USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1891-1893 > Part 19
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No.
Commontocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, . .
June 27th , 89 Lavan Il. Vickery
2. Name, . (Maiden Name),* 12 Esra Vickery
Female
Widow
White
4. Color, f
5. Age,
79 Years, 10 Months, 12 Days. forfatter Gull Stones
two months
L. A. Harlow M. 2
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, .
14. Birthplace of Mother, .
15. Place of Interment, .
Signature of Undertaker or other person making the Return, . · ·
DATED at
N Chelmsford
June 28 1893
* 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.
......
Gilson
(Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Disease or Cause of Death, (Primary and Secondary), # 1
6. {Duration of Sickness, . By whom certified, ·
North Chelmsford Muss. House keeper
...
North Chelmsford class. Lyngsborough Mars. Salomon Gilson omon Merci, (Wyman) Gilson Pelham
Pelham
NA
1
lass
Is thus to She Con
[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 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.
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 cluly appointed agent, or, if there is no board of health in such city or town, from the eity or town clerk. No such permit shall be issued until there has been delivered to sueh board, or agent or elerk, as the ease 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, or if the certificate of the attending physician cannot be obtained, for good and sufficient reasons, carly 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 certifieate as is required of the attending physician; and in ease of death by violence, the medical examiner shall, if requested, make the same. When sueh 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 execeding fifty dollars. [Approved May 4, 18SS.
2.6 Adams Thomas M Atwood Maria Atwood sa Ayotte Antoine
47 80 bapp game of 1 81 book Sarah P. 63 116 Crowley Timothy 125 220 Curran James 132 Ay otte Thomas 223 Clark Charlotteet. 140 Byotte Alexandre 224 Chamberlin sach 16.2
boutures /66 Carter M Jamie 180 Callahan Mary J. 207 ; K Chantiers Williane M. 216 20 Laux 34 Goodmande Harthe 2. N C 44 Dearborn Delrey X. 2 22 53 JEau Eliza
Blood Sarai
Brown - Jancit t. Tradt Erric q. Burning Finances of. Brown William A. Battles William 1 Bray Charles H.
76 - aux c xp veck 1. 37
77 DEvent Channel
Burun Emma F. 82 Davis Bernice Beau Nathan 6.88 Ayar Rachel & (
45- 69 89
BlodgEM Betsey 8, 99 Davon Lewis M Boughton Nière & /05/ ...... in 1
100 118 Butlers Many & Byam 114 Wally Bridget 108 Iulie ( lizabeth 119 131 134 Bridg ford Margarite 2, 156 Dixon Blackman Frances A. 107 Wadmin tabella is. 141
B
C D
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F
G H
L M
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Contrerfreed B
D
Davis George 8. 154 .
184
Bailary Mary J. 18y Devine Clean 189
Brown Lydia Ml 193 Bridg ford Beatrice 222 Batchelder Orrin 8. 225 Bridg ford Mary J. 234
Gay Adeline F. Eagleton Patrick 138 Gmiston Robert Edmonds Philip. 192 Gallagher John Edwards Harriet Eaton Mary Olla 219
200 Ermon Dore Mauzo Garneau Antonia 1
Greene Alice May
Gordon William 2 177 183
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Gagnon (ver)
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1
Harries ou fares et L
M.it Elisabeth F. M Hill- Grunge S. A. 27- N .
Not acil fo 36
Hildreth Bracjamie 16 47 2
Hodgson Fired 59 24 Hodges Benjamin Ct. 8% 61 Higgin us . . /03
87 Nael Ebeneser /26
115 Harriman Sarah 159
130 Holland Jour 160
142 Hubbard Are CH 169
221 Have Mercy M. 17/
Hauson Sarah J 174
Hoyt Jonathan f. 176 179
Hayas Matthew
9
Jimegan Bernal Jimmick Richard Fransinno - -
Jakey Bridget L'aulayson Ella 6 Flanders Franny E. Fish Parles til. In
68
90 E F G
Gilineare Antonia 218 Gagnon Joseph S. 237
Gilbert Jerome B. 258
Nurchis Nallie 8 181 Hapgood Antoinette M. 195 Hutchinson Hezekiah A. 198
Howard Cristiana R 214.
I+J
110 -Mansfiel priest 2 61 el artore
n 25 4 Mooney Aques 11 Mahoney Mary 2.7
C Josselin Myrthe Jacobson Christina Jeffrey Harriet 150 dla boy Walter 1. 46
Kittredge Kelleher Michael Reisen Mary
LE Diaul verra Lane Mary Leaky Robert ON.
Lancom Jonathan 104 Morton Marcha
139
Lane Daniel W 146 Marchall Area R. 143 3
Lane John H
185 Magant Regina 144
Lowell Almera N. 190 Mabarthy Mary 145 197 Morton Mary 167
Lauphere Mary J. Le Mail. Little Michael
203 M Entire Martine W. 170 215 Manomin James 182 2 Eavill Stephen B 217 Mc 2 mand Margaret 204
Morton True 209
Marshall Ann E. 3) Me Emis (Infant) 5'8, K 64 L 128 No Cabe Nauce, 153 Millar Alfred S. 91 M
196 Minuter Ova 92 N
208 Mc Mahon Catherine 93 Me Nally
Bridget 102 Marchall Myra 109 69 .0 8meanery
>5- 11º licciana Katra 135
M.
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Me Onaney Magam Heury B. 230. Mier Victorie 209 Mitchell Louisa 24/ 243
Jours Matter S. 233
Nicklas Elbridge 9, 26
O Verl Bartholomew Olsen Aguente Ohlsen Sven Osgood Ganger /
Ober Albert W 235
Dolley Grace $. Pernam David Pollard Dawson Perry Abigail B. Petersen Clara Prince Mary ! Peterson Caroline Themado Laura A. Provancha George Park Andrew J. Autrey Sarah M. 19 Pike Wor OB. 98 Parker James A. 10% Parker Eli P.
66 72 73 74 133 149 158 163 165 173 186 19/ N
23/ 242
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Dingley Williams 78
Quessy Joseph G. 106. - Dressy Margaret 11. 120
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Smith Sheehan Johanna Ripley Steams Russell Stativa 30 Sheets 6 0 60 pieds J'aimail. V. Robinson Frederick N 7/ Sweet Russian La 83 (vi )=a
Roberge Gruest
Grady Franck 94 Smith Isabelle Roberts Nathaniel 112 Stackpole Ellen M. 56 Reader Detrick
5 124 Streete George W. Roby Christopher 199 Spaulding glice 8. 95 James Joseph T. 201 Sweat Charlotte Frances 117
122
Reardon John 6. 2020mich Lydia 8.
1275 Rodliff Horatio N. 210 Steams Edwin 2 Robert Medard 228 Smithson David 129 Reed Frederic G. - Lucy
229 Seymour 136 Roby Caroline w 2x4 Spaulding sarah B. 152 need Thanks S. 2500panicking Williame N. 155 Shields Many A. 164
Trudeau J. Baptiste Toye William Fully Margaret a, 62 Iramblay Joseph H. Tremblay Pierre 1137 Julie Florance , 147 Taylor Slan F 168
T
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Smith Sarah +. Shad forum 5
175 Trudeau Ova M. 194 178 Tremblay Marie × 206 - 188 Sample Mary 232 205 Truley George &. 240 . Severance Elizabeth B. 227 vanillay Marie 248
Sweetser Many
Shepherd Cecil R. 2316
Sleeper Abbey A.
Smith Harcam 247 Smith --- - -
249
V
Yassalin Yasalin. - -
148
1
Nestore 3
Wright Nacel & 70
Whittier, Samuel 10/
Worten Edgar A. 121
Hining E dich A. 172 Ward Florence 8 211
Warley Sarah 212 Westburg Ida 226 Warren Odwie H. 246
Ree
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),*
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, .
53 Years,
Months,
Days.
Chrono bronchitis
1
1
Levesal PLAN
4
North Chelmsford Muss.
Housekeeper
8. Occupation, .
9. Place of Death, . .
10. Place of Birth,
11. Name of Father, ·
James Cummings
Mary- Gumm 1
J
12. Name of Mother, . (Maiden Name),
13. Birthplace of Father, . Ireland
11. Birthplace of Mother, .
15. Place of Interment,
Lowell Mars.
Signature of Undertaker or other person making the Return, .
Arthur H. Sheldon
1
DATED at ....
rs orl, on
5
18%
* 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.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1891 .- 5,000.
June 30th 1893 Marquet Donecan Cummings Patrick Donegan Female
Married White ..
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
North Chelmsford Class Ireland
Ireland
[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 tlie best of his knowledge and belief, the name of the deceased, his agc, 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.
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- inent containing the facts required by this chapter to be returned and recorded, togetlicr with the certificate of the attending physician, if any, as required by section threc of this chapter, or in lieu thercof a certificate as hercinafter 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 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.
Rev No.
Commonbocalty 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,
Henly Quedn & Palmer. Sucan a martaino Cristian & Pulver M d'emale 1Vidamed
4. Color, t
5. Age, . . 66 Years, 6 Months 287 Days. Disease or Cause of Death, (Primary and Secondary), ; Alcevat in of tourelles 4 HENRET Dr. Dr. flecken,
6. {Duration of Sickness, . By whom certified,
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, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
DATED at , O11 1 ...
18 3
/
* 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.
So Chelmsford
To Chelmsford
......
S. Martino < Truean R aller Gloucester Mare, stoucester trace To Chelmsford
[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. Scction 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 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, 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 arc dc- 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 persou violating any of the provisions of this section shall be punished by a fine not exceeding fifty dollars. [Approved May 4, 1888.
Reo No.
Commonbocalth of Massachusetts.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death,
2. Name, ·
,02 8.92 Amasa ). Chandler
(Maiden Name),* · (Name of Husband),*
Male .........
3. Sex, and whether single, Married, or Widowed,
Single
Mia.
4. Color, t
3. Age, .
·
Years,
Months,
22. Days.
Blood poisoning
Disease or Cause of Death,
(Primary and Secondary), ;
22 days
6. {Duration of Siekness, . By whom certified,
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, .
14. Birthplace of Mother, .
15. Place of Interment, ·
Signature of Undertaker or other person making the Return, . · · ·
Arthur to Sheldon
DATED at.
K Chelmsford, 01
July, 0th
1893
* If a Married Woman or Widow. I If a Soldier who served in the War of the Rebellion.
tlf other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] l'late. Ed. May, 1891. - 5,000.
O.P. Forter MD, Lowell North Chelmsford Muss.
North Chelmsford Mass. North Chelmsford Mass. Bert W. Chandler Edith l (Chase) Chandler
Lowell Mass.
North Chelmsford Hors,
[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 tlie best of his knowledge and belief, the name of the deceased, his age, the disease of which he dicd, the duration of his last sickness, and the date of his decease. If a physician neglects or refuses to make a certificate, as aforcsaid, 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 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 finc not exceeding fifty dollars. [Approved May 1, 1888.
Red
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Deathı, .
Feely 15 -1893 Mary Dalung
2. Name,
(Maiden Name),* · (Name of Husband),*
*****
Farnes
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, .
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified,
7. Residence,
8. Oeeupation, '. .
.
Housekeeper
9. Place of Death, . .
·
ruland 010
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, . ·
Fraich Boudreau
DATED at
Cheese Jord
. , Onl.
July 15
1893
* 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.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks.] Plate. Ed. May, 1891 .- 5,000.
... ...................
80 Years,
Months
Days.
A Ofreces fond
10. Place of Birth, .
ruland
[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.
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 cluly 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 no 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 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.
Ree No.
Commontocaith 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,
16 rue.
4. Color, t ·
5. Age, 15 Years, / Months, / Days.
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified, .
Dr. En El amiberique.
douthe Other ford 20
7. Residenee,
8. Oeeupation, .
9. Place of Death, . .
10. Plaee 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, .
-
2017:12
DATED at
, on -11121
1897
* 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.) Indian. If of other Races, specify what.
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