .
BIRTHPLACE OF MOTHER #
(Granada)
OCCUPATION School. -
INFORMANT § Hate
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
UNDERTAKER
ADDRESS 1/38
IA Archambault mernunca
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during fast
illness, from
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 :
Disease the trash
(DURATION) .. DAYS
Contributory :
... (DURATION) .. ... DAY 8 (Signed) . theigs, Who. Medical Examiner MED. Ch7, 1969 (Address) 160 Therrenack h.
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
...
Edward & Rotting
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 details. # Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.Registered No ..
Date of l
Death 1
1
1
COMMONWEALTH OF MASSACHUSETTS
162
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME 20 Coulson
Registered No ..
3
Place of l
Your Chelmsford, mais).
Date of Jan 8
Death * S
Residence
Toest Chelunsford mass Age.
17 bear 11
.. months ..
18 days
STATISTICAL DETAILS
SEX female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
manuel
MAIDEN NAME 1
HUSBAND'S NAME t
-
BIRTHPLACE #
Finnkotell, Parkshin C, England
NAME OF FATHER
Farine z
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER ! Ceizabell tation
BIRTHPLACE OF MOTHER #
OCCUPATION
House Reefer
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Jamy 7 190 to pray .199 ...... , 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 :
(DURATION) 2
... DAYS
Contributory :
.(DURATION) . DAYS
(Signed).
7 E Vaney
M.D.
·man / 1900 (Address).
2. Challenger
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 Jan. 10 1900 Edward ) Raffina
5
Corn 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, glve 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
PLACE OF BURIAL OR REMOVAL I
Wer Chelunsford
DATE OF BURIAL
Jan. 11
.. 1960.
UNDERTAKER
Its No hidden
ADDRESS localford cifra
Death
1980
COMMONWEALTH OF MASSACHUSETTS
163
CITY OF LOWELL
1
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of )
Death * S
Residence
Age
.. years ..
.months. 27 /
.. days
STATISTICAL DETAILS
SEX Y 76
-
MAIDEN NAME +
HUSBAND'S NAME t
Amago
Horatio Bl Downs.
BIRTHPLACE # Lowell mark.
NAME OF
FATHER
Jeorge
gas
BIRTHPLACE
OF FATHER#
Malden Mars
MAIDEN NAME
OF MOTHER
Hannah Hopkins
BIRTHPLACE
OF MOTHER #
Decham Mare.
OCCUPATION at Home
INFORMANT §
10 Geo H. Downs.
PLACE OF BURIAL OR REMOVAL !!
Hest laura Cem. Lol.Jan.
DATE OF BURIAL
1900
UNDERTAKER
Geo Ht. Really
ADDRESS
49 Branch LA
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Jan 8 190 0 to Aline CI 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 : Uracmia
Contributory :
Exhaustive
(Signed)
3. 16 Byam
(DURATION) DAYS
Jour G 1960 (Address) 24
3. St.
.M.D.
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/ Jan /1 1900
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 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
Registered No ..
Date of l
Death
1
190 0
1.8 %)with
1
COLOR
1.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
00
:- (DURATION)
DAYS
COMMONWEALTH OF MASSACHUSETTS
164
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Ruth
J. ackroyd
.. Registered No ....
431
Place of l
Yworth Chelmsford Amass
Date of l
Jan 10th 1980
Death
5
.months ..
24
.days
STATISTICAL DETAILS
SEX Hemark
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
widnie
MAIDEN NAME + Ruth
HUSBAND'S NAME t George H. Mikroud
BIRTHPLACE # Southampton n. B
"NAME OF
FATHER
Levi
Grant
BIRTHPLACE
OF FATHER
Southampton n. B.
MAIDEN NAME
OF MOTHER
Sarah Way
BIRTHPLACE OF MOTHER # Southampton n. B.
OCCUPATION
nonce
INFORMANT §
PLACE OF BURIAL OR REMOVAL Ii DATE OF BURIAL River suite Cemetery north ChelmsfordJan 12 1960
UNDERTAKER 6.In. Young
ADDRESS
33 Prescott es
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. Dec 28
1909 to Jasny/10 ... 190.0 .... , 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 :
Gangrene of Food.
. (DURATION) 13
DAY8
Contributory :
nukunnen
.. (DURATION).
DAYS
(Signed)
JE James
M.D.
Jan /2 1900 (Address).
Michelinfeny
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death 7
.years ...
months. days
Where was disease contracted, If not at place of death ?
Filed Van. 12 1990 Edward Raffina
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 detalls.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Death * S
Residence
Ywith Chelmsford Mars Age.
71
.years ..
Grand-
COMMONWEALTH OF MASSACHUSETTS
165 Chelmsford.
RETURN OF A DEATH
(CITY OR TOWN.) 6
Place of l
Chelmsford Centre
Death * S
Residence
Chelmsford
Age
33
.years ..
.months.
07
.days
STATISTICAL DETAILS
SEX Hemala
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
married
MAIDEN NAME +
Bessie V Crossman
HUSBAND'S NAME t
My L Parle
BIRTHPLACE #
Haviview New Brunswick
NAME OF
FATHER
Mr Crossman
BIRTHPLACE
OF FATHER#
Havivier A.B.
MAIDEN NAME
OF MOTHER
Thary Rys
BIRTHPLACE
OF MOTHER
Sackville, n. B.
OCCUPATION
Housewife
INFORMANT §
My L Parler
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
Prins Rillas Cena Chelan Jan 14
1960
UNDERTAKER
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
iliness, from ...
1909 to ...
Jan. 13 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 :
Chronic gastritis
.(DURATION). DAYS
Contributory :
:. (DURATION).
.. DAYS
(Signed).
masa toward.
M.D.
Jan.14 1980 (Address).
Chelmsford Mass.
SPECIAL INFORMATION only for Hospitais, 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
Jan. 14
1960 Edward &. Robbing
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 statisticai details. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
FULL NAME
Bessie Y Parlee
Registered No ..
Date of l
Jan 13 1960
Death
1
COMMONWEALTH OF MASSACHUSETTS 1
166
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
l'c Quade
.Registered No.
Place of )
Death * S
Quigley Ave North Chelmsford
Death
190
Residence
Quigley North Chelmsford
Age.
.years ..
.months.
.days
STATISTICAL DETAILS
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
North Chelmsford
NAME OF
FATHER
John J. Mc Quade
BIRTHPLACE OF FATHER$
Lowell Mass %
1
MAIDEN NAME OF MOTHER Florence Finch ...
BIRTHPLACE
OF MOTHER $
England
OCCUPATION
INFORMANT §
John J. Mc Quade, father
PLACE OF BURIAL OR REMOVAL !!
Stv Peters tt
DATE OF BURIAL
Jan. 15/1O
UNDERTAKER ADDRESS 1+ R onwelt Klas House was
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
iliness, 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 as follows :
Primary :
Congenital
... (DURATION). DAYS
Contributory :
.(DURATION) DAYS
(Signed)
1
M.D.
fun IS 1900 (Address) M.Chelmsford
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 Jan 15
...
1900 ...
Edward Potting
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, glve 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. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Chelmsford
Date of \ Tar 14/10
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
167
RETURN OF A DEATH
(CITY OR TOWN.)
8
FULL NAME
Alfred A. Miner
.Registered No ..
Place of l
Mt Pleasant street
Death *
S
Mt Pleasant street
Age
.. years.
months.
.days
STATISTICAL DETAILS
SEX
nale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED sinz 18
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
North Chelmsford
NAME OF
FATHER
Henry Miner
BIRTHPLACE
OF FATHER#
Lowell
-
MAIDEN NAME
OF MOTHER
Elizabeth McTeague
BIRTHPLACE
OF MOTHER #
Scotland
OCCUPATION
INFORMANT §
Henry Miner, Father
Filed Jan. 19 1900 Edward S. Kolding
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 glving statistical details,
UNDERTAKER ADDRESS to lonwell Done Jours
well full II Name of cemetery.
PHYSICIAN'S CERTIFICATE
190 ..
I HEREBY CERTIFY that I attended deceased during last
illness, from
.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 :
mi
autio
.. (DURATION) .. DAYS
Contributory :
.(DURATION) . DAYS
(Signed) ......
M.D.
19010 (Address) No. Chalmiljard
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 ?.
PLACE OF BURKAL ORIREMOTE St Josephs Cemetery
DATE OF BURIAL
Jan I9./IQ0
Date of [ Jan 18/10
.190
Death
5
Residence
Chelmsford
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
168 Lamell
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Henry alors
Place of 1
Mouth Chelmsford Meaza.
Date of l
ran, 2g
...... 190//
Death * S
Residence
Worth Chelmsford, Man.
.... Age
36
years.
.months.
.. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED .
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # England
NAME OF
FATHER
albert 8. start
BIRTHPLACE
OF FATHER#
England
MAIDEN NAME
OF MOTHER
Elizabeth Daniele
Ohza
BIRTHPLACE
OF MOTHER #
England
OCCUPATION Varder-
INFORMANT § Schu aflavio
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ...
July
1909 to Jam 29 19/0,
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 :
Valvulas Drian
Primary :
....
....
The Heart-
0
about two year (RATION). .. DAYS
Contributory :
(Signed).
I. S. Walley
... (DURATION). .. DAYS
M.D.
San 3/ 1980 (Address) 40 Andaluces 81-
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
Jan. 3/
190 Edward Rohling
Com 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 detalls. !! Name of cemetery.
PLACE OF BURIAL OR REMOVAL II
Edeen Cemetery
UNDERTAKER
V. a. Weinbeck
ADDRESS
soliddr. St
DATE OF BURIAL
Registered No. 301
Death
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A) DEATH
(CITY OR TOWN.) (530)
10
FULL NAME
Place of )
He Thelmo jordy Was.
Death * S
Residence
/o. Chelmo Land Mas ..... Age.
53
5
.. months.
21 days
STATISTICAL DETAILS
SEX
COLOR
DV
SINGLE, MARRIED,
WIDOWED, OR
DIVORGED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Bradford England
NAME OF
FATHER
Nm. 7, Ball
BIRTHPLACE
OF FATHER$
England
MAIDEN NAME
OF MOTHER
Hanknown
BIRTHPLACE
OF MOTHER $
England
OCCUPATION
,
INFORMANT §
These Jem
enviei Ball
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Die,ce 1909 to Jau 3/4 ........ 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 : Intestinal Ulceration
(DURATION) .. DAYS
Contributory :
.(DURATION). .. DAY & (Signed) Hay Holbrook M.D. mely 1290 (Address) 295 CentralSe
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 Tel. 2
1980 du
00 Edward S. Putting
0
Clerk
PLACE OF BURIAL OR REMOVAL !!
Tiserve de feméter
DATE OF BURIAL
Jef 3
1900
UNDERTAKER
V.a. Hunbeck
ADDRESS Si Meddy, St.
* 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 details. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
169
Da'C
.Registered No.
Date of l
San, 31.
Death
.. years ..
COMMONWEALTH OF MASSACHUSETTS
170 Chelmsford (CITY OR TOWN.)
RETURN OF A DEATH
FULL NAME
Carola M. Steanne
Registered No ..
11
Place of 1
Death *
Chelmsford
Date of l
Jan 31
196 0
Death S
Residence
Chelmsford!
Age
47
/11
.. months ..
0
.days
STATISTICAL DETAILS
SEX
COLOR
Hemale white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Plymouth 18
NAME OF
FATHER
Jan II Steanne
BIRTHPLACE
OF FATHER#
Hairfield Of.
MAIDEN NAME
OF MOTHER
Rhoda & Russell
BIRTHPLACE
OF MOTHER #
Cavendish Ut.
OCCUPATION
at home
INFORMANT §
NL Stearns
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last illness, from Sefut 7 1909 to Jan 31 1980 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 :
Carcinoma A Stomach
9 Breast
(DURATION) ..
DAYS
Contributory :
Ch. Par. Nephritis
(Signed)
13. 8. Bryan
M.D.
Feb 2 1980 (Address) 24325 Lowved
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
Fiel. 8
.....
960 Edward J. Roffing
Clown
Clerk
PLACE OF BURIAL OR REMOVAL !!
Centralen
Cavendish OF
DATE OF BURIAL
Keb 4
.... 196 .. 0
UNDERTAKER
Walter Perhow
ADDRESS
Chelmsford
* 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 details. || Name of cemetery.
.. yeard
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.(DURATION) .. .. DAYS
171
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Laura 0. Perkins
.Registered No ..
193
Place of }
Death * S
Lowell General Hospital
Date of l
Death
February 2 1970
Residence
West Chelmsford, Mass
Age
19
.. years ..
--
.months.
.days
STATISTICAL DETAILS
SEX Female
COLOR
White
7SINGLE, MARRIED,
WIDOWED, OR
MAIDEN NAME +
Laura Spicer
HUSBAND'S NAME Ť
Frank Perkins
BIRTHPLACE#
Spencer Island. N. S.
NAME OF
FATHER
Isaac Spicer
BIRTHPLACE
OF FATHER#
Unknown
MAIDEN NAME
OF MOTHER
Lydia Clourey
BIRTHPLACE
OF MOTHER #
Unknown
OCCUPATION
INFORMANT § At Home
Husband
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jan 24, 1900 to Feb 2, 1920 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).
3
... DAY8
Contributory :
Fibroid tumor of Uterus
.(DURATION) . DAY8
(Signed)
F. L. Gage
M.D.
Feb 3, 1920 (Address).
110 Branch St
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 Feb 4. 19010
25d. (Hadmien
Cityclerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Edson Cemetery
Job .... 5 ......... 1901.0 ...
ADDRESS
58 Prescott st
* 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, glve Its NAME Instead of street and number.
t In case of marrled or divorced woman, or widow. # State or country , also city, town or county, If known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
UNDERTAKER
J B. Currier co
12
COMMONWEALTH OF MASSACHUSETTS
172
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Stillborn
-
neuman
Registered No. 13
Place of )
Chelunsford m
Date of l
Feb. 3,
19010
Death )
Residence
Host Chelmsford
Age
Stillborn.
.months.
.. days
STATISTICAL DETAILS
SEX
formale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Host Chelmsford
NAME OF FATHER William H. newme
BIRTHPLACE OF FATHER# Hillsboro
n. H.
.
MAIDEN NAME OF MOTHER nellie m. Foster.
BIRTHPLACE OF MOTHER# North Haverbill n.H.
OCCUPATION
INFORMANT § Father
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
River Side Comerty,
Feb. 4
........ 1900 ....
UNDERTAKER 7. Chilistort.
ADDRESS
James S. Wottoy. M. Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 190 ..... to. Jaby 3. 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 : shel ton
Contributory :
(DURATION). DAYS
(Signed).
.M.D.
1960 (Address
SPECIAL INFORMATION only for Hospitais, 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
Fieber5
1960 Edward & Rotting
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 details. Il Name of cemetery.
.(DURATION) .. DAYS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Death * S
t
!
١
COMMONWEALTH OF MASSACHUSETTS
173
Chehomeland
(CITY OR TOWN.)
FULL NAME
Chester Littlefield Bell
Registered No. 14
Place of )
Seat Chelmsford
Date of l
Feb. on
.1900
Residence
Stratford man
Age.
.years.
2
... months.
2/
... days
STATISTICAL DETAILS
SEX
Male
-
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME 1
BIRTHPLACE # fastfood mais.
NAME OF
FATHER
archibald Gardner Bell
BIRTHPLACE
OF FATHER#
Hartford Mass.
MAIDEN NAME
OF MOTHER
minnie Porter Littlefield
BIRTHPLACE
OF MOTHER#
Conway N. It.
OCCUPATION
INFORMANT §
Father
ther
PLACE OF BURIAL OR REMOVAL !! west cem
DATE OF BURIAL
tel
7
1900
UNDERTAKER
a. F. Midden
ADDRESS
Hartford R.E.D.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from July 1 1980 to aby 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 : tuberculose
(DURATION) SE
DAYS
Contributory: too muchshe?
.(DURATION). DAYS
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