USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 12
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Recovery
Commonbocalth of Massachusetts.
64
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
2. Name,
Victor Swanson.
(Maiden Name),* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
5
. ..
4. Color, t .
J. Age, . Years, 2 Months, 25 Days. Gastric Lever
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Sickness, . By whom certified,
weeks Is Harlow vyngaborough
West Chelmsford
7. Residence,
8. Occupation, . .
9. Place of Deatlı,". .
10. Place of Birth, . .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making( the Return, .
LAwrhidden
DATED at
A Chelmsford
, on
April 28
1592
* If a Married Woman or Widow. # If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indlan. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1891 .- 5,000.
West Chelmsford Quincy Jack Swanson Noharm Anderson Sweden Sweden
West Chelmsford
No.
18 1892
Male
[ACTS OF 1888, CHAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Seetion three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnishi 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 deeease. If a physician negleets or refuses to make a certificate, as aforesaid, he 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 eity 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 eity or town clerk. No sueh permit shall be issued until there has been delivered to such board, or agent or elerk, as the case may be, a satisfactory written state- inent 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 seetion 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 eannot 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 elerk, 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 to its agent, the board or agent shall forthwith countersign and transmit the same to the elerk 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. [Approved May 4, 1888.
I
-
Rec
1650
[PLEASE FILL OUT WITH INK. ]
Undertaker's Return
To the Board of Health and the Clerk of the City of Lowell,
IF Undertakers must make this return before the burial or removal of the deceased.
Date of Death, ferty
I89 . Name, { Y,eller
Maiden Name,
Sex # male; Color,. --
Single, Married, or Widowed,
Age, -years, -months, . day's.
Name of Attending Physician,
Residence of Deceased-No ...
Chelmsford
Street (or Corporation,) Ward
Occupation, Husband's Name,
Place of Death-No.
Street (or-Corporation,) Ward ..
2
Birthplace of Deceased,
Father's Name,.
+2 Ther louga Father's Birthplace,
Mother's Name, Galda 1 Mother's Birthplace, ebenruller
Mother's Maiden Name, "
Place of Interment, .
ba Thelie
Cemetery Range,
Lo ................ Gra .............
Signature of Undertaker or Informer,
2
Dated at Lowell, this
3 th
day of
1892
Physician's Certificate of the Cause of Death. [See extracts from Acts of Legislature below. ]
Date of Death, .....
2
189 2
Name and Sex of Deceased,
male,
Place of Death-No.
Street (or Corporation. Disease or Cause of Death, duration of * . . .. .... Complications, ..
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, ..
Residence, No. (flere Chand Street
Dated at Lowell, this 4 day of .. N 1892
* Rerkoned to the time of death.
180
-------
10 --
RETURN OF DEATH
Rec
Commonwealth of Massachusetts.
166
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),* . (Name of Husband),*
Male
4. Color, t
5. Age, .
Years, ..
Months,
Days.
Still born
In like to lotulme ford
Test Chelmsford
7. Residence,
8. Occupation, .
9. Place of Death, .
10. Place of Birth, .
11. Name of Father,
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment, .
Hest Chilomeford
Charles & Walker Lillia andrew
Sunderland It arlington Ht
West chelmsford
Signature of Underluker or other person making the Return, .
Doshidden
DATED at
West Chilme from July
11
* If a Married Woman or Widow. { 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.] Plate. Ed. May, 1891. - 5,000.
10 1892
Machen
3. Sex, and whether single, Married, or Widowed,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
[ACTS OF 1888, CHAP. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
SECTION 1. Section three of chapter thirty-two of the Public Statutes, requiring attending physicians to furnish for registration certain facts relating to deccased 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 liis last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforesaid, he 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 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 state- ment 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 110 attending physician, orif 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 samc. When such satisfactory statement and certificate are de- livered 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. [Approved May 4, 18SS.
Rel
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN.
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must make this return before the burial or removal of the deceased.
7
·
Date of Death July 29
189. Name,
Maiden Name,
Sex, ..... .. male; Color, 2
Single, Married or Widowed, Age, - years, / months, 27 days.
Name of Attending Physician,. (Dr cibiqueautix
Residence of Deceased-No. Themto ford /hugostreet (or Corporation), Ward.
Occupation, .. Husband's Name,
Place of Death-No. Cherils ford RoadStreet or Corporation), Ward
Birthplace of Deceased,
Cheils Ford
Father's Name,
Matese remblay
.. Father's Birthplace,
Canada
Mother's Name,
Henriette Mother's Birthplace,
Mother's Maiden Name,
4
Carreaux
Place of Interment,
Catholic
Cemetery Range
.... , Lot .. ........ , Grave.
Signature of Undertaker or Informer,
Dated at Lowell, this
29
the
day of
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death, Arele 29 189 2
Name and Sex of Deceased,
.male,
Place of Death-No.
Street (or Corporation).
Disease or Cause of Death, - Cholera infantino duration of *.
Complications, I certify that the above is a Aud uthy the best of my recollection and belief.
Name and Professional Title,
Residence, No. 310 merriman Street
Dated at Lowell, this 29 day of
189.2
*Reckoned to the time of deatlı. [Be very particular to fill the blanks, and strike out words that are not correct, such as street or corporation, single, married or widowed, and insert "fe" before male when the deceased is a female, and when the deceased is colored, please insert.
...... .
180
. . . . ..
........
-: 10-
RETURN OF DEATH
RCL UNDERTAKER'S
RETURN.
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must make this return before the burial or removal of the deceased.
Date of Death July 22h
189C
Name,
Lennie E Jaagen
Maiden Name
Sex, Lemale; Color,
Single, Married or Widowed,
Age, ..
.... years, .
2
..... months,
4 days.
Name of Attending Physician,
Residence of Deceased-No.
Chelmsford
Street (or Corporation), Ward
Occupation, ..
Husband's Name,
Place of Death-No. .
Chelmsford
Street of Corporation), Ward
Birthplace of Deceased,
Chelmsford
Father's Name, Lawrence & Sorgen Father's Birthplace,
Heweach maine
Mother's Name,
Emma 9
Mother's Birthplace,
Waren 22
Mother's Maiden Name, .
Haldrom
Place of Interment,
.Cemetery Range
Lot ............... Grave ....
Signature of Undertaker or Informer,
Jamen Il Branka
Dated at Lowell, this
23 en
day of
180 2
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
July 22
1892
Name and Sex of Deceased,
Lenale ,
Place of Death-No.
-Street for Corporation).
Disease or Cause of Death,
Cholera cufantino
duration of * ..
......
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
Residence, No.
52
Street
Dated at Lowell, this
2032
day of
July
189 ... 2
*Reckoned to the time of deatlı. [Be very particular to fill the blanks, and strike out words that are not correct, such as street or corporation, single, married or widowed. and insert "fe" before male when the deceased is a female, and when the deceased is colored, please insert.
168
PLEASE FILL OUT WITH INK.
RETURN OF DEATH
-OF-
..... 180
Is Trueworthy
169
7
PLEASE FILL OUT WITH INK.
UNDERTAKER'S
RETURN.
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must make this return before the burial or removal of the deceased. Date of Death august 23
189.22
Name,
Mary de Menonein
Maiden Name,
Sex male; Color,
-Single, Married or Widowed,
Age, 56 years, - months,. ... days.
Name of Attending Physician,
Residence of Deceased-No.
Chelusford
Street (or Corporation), Ward
Occupation,
Not Have
.Husband's Name,
Place of Death-No.
Chelmsford
Street or Corporation), Ward
Birthplace of Deceased,
Theland
Father's Name,
Je hundley Trans father's Birthplace,
Mother's Name,
Mother's Birthplace,
Ireland
Mother's Maiden Name,
Place of Interment,
Catholic Lowell
.. Cemetery Range .. , Lot .. . , Grave .. .....
Signature of Undertaker or Informer,
Dated at Lowell, this
day of
189
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
august 23
1892
Name and Sex of Deceased,
Mary Mc Menconim
finale
.małe,
Place of Death --- No.
Chelmsford
Street (or Corporation).
Disease or Cause of Death,
Wieder of the Stomach
duration of * three months.
Complications,
Hemorrhage from Stomach
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, John Colyoki Nichols M.D.
Residence, No.
Chelankford Mais
Street
Dated at Lowell, this
twenty Korinth
day of
Ring. +
180°
:
-
.
..
.. .. . . . . . . .
-10-
RETURN OF DEATH
170
PLEASE FILL OUT WITH INK.
UNDERTAKER'S
RETURN.
To the Board of Health and the Clerk of the City of Lowell.
Undertakers must make this return before the burial or removal of the deceased. Date of Death Ruc,just 29
Name,
1892
tienereces
if france
Maiden Name,
Sex, ......... male; Color,
Single, Married or Widowed,
.....
Age, ............ years, ..
3
months,
.days.
Name of Attending Physician,.
Residence of Deceased-No.
Street (or Corporation), Ward
Occupation,
Husband's Name,
Place of Death-No.
2.
Forthe Chicksford Lucas street or-Corporation), Ward
Birthplace of Deceased, ..
Father's Name,
Marcas Layer
Father's Birthplace,
Mother's Name,
Dicasy/
Mother's Birthplace,
Mother's Maiden Name,
Buary £ forder
Place of Interment,
Catholic lonely Cemetery Range.
, Lot ..
, Grave ..
Signature of Undertaker or Informer,
Dated at Lowell, this
....
day of
189
Physician's Certificate of the Cause of Death.
(See extracts from Acts of Legislature below.)
Date of Death,
aug. 29.
189.9.
Name and Sex of Deceased,
Francis fragole Joyce
.. male,
Place of Death-No.
Chelmsford.
Street (or Corporation).
Disease or Cause of Death,
marchmus
duration of *
3 months.
...
Complications, ...
Dianhora
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title
JohntoVichos
M.D
Residence, No.
Chelmsford
Street
Dated at Lowell, this
0300
day of ...
189 2
189
...
.. ............ ..
. .....
-OF-
RETURN OF DEATH
Commonlocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),* · (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, Years, ~ .Months, - Days. Premature birth
Disease or Cause of Death, (Primary and Secondary), #
6. {Duration of Siekness, . By whom certified, ·
A. B. Edwards M. D.
North Chelmsford Hass.
7. Residence,
8. Oeeupation, . . . .
9. Place of Death, . .
10. Place of Birth, . ·
.
11. Name of Father,
12. Name of Mother, · (Maiden Name),
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
4 reward Porvell Class
Signature of Undertaker or other person making the Return, . ·
DATED at
Forth Chelmsford, on
fue, 28th
1892
* If a Married Woman or Widow. { If a Soldier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (I.) Indlan. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1891. - 5,000.
İ
Act 28th 1892 Marcaret 2of 222
France ......... ...
.
£
Single
North Chelmsford Has North Chelmsford Mais Thomas Ellen (e atom) Jobm St. Johns V. B.
[ACTS OF 1888, CHAP. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
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, he shall be pull- 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 thic 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 therc has been delivered to such board, or agent or clerk, as the case may be, a satisfactory written state- ment 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 de- livered 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. [Approved May 4, 1888.
Commonwealth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, . . (Maiden Name ) ,* · (Name of Husband),*
Sarah
Termins
1
Female
3. Sex, and whether single, Married, or Widowed,
Single
White
4. Color.t . ·
5. Age, . Years, 5 Months, 13 Days.
Disease or Cause of Death, (Primary and Secondary), ;
6. Duration of Sickness, . By whom certified,
7. Residence, . . .
8. Occupation, . .
·
. North Fremst
10. Place of Birth, .
11. Name of Father, ·
12. Name of Mother, . (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person.making the Return, .
IrThus to fieldon
C.
DATED at
1. Hur ford, 011
Left 1 st
18 2
* If a Married Woman or Widow. { If a Soklier who served in the War of the Rebellion.
t If other than White. (M.) Mulatto. (1.) Indian. If of other Races, specify what.
{Be very particular to fill all Blanks.] Plate. Ed. May, 1891. - 5,000.
Cholera Infantum
3 days
A.B. Eduvara
Forth Chelmsford
9. Place of Death, .
Patrick Kering
Annie Harrington Kermis Ireland
Ireland
Lowell Mass
[ACTS OF 1888, CHLAF. 306.] AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows .
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 deccascd, his age, the disease of which he died, the duration of his last sickness, and the date of his deeease. If a physician neglects or refuses to make a certificate, as aforesaid, he 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 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 state- ment 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 licu thereof a certificate as hercinafter 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 de- livered 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 otlier 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. [Approved May 4, ISSS.
Commontocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name,
(Maiden Name),* · (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Single
White
4. Color, t
5. Age, .
Disease or Cause of Death, (Primary and Secondary), #
1
6. Duration of Sickness, . By whom certified, .
7. Residence, .
8. Occupation, . .
9. Place of Death, . ·
10. Place of Birth, .
11. Name of Father, · 12. Name of Mother, · Hannah (ll Hunter) Hor den (Maiden Name), 13. Birthplace of Father, . terfield s.H. 14. Birthplace of Mother, . Tyngsboro plass. North Chuelinsford Has,
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur H Sheldon
DATED at
Soft A Chelmsford Sept 7th
189.2
* If a Married Woman or Widow. # 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.] Plate. Ed. May, 1891 .- 5,000,
feb 1- 6h 872 Charles H. Horten
..... . . .. . ..
.. ...... . ...... ........ ...... . .. ..
Male .... . ...... .....
52 Years,
Months,
2 Days.
Brights disease.
6 months
7. W. Pile 1. 2)
North Chelmsford Class, proof for ter.
A Chelmsford Mais. Agustina A. N. Allen Worden
[ACTS OF 1888, CHAP. 306.]
AN ACT
RELATING TO THE CERTIFICATES AND REGISTRY OF DEATHS, AND THE BURIAL AND REMOVAL OF BODIES OF DECEASED PERSONS.
Be it enacted, etc., as follows :
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, he shall be pun- ished by a fine not exceeding fifty dollars.
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