Deposition : births 1897-1918, Part 1

Author: Chelmsford (Mass.)
Publication date:
Publisher:
Number of Pages: 120


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DEPOSITION BIRTHS


Acts of 1897, Chapter 444, Sections 14, 15 and 30.


SECTION 14. Whenever the record relating to a birth, marriage or death in the records of any city or town does not contain all the facts required for record, or when it is alleged that the facts are not correctly stated in such record, the clerk of such city or town shall receive a deposition under oath, made by one who was required by law to furnish the information for the original record, or, at his discretion, by three or more credible persons having knowledge of the case, containing such facts as are desired for record. Having received such deposition he shall then file the same, and record said facts in a separate book to be kept for recording such depositions, adding thereto the name and residence of the deponent and the date of such record, and shall there- upon draw a line through the incorrect statements without erasing them, and enter upon the original record the facts needed to amend the record, and forthwith, if a copy of the record has been sent to the secretary of the Commonwealth, forward a certified copy of the corrected record to the secretary upon blanks provided by him for the purpose, who shall thereupon amend the record in his office, and state in the margin thereof his authority for so doing. Reference to the record of the deposition recorded shall be made by the clerk against the original record. The clerk when furnishing a copy of such record shall certify to the facts contained in the record as amended, and shall state in addition that the certificate is issued in accordance with the provisions of this act, and a copy of this section shall be printed on every such certificate. Such deposition, or a certified copy of the record of any other city or town, or of the record made at the time by any person since deceased who was required by law to furnish the evidence of a birth, marriage or death may, at the discretion of the clerk, be made the basis for the record of a birth, marriage or death not previously recorded, and such copy of record may also be made the basis for completing the record of a birth, marriage or death which does not contain all the required facts.


SECTION 15. Any person who wilfully makes a false return in regard to any birth or death shall forfeit not exceeding fifty dollars.


SECTION 30. Any of the oaths required by any of the provisions of this act may be administered by the clerk or assistant clerk of any city or town in his official capacity.


SPECIAL NOTICE.


Depositions are to be made on the blanks contained in this book, in which they are to be preserved.


When a deposition relates to the records of some other city or town, it is to be made on one of the blanks furnished for the purpose and forwarded to the clerk of that city or town.


Note that in making corrections, a line is to be drawn through incorrect state- ments without crasing them, and that if a copy of the erroneous record has been sent to the Secretary of the Commonwealth, a certified copy of the corrected record must also be forwarded.


Commonwealth of glassachusetts.


No /


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose S and says that the record relating to the birth of Dorating Parkhurst Hall in the Tour of Thecus ford (Name of child.) (City or town.) (Name of city ar town.) does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : - -


Date of birth, September 26-1898


Name of father,


William & Hall


Name of child Dorothy Parkhurst Hall


Sex, Firmale


Color, White


Condition (twin, &c.),


Place of birth, Chelmsford


Maiden name of mother,


Hortense( Parkhaus)


Residence of parents, . Chiles Jord (at time the birth occurred. )


Occupation of father,


Pattern Make


(at time the birth occurred.)


Birthplace of father,


Checars ford


Birthplace of mother,


Ghans ford


SIGNATURE. Hm, & fall


RESIDENCE. (City or town, street and number, if any.)


Precisford


Relation to child, if any. Father


LittleTon Street


1


Date, Avec 8 - 189?


Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by.


Recorded July 8 189


Good. Partners, TownCom


(''ity or town.)


Of frems ford Mass.


Commonwealth of Massachusetts.


No.


of


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath deposes and says that the record relating to the birth of Forrest Sherman White


in the Tour of Chelmsford.


(Name of child.)


(City or town.)


(Name of city of town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, September 2, 19.03.


Name of child, Forrest Sherman White


Sex, Male


Color, archite


Maiden name of mother,


Cena E. Dustin


Residence of parents,


Chelmsford


(at time the birth occurred. )


Occupation of father,


Fraughteman


(attime the birth occurred.)


Birthplace of father,


Hudson N. H.


Birthplace of mother,


LEE N. H.


SIGNATURE.


George F. White


RESIDENCE.


(City or town, street and number, If any.)


No Chelmsford


Relation to child, if any. Father


Date, april 28, 1904


Then personally appeared before me the person whose signature appears above and made


oath that the statements subscribed to by him are true.


Eduard J. Bobbing Con Clerk: (City or town.)


Recorded apr. 28, 1944


Of __ Chelmsford Mass.


Condition (twin, &c.),.


Place of birth,


Chelmsford


Name of father,


George S. White


Commonwealth of Massachusetts.


No.


3


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap, 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth of Katherine Ping Hall in the Town of 4 helmejord (Name of chlid.) (City or town.) (Name of city/or town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record :


Date of birth, January 26, 1903


Name of child, Katherine King Hall.


Sex, Female White


Maiden name of mother.


Hortense Parkhurst


Residence of parents,


(at time the birth occurred


Fraughtsman


Occupation of father,


(at time the birth occurred.)


Birthplace of father,


Chelmsford


Place of birth,


Imeford


Birthplace of mother,


Chelmsford


SIGNATURE. William H. Hall


RESIDENCE.


(City or town, street and number, if any.)


Chelmsford


Relation to child, if any. Father


Date, august 5, 1964


Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by him are true.


Recorded ang. 5, 1904


Edward . atting them (City or town)


Clerk.


Of . .. Chelmsford Mass.


Name of father,


Gilliam H. Hall


Color,


Condition (twin, &c.), Świn


Commonwealth of Classachusetts.


No. 4


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath deposes and say that the record relating to the birth of Nellie Lois Parle


(City or town.) (Name of city or town.) . (Name of child.) in the Town of Chelmsford


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth,


abril 18, 1904


1


Name of father


I. Theodore Parle


Name of child, Nellie Lois Parlee


Maiden name of mother,


. Nellie Storme.


Residence of parents,


Thelmalad


(at time the birth occurred.)


Occupation of father,


Carpenter


(at fitne the birth occurred.)


Birthplace of father,


New Brunswick


Birthplace of mother,


England


SIGNATURE.


L'Theodore Parle


RESIDENCE.


(City or town, street and number, if any.)


Chelmsford


Relation to child, if any. Father


Date, May 2, 1905.


Then personally appeared before me the person whose signature appears above and made


oath that the statements subscribed to by - him are truc.


Odward J. Robbins (gir or town.)


Clerk.


Recorded


Of Chelmsford Mass.


Sex, Female


Color, It hite


Condition (twin, &c.), Jwvin


Place of birth,


Chelmsford


5


Commontucalth of Massachusetts.


No. 5


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth of Israel & ayotte (Name of/child.) in the Town of Chelmsford


(City or town.) (Name of clty or/town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, November 3, 1891


Name of child, Serael . ayotte


Sex , male


Color, White


Maiden name of mother,


Exilda Lambert


Residence of parents,


Chelmsford


(at time the birth ogeurred.)


Occupation of father,


Farm Laborer


(at time the birth occurred.)


Birthplace of father,


Canada


Birthplace of mother,


Canada


SIGNATURE, anthony his X ayotte


RESIDENCE.


(City or town, street and number, if any.)


Chelmsford


Relation to child, if any. Father


Date, august 11, 1906


Then personally appeared before me the person whose signature appeare above and made


oath that the statements subscribed to by hum are true.


Edward J. Rolling Town Clark


Recorded


Of Chelmsford Mass.


Condition (twin, &c.),


Place of birth,


Chelmsford.


Name of father,


anthony . Carotte


Commonwealth of Classachusetts.


No.


6


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap, 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth


of Thomas Jeffery Hoare


in the Jown of Chelmsford


Name of child. )


(City or town.) (Name of city or town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, February 4, 1881


Name of child, 1. Thomas Jeffery Hoare


Sex, male.


Color, White


Occupation of father,


farmer


(at time the birth occurred.)


Birthplace of father,


Cengland


Birthplace of mother,


England


SIGNATURE.


RESIDENCE.


(City or town, street and number, if any.)


James Brown 15 Ohney St. 20wall mark


Relation to child, if any. Father


Date, September 10, 1906


Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by him are truc.


Edward Jobbing Town Clerk


(City of town. y


Recorded


Of Chelmsford Mass.


Condition (twin, &c.), ....


Place of birth,


Chelmsford


Name of father,


James B. Hoare


Maiden name of mother,


Rachel Jeffery


0010


Residence of parents, ....


Chelmsford


(at time the birthi occurred.)


Commonwealth of Massachusetts.


No.


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth Ruth Crisere Hunter .in the Vown of Chelmsford


(Name of child.)


(('ity or town.)


(Name of clty or town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record :


Date of birth, March 12, 1893


Name of father,


William R. Hunter.


Name of child,


Ruth Criesie Hunter


Maiden name of mother.


Crissie S. Staples


Residence of parents


No. Chelmsford


(at time the birth ogcurred.)


Oceupation of father,


Paving-cutter


(at-time the birth occurred.)


Birthplace of father,


Scotland


Birthplace of mother,


Canada


SIGNATURE, William H. Hunter, North Chelmsford


RESIDENCE.


(City or town, street and number, if any.)


Relation to child, if any. Chatice


Date, June 22, 190 7


Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by him .are true.


Edward Rafting


. Clerk.


"City of towH.)


Recorded


Of


Mass.


Sex, Feriale


Color,


Condition (twin, &c.),


Place of birth, ".


North Chelmsford


No. 8


Commonwealth of Classachusetts.


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth of Charles Edward Wat (Name of child.) in the Town of Chelmsford


(City or town.) (Name of city/or town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : --


Date of birth, July 16, 1904


Name of child, Charles Edward Tratt


Sex,


Color, White


Condition (twin, &c.),


Place of birth,


Unelmara Mase.


Name of . father Grave " Hatt-


Maiden name of mother auric


Residence of parents,


thehnout Man.


(at time the birth occurred.)


Occupation of father,


Carpenter


(at time the birth occurred.)


Birthplace of father, ,


Birthplace of mother, amman Poraine


SIGNATURE.


RESIDENCE. (City or town, street and number, if any.)


Relation to child, if any.


Date, Jeman


Then personally appeared before me the person whose signature appear above and made outh that the statements subscribed to by The are true. Edward I. Rolling Clerk.


Recorded


(City or town.)


Mass.


2472


Commontocalth of Massachusetts.


No.


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH.


(St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth


(Name of child.) in the Crown of Chelmsford


(City or town.) (Name of city of town.)


does not fully and correctly state all the faets relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, July 11, 1109


Name of child, 7 Idie houve Bradley


Maiden name of mother, aquitho L Sex, Minute


3 Bullock


Residence of parents,


(at time the birth occurred.)


Color, 2 hits


Occupation of father,-


Narenner


/ (at time the birth occurred.)


Birthplace of father,


Beckmanntown N. 210


Birthplace of mother,


New Brunavier


SIGNATURE.


RESIDENCE. (City or town, street and number, if any.)


Relation to child, if any.


Date, tiernan


Then personally appeared before me the person whose signature appears above and made


oath that the statements subscribed to by him are true. Edward & Rotting (('ity or tuwu.)


Clerk


Recorded


Of Ancora Mass.


Condition (twin, &c.),


1


Place of birth, heime 'and


Name of father, Seine 2. Bracia


Commonwealth of Massachusetts.


No. 10


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath deposes and say that the record relating to the birth of alfred Idans Byam


(Name of cht!do in the Town of ... Chelmsford


(City or town.) (Name of city or town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, June 0 1852


Name of father,


: George a. Byany


Name of child, Arnold adama Byum


Maiden name of mother,


Residence of parents, ...


Chelmsford Marz


(at time the birth occurred.) A U


Color, Ithit


Occupation of father,


gauyer


(át time the birth occurred.)


Condition (twin, &e.), ...


Birthplace of father,


Chelmsford


Place of birth, ...


Birthplace of mother,


Chelmsford


SIGNATURE.


RESIDENCE. (City or town, street and number, if any.)


Relation to child, if any.


Date,


Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by are true.


Clerk


(City or town.)


Recorded


Of


Mass.


Sex, male


Commontocalth of Massachusetts.


No. 11


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth


(Name of child.) in the (City or town.) (Name of city or town.) L 1 does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, July 11, 1886


Name of child, Hay Sinewh Shoulding Byany


Sex,


Color, ichit


Condition (twin, &e.),


Place of birth, ...


Chelmsford back.


Name of father, George i. Byjam


Maiden name of mother.


Residence of parents,


(at time the birth oeeurred.)


Occupation of father,


à aurier


(at time the birth oeeurred.)


Birthplace of father,


Birthplace of mother,


Chelmsford Mars.


SIGNATURE.


RESIDENCE. (City or town, street and number, if any.)


Relation to child, if any.


Date,


Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by him are true.


. Clerk.


(City or town.)


Recorded


Of


Mass.


Commonwealth of Massachusetts.


No.


12


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record, relating to the birth OM robert Edward Coughlin .. in the John of _- Ohelmet and (Name of child.) (City or town.) (Name of city or town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, Nov. 19, 1908


Name of child, Robert Edward longhi


Maiden name of mother.


Mary Carmichael


Chelmsford


Color,


White


Occupation of father,


Gransee (Halen, mill)


(at time the birth occurred.)


Birthplace of father,


Ireland


Place of birth.


Chelmsford mars.


Birthplace of mother,


Small mass.


SIGNATURE. Imichael& Coughlin.


RESIDENCE. (City or town, street and number, if any.)


Chelmsford


...


Relation to child, if any. Father


Date, august 5, 1910


Then personally appeared before me the person whose signature appears above and made


oath that the statements subscribed to by him are truc. Odvar


Clerk.


(City or IgnIN)


Recorded


Of


Mass.


Name of father


michael. Coughlin


Sex, male


Residence of parents,


-


(at time the birth occurred.)


Condition (twin, &c.),


62


Commonwealth of Classachusetts.


No. 13


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath deposes and says that the record relating to the birth of James


(Name of child.) mullin in the Town of Chelmsford (City or town.) (Name of city of town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


22


Date of birth,


ang 20,


1897


Name of child,


James Mullin


Sex, male


Color,


White


Condition (twin, etc.), ..


Place of birth,


Chelmsford mac,


Name of father,


John Mullin


Maiden name of mother


Mary Burke


Residence of parents,


Chelmsford


(at time the birth occurred.)


Occupation of father,


Hoolen -chine


Birthplace of father,


(at time the birth occurred.)


Ireland


Birthplace of mother,


Ireland


SIGNATURE.


John hillin


RESIDENCE.


(City or town, street and number, if any.)


Chelmsford


Relation to child, if any. Father


Date, September 30, 1911


Then personally appeared before me the person whose signature appears above and made


oath that the statements subscribed to by him .are true.


Recorded


Edward . Rolling


Clerk


d'ity or ident. )


Of Chelmsford


Mass.


57


Commontocalth of Classachusetts.


No.


14


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath deposes and says that the record relating to the birth


of Lyman. a. Byjam in the Crownof ... Chelmsford (Name of child.) (City or town.) (Name of city of town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record :-


Date of birth, January 1, 1875


Name of child, Lyman a. Byam


Sex, male


Residence of parents,


So. Chelmsford man


(at time the birth occurred.)


Farmer


Occupation of father,


(at time the birth occurred.)


Birthplace of father,


So. Chelmsford mais


Condition (twin, &c.) , ...


Place of birth,


So. Chelmsford mars.


Birthplace of mother,


Boxborough man


SIGNATURE.


RESIDENCE.


(City or town, street and number, if any.)


Relation to child, if any.


frank & Bjam.


So Chelmsford Father


Date, March 31, 1913


Then personally appeared before me the person whose signature appears above and made oath that the statements subscribed to by him are true.


Edward J. Rothing (Aty or town.)


Clerk


Recorded


Of Chelmsford Mass.


Name of father, ..


Frank C. Byam


Maiden name of mother,


amelia F. Hetherbec


Color,


White


57


Commonwealth of atlassachusetts.


No.


15


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth of Selma Florence Bengtzon in the Town of thelmaford (Name of child.) (City or town.) (Name of city or toryn.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, Oct. 8, 1899


Name of father,


alexander a. Bengtzon


Name of child, Selma Florence Bengtsson Maiden name of moth


matilda Larcon


Sex, Female


Residence of parent


Nast Chelmsford


(at time the birth occurred.)


Color,


White


Occupation of father,


Stone-cutter


(at time the birth occurred.)


Condition (twin, &c.),


Birthplace of father,


Sweden


Place of birth,


Host Chelmsford


Birthplace of mother,


Surden


SIGNATURE,


RESIDENCE.


(City or town, street and number, if any.)


Relation to child, if any. Father


Alexander 4. Bengtzon N. Chelmsford


Date, Oct 25, 1913


Then personally appeared before me the person whose signature appear above and made oath that the statements subscribed to by him ... arc truc.


Echoand I. Rotting


Clerk.


Recorded


Oct. 25, 1913


¿City or town.)


Of Chelmsford


Mass.


67


Commonwealth of Classachusetts.


No.


16


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth of Choali Francia Mullin in the (Name of child.) (City or town.) .. of (Name of city or town.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of facts omitted or incorrectly stated in said record : -


Date of birth, Sept. 20, 1898


Name of father


John Mullin


Name of child harlee Francis Hellin


Maiden name of mother,


Mary Bruke


Residence of parents,


the lin ford


(at time the birth occurred.)


Occupation of father,


Horole-Sfinner


(at titne the birth occurred.)


Birthplace of father,


Ireland


Birthplace of mother, (


1


helind


SIGNATURE.


John Mullin


RESIDENCE.


(City or town, street and number, if any.)


- Chelmsford


Relation to child, if any. -Father


Date,


Hov.


5, 1913.


Then personally appeared before me the person whose signature appears above and made


oath that the statements subscribed to by are truc. Edward /11 Rotfry


Clerk.


Recorded


Of


Mass.


Sex, male


Color. While


Condition (twin, &c.),


Place of birth,


Chelon ford


1


Commonwealth of glassachusetts.


No. 11


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH.


(St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth of Charles Frederick Baldwin in the Town of ... Chelmsford


(City or town.) (Name of city ør town.) , (Name of child.)


does not fully and correctly state all the facts relating to said birth, and that the following is a true statement of faets omitted or incorrectly stated in said record : -


Date of birth, ZUlay 16, 1895


Name of father,


Charles H.


Name of child, Frederick Guy Baldwin


Maiden name of mother,


Hunnis In.


Residence of parents,


Chelmsford


(at time the birth occurred.)


Occupation of father,


farmer


(at time the birth occurred.)


Birthplace of father,


Lowall Mark.


Birthplace of mother,


Stone n. B.


SIGNATURE.


RESIDENCE.


Relation to child, if any.


(City or town, street and number, if any.)


Uncle


1) Date, Connar 29 1914.


Then personally appeared before me the person (whose signaturd appears above and made


oath that the statements subscribed to by him are truc. Edward . Rolling Clerk


Recorded


January 29, 1914


(City of town.)


Of Chelmsford Mass.


Sex,


Color,


Débute


Condition (twin, &c.),


Place of birth,


Chelmsford


r


Frederic G. Baldwin Lowell Mass.


١٠٠٠


8.5-


No. 18


Commontocalth of Massachusetts.


DEPOSITION


CORRECTING RECORD RELATIVE TO A BIRTH. (St. 1897, Chap. 444, Sect. 14.)


(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)


The undersigned on oath depose and say that the record relating to the birth of Josephine Margaret Higgins in the Crown of Chelmsford




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