USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 10
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The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. (See section 7.) Penalty for neglect to comply with the requirements of seetions 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certifieate setting forth the required faets. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
canal rites preliminary to the interment of a human body shall obtain the physician's 1 1. wanting 1 to the board of
Rec
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City or Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Sex
x Female color,
Date of Death,
Feb, 20
1899 ; Age, 44 Years,. 2 Months, .Days.
Maiden Name, { If married, widowed )
or divorced.
Lipanna M. Perhan
Husband's Name,
Lewis Dutton
Single, Married, Widowed or Divoreed,
Widow Occupation,
Housewife
1
*Residenee, aiso state fully. )
{ If out of town, }
Chelmsford
Place of Birth,
Chehereford
*Place of Death,
Chehulsford
Name of Father,
Sammell T. Palam
Birthplace of Father,
Wilton M. Fl.
Maiden name of Mother,
axenach (Levis)
Birthplace of Mother,
Francistown, D. 26
Place of Interment, (Give name of Cemetery),
Chelmsford Center
Dated at
Chelmsford, Mais
ture and
Walter Perhan
on
Feb. 21,
189 9
place of business
3
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Legauma N. Duetter Age, 448.2 M.
D.
Place and Date of Death, ¿
died at
Thehusferd Feb 20
1899
Disease or Cause of Death, §
Pulmonary Lebenque alix
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician. Lawell mass.
M. D.
Date of Certificate,
1899 .
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If ehild died immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
6
1
No.
RETURN OF THE DEATH
OF
at
Date,
189 ..
Filed,
189
The provisions of chapter 444 of the Aets of 1897 require that every householder in whose house a death occurs, the - oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of sueli a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred. (See section 6.)
The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. (See section 7.) Penalty for neglect to comply with the requirements of seetions 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts. (See section 10.)
Penalty for refusal or negleet, ten dollars. (See section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certifieate made in accordance with section 10, and return it, together with the facts required by section i, to the board of health or to the clerk of the city or town in which the death occurred.
Rec
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City of Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
George & Duran
Sex, Mole Color, White
Date of Death,
March
4th
.1899; Age, 55 Years,
2 Months,
6 Days.
Maiden Name, {If married, widowed )
or divoreed.
Widowant
Husband's Name,
-
1
Single, Married, Widowed or Divorced, Widowed Occupation, Blacksmith
* Residence, { If out of town, }
¿ also state fully. §
North Chelmsford
Mass
Place of Birth,
North Chelmsford
11
* Place of Death,
North Chelmsford
Name of Father,
Thomas
Durant
Birthplace of Father,
Chelmsford Mass
Maiden name of Mother,
Elizabeth (Marshall) Durant
Birthplace of Mother,
Sharon
N.A.
Place of Interment, (Give name of Cemetery), ...
North Chelmsford Cemetery
Dated at. North Chelmsford
Signature and
Arthur N. Sheldon
on
March 6th
189 9
place of business
of Undertaker.
North Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death, ;
died at.
North Chelmsford March 4
189.9
Disease or Cause of Death, §
acute Fleuriey
Duration of sickness,
two weeks
I certify that the above is true to the best of my knowledge and belief.
JE Varney
Signature and Residence S
of
Certifying Physician.
North Cheluo fond
M. D.
Date of Certificate,
March 5%
189 9.
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If child died immediately after birth, so state.
§ If a Soldier or Sallor in the War of the Rebellion, give both Primary and Secondary Cause.
68
George & Durant
Age, 55 Y. 2 1. 6 D.
No.
RETURN OF THE DEATH
OF
at
Date,
189
Filed,
189
The provisions of chapter 444 of the Acts of 1897 require that every householder in whose house a death occurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death oceurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the city or town in which the death occurred. (See section 6.)
The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such deathi. (See section 7.) Penalty for neglect to comply with the requirements of seetions 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required facts. (See section 10.)
Penalty for refusal or neglect, ten dollars. (Sec section 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certifieate made in accordance with section 10,
health or to the clerk of the city or than in w'
Rec
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 of removal of the deceased.
Date of Death,
Mas 9th
189% Name.
Julia do Autreer
Maiden Name,
Sex, .male; Color,
Single, Married or Widowed, married
Age, 5.5 years, 3
months, 11 days.
Name of attending Physician, In Solomon
Residence of Deceased-Novo Gehuld Street, (or Corporation), Ward
Occupation, Husband's Name
Place of Death-No. 0/0
.Street, (or Corporation), Ward
Birthplace of Deceased,
Father's Name hemar pmabridge
Father's Birthplace,
Mother's Name,
Silvia
Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Echar
Cemetery Range.
Lot
, Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
9 th
day of alui
1899
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
March 9th
1899
Name and Sex of Deceased, Julia A. Huntress
Le male.
Place of Death-No.
North Chamfort
Street, (or Corporation).
Disease or Cause of Death,
Paralysis
duration of
*
Gru Bear
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,
WilliamDSotemon m .?
Residence, No.
Street,
Dated at Lowell, this
Thursday
day of.
wasch
1899
*Reckoned to the time of death.
[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. ]
Approved,
69
When the Childt is still-born, so specify.
RETURN O. DANNY
OF
189
/
-
1
70
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,
March 140 ISO 9
Name
mary m?
Chaney
Maiden Name,
Sex,
male, Color,
Single, Married or Widowed, Dr Vanner
Age Jayears 7 months days.
Name of attending Physician, Residence of Deceased-No Worth Chefers on Street, (or Corporation), Ward
Occupation, Husband's Name
Place of Death-No ..
forth Selinaford Street, [or Corporation], Ward
Birthplace of Deceased,
Wieland
Father's Name,
Paties Mi Chaner
Father's Birthplace,
Ireland
Mother's Name,
Ulice
Mother's Birthplace,
.......
Mother's Maiden Name,
M: rally
Place of Interment,
Catholic Loures
Cemetery, Range~, Lot
,Grave,
Signature of Undertaker or Informer,
James J. ODonnell
Dated at Lowell, this
14
day of.
189
9
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW. )
Date of Death,
March 14
1899
Name and Sex of Deceased,.
Mary
Mª Enancy
female.
Place of Death-No ...
north Chelmsford
Street, (or Corporation.)
Disease or Cause of Death,
Old age
duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title, I à Varney me o ..
Residence, No. Ninh chehundert
Street,
Dated at Lowell, this.
14ch
day of.
Munch
189 .. 2 ..
*Reckoned to the time of death.
[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 "fc" before male when the deccased is a female and when the deceased is colored please insert.]
Approved,
When the Child is still-born so specify.
OF DEATH
OF
189
Rcc
71
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, Mar 16
189.9. Name Henry & Merrill
Maiden Name, Sex, ....... male, Color,
Single, Married or Widowed, Age26 years. 10 months 25days.
Name of attending Physician,
Residence of Deceased-No. Ofiterrefund Street, (or Corporation), Ward
Occupation, Husband's Name
Place of Death-Ne ...
Whiteausland Street, [or Corporation], Ward
Birthplace of Deceased,
Father's Name, Lyman N Merrily Father's Birthplace, Plymouth MIX
Mother's Name, Enzenline BB u 4 Mother's Birthplace,
Mother's Maiden Name,
Place of Interment,
Plymouth Cherry, Range.
Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this.
17
day of black
189.9%.
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death, Mar 16 1899
Name and Sex of Deceased, Harres & Merrill male.
Place of Death-No. Chterstand Mars Street, (or Corporation.)
When the Child is still-born so specify.
Disease or Cause of Death,
Intraculosin
duration of*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, Canaux Of, Chambuting m. D.
Residence, No .-
Chelwishing
Street,
Dated at Lowell, this.
day of
189.4.9 ...
*Reckoned to the time of death.
[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.]
Approved,
RETURN OF DEATH
OF
189
...
72
Onee
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, char 26
1899
Name Marissa P Hunk
Maiden Name,.
Sex, .. Lemale, Color,
Single, Married or Widowed, Age 817 years. 6 months 26 days.
Name of attending Physician,
(De Chamberlin)
Residence of Deceased-No High
Street, (or Corporation), Ward
Occupation,
ant Have
Husband's Name Amas Hunk
Place of Death-No. Street, [or Corporation], Ward
Birthplace of Deceased,
Father's Name, John Prestane
Father's Birthplace, Kasseney MMx
Mother's Name, Curice Prestan Mother's Birthplace, cukinany
Mother's Maiden Name, Carpintero
Place of Interment
Cabbar & S. Cemetery, Range ..
Lot
Grave,
Signature of Undertaker or Informer, & 13 Caricias
Dated at Lowell, this.
250
day of
.......
1899.
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW. )
Date of Death
Mar
26
1899
Name and Sex of Deceased, /Narciso
isa P
Hunk
male.
Place of Death-No.
High ht Ofleonsted Street, (or Corporation.)
When the Child is still-born so specify .
Disease or Cause of Death,
Sandy Debility
duration of *.
Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title, Edward Of, Chamberlin, M. D.
Residence, No.
Chelmsford
Street,
Mass
Dated at Lowell, this
27 fr
day of
Marche
1899.
*Reckoned to the time of death. [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.]
Approved,
DEATH
OF
189
1
73 1
Shee
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,
189.2
Name Mary & Mª Gillian
Maiden Name,
Sex, male, Color,
Single, Married or Widowed,
Age // years. 2 months days.
Name of attending Physician,
Residence of Deceased-No.
Cast Cheluns ford Street, (or Corporation), Ward
Occupation,
Husband's Name
Place of Death-No.
Last Chelunsford
Street, [or Corporation], Ward
Birthplace of Deceased, frites /1/1000
Father's Name, Michael M: Gillian
Father's Birthplace,
Vieland
Mother's Name,
Mother's Birthplace,
..
Mother's Maiden Name,
Conway
Place of Interment
Catholic
Cemetery, Range ...
.. ,ILot
Grave,
Donnell
Signature of Undertaker or Informer,
Dated at Lowell, this.
3d
day of.
april
1899
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
alm. 3!
1899
Name and Sex of Deceased, Mary J. M: Lillian
pzmale.
Place of Death- Chilometrifa East
.Street, (or Corporation.)
When the Child is still-born so specify .
Disease or Cause of Death,
anaemia
duration of*
8 months
Complications,
Bronchitis
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title, masa Staward M. D. Residence, No.
Street, ...
Dated at Lowell, this
day of.
apr.
189 .. 9 ..
*Reckoned to the time of death.
[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.]
-
RETURN OF DEATH
OF
189
74
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, April 5 1899 Name Henriette Tremblay
Maiden Name, Henriette Perreault Sex Female, Color, Whati
Single, Married or Widowed, Age 45 years. ~ months~ days.
Name of attending Physician, or Rochette
Residence of Deceased-No. Themes ford Center Street, (or Corporation), Ward
Occupation,
Housekeeper
Husband's Name Jule Tremblay
Place of Death-No. Chemilford Leenden Street, [or Corporation], Ward
Birthplace of Deceased,
Canada
Father's Name, Jule
Peneauch
Father's Birthplace,
Teunada.
Mother's Name, Marii
Mother's Birthplace,
Mother's Maiden Name, -
Place of Interment,
Chemes food
Cemetery, Range. , Lot .. ...... Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this.
6
day of
189.2
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death, Mary 5- 189 ... 2.
Name and Sex of Deceased, Aurulto Travelbay male.
Place of Death-No ....
Cercles
Street, (or Corporation.)
Disease or Cause of Death,
Excelente
When the Child is still-born so specify. duration of* 2 years Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title, CDrachelto
Residence, No. 740 Marwan
Street,
Dated at Lowell, this
6 te
day of ..
carel
1899
*Reckoned to the time of death.
[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 deccased is a female and when the deceased is colored please insert.]
RETURN OF DEATH
OF
189
Rec
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, April 15 189.9. Name Theodore Tremblay
Maiden Name,
Sex, ~ male, Color,
Single, Married or Widowed, ... Age ........ years ...... months:3 .. days.
Name of attending Physician,
Dr Rochette
Residence of Deceased-No. Chemes ford Centre Street, (or Corporation), Ward
Occupation, Husband's Name
Place of Death-No. Thenbeford Centre Street, [or Corporation], Ward.
Birthplace of Deceased,
1.1
Father's Name, Jule Sunday
Father's Birthplace,.
Canada
Mother's Name, Anna Mother's Birthplace,
Mother's Maiden Name, - farlin
Place of Interment,
Thenbe ford
Cemetery, Range Lot ........ , Grave,
Signature of Undertaker or Informer, Joseph Albert
Dated at Lowell, this.
15
day of.
April
189 .. 9.
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death, ... 1899
Name and Sex of Deceased, Theodor Freueblay male.
Place of Death-No. 6 keulford
Street, (or Corporation.)
When the Child is still-born so specify.
Disease or Cause of Death,
Debell-
duration of *.
3 days
Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title, Arbaelect 4
Residence, No. 140 Manual12
Street,
Dated at Lowell, this
16.15
.
day of.
189 ... 9.
*Reckoned to the time of death.
S
[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. ]
75
RETURN OF DEATH
OF
,89
Ret
76
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH.
To the Clerk of the City of Town in which the death occurred.
(FILL OUT WITH INK. ALL NAMES TO BE IN FULL.)
Name,
Edwin Lincoln
Sex, Que. Color,
Date of Death,
april
22
1899 ; Age, 38 Years,. 38 Months, /7_Days.
Maiden Name, { If married, widowed )
Husband's Name,
Single, Married, Widowed or Divorced, ...
Single
Occupation,
Farmer
* Residence,
¿ also state fully. §
Chelmsford,
Quase
Place of Birth,
11
11
11
*Place of Death,
11
"
11
Name of Father,
abbott Russell
Birthplace of Father,
Jorusend, Quase.
Maiden name of Mother,
Statua Garland
Birthplace of Mother,
Topsham, VL.
Place of Interment, (Give name of Cemetery),
Chelmsford Center
Dated at
Chelmsford
Signature and
Hatte Perham.
on
april 22
1899
place of business
of Undertaker.
Chelmsford Mars.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age, 38 Y.
M. 17 D.
Place and Date of Death, ; died at Juliusfare Wars april 2, 189 Street tauliner induced by Priamona's
Disease or Cause of Death, §
Duration of sickness,
5/1, days-
I certify that the above is true to the best of my knowledge and belief.
Signature aud Residence
Eduved It, Charcuter
M. D.
of
Certifying Physician.
Date of Certificate,
1 1899.
Give also street and number, if any.
t Or sex of infant not named. If still-born, so state. # If child died immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
No.
RETURN OF THE DEATH
OF
at
Date,
189
..
Filed,
189
The provisions of chapter 444 of the Acts of 1897 require that every householder in whose house a death oeeurs, the oldest person next of kin present at the time of the death of any of his kindred, or the person in charge of an institution in which a death occurs, shall, within five days after the date of such a death, give notice thereof to the board of health or to the clerk of the eity or town in which the death oeeurred. (See section 6.)
The commanding officer of a vessel shall give notice of the death of any person under his charge to the board of health or to the clerk of the city or town within the Commonwealth at which his vessel first arrives after such death. (See section 7.) Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars. (See section 8.)
A physician who has attended a person during his last illness shall forthwith after the death of said person, upon request, furnish for registration a certificate setting forth the required faets. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See seetion 11.)
Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certifieate made in accordance with section 10, and return it, together with the faets required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
Rue
Ed. Sept., 1859. 5 M.
[ACTS OF 1889, CHAP. 208.] AN ACT
Plate.
IN RELATION TO THE RETURNS OF BIRTHS AND DEATHS.
Be it enacted, etc., as follows :
SECTION 1. The elerk or registrar of each city and town shall on the first day of cach monthi make a certified copy of the record of all deaths and births recorded in the books of said city or town during the previous month, whenever the cleeeased person or the parents of the child born, were resident in any other city or town in this Commonwealth at the time of said death or birth; and shall transmit said certifled copies to the clerk or registrar of the city or town in which suel deceased person or parents were resident at the time of said death or birth, stating in addition the name of the street and number of the house, if any, where such deceased person or parents so resided, whenever the same ean be ascertained; and the clerk or registrar so receiving such certified copics shall record the same in the books kept for recording deaths or births. Sueh eertificd copies shall be made upon blanks to be furnished for that purpose by the secretary of the Common- wealth.
SECTION 2. This act shall take effect upon its passage. [Approved April 5, 1889.
Blank to be used in compliance with the foregoing.
Copy of the Record of a
DEATH
recorded in the books of the. City of. Lowell.
(City or Town.)
during the month of. April 1899.
1. Date of Death,
April 13, 1899
2. Name,
(Maiden Name), . (Name of Husband),
Amélia Gammell Davis
3. Sex, and whether single, Married, or Widowed,
Finale
married
4. Color,
50 Years,
6. Duration of Siekness, By whom certified,.
lo trish M. D.
7. Residenee,
1 West Chelmsford at Home
8. Occupation,
St John's Barbital Lowill
9. Place of Death, .
Princeton Mars
10. Place of Birth,
11. Name of Father,
12. Name of Mother,
13. Birthplace of Father, .
14. Birthplace of Mother, .
15. Place of Interment, .
Lowell Cemetery
I certify that the foregoing is a true copy.
Attest :
April 22 Isqc.
(City or Town.) .Clerk.
77
Isaac Davis
Lydia Davis
Months, Days. Fileraid Sumar
5. Age,
Disease or Cause of Death,
NO.
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death, .
2. Name,
March 2329 1899 Samuel Hodgson
(Maiden Name) ,* (Name of Husband),*
3. Sex, and whether single, Married, or Widowed,
Male Married White
4. Color,t
5. Age, Disease or Cause of Death, (Primary and Secondary), ;
61 Years, 9 Months, 22 Days. Cancer of the liver three months
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, (Maiden Name),
13. Birthplace of Father, .
11. Birthplace of Mother, .
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
Arthur H. Sheldon
DATED aty
North Chelmsford , on March 24
1899
1
* If a Married Woman or Widow. + If a Soldier who served in the War of the Rebellion.
1 If other than White. (M.) Mulatto. (I.) Indian. If of other Races, specify what.
[Be very particular to fill all Blanks. ] Plate. Ed. Dec., 1800, -5,000.
F. E. Varney M.D. North Chelmsford. Mars. Overseer North Chelmsford Mass. Bradford, England Jonas Hodgson. (Hodgson) Hodgson Bradford, England Bradford England North Chelmsford, Mass.
78
Commonlocalth of Massachusetts.
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