USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 12
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12 | Part 13 | Part 14 | Part 15
Name and Professional Title,
Residence, No. 226 Ovesthard Street,
Dated at Lowell, this
F
day of.
189 .......
*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,
BOARD OF HEALTH.
RETURN OF DEATH
OF
189
88
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
June 24
189 9
Name
Firancori A. Serveres
Maiden Name
Sex. ~ male, Color, While
Single, Married or Widowed
Age 1 years 6 months ...... days.
Name of attending Physician, Ar Richard
Residence of Deceased, No. Themes ford Center Street, (or Corporation), Ward
Occupation,
Husband's Name
Place of Death, No. Themesford Center
Street, (or Corporation), Ward
Birthplace of Deceased, 11
11
Father's Name, Adeland - Servais
.. Father's Birthplace,
Canada
Mother's Name,
Eugenne
Berard
Mother's Maiden Name, -
Place of Interment,.
Themesford
Cemetery, Range
,
Lot
., Grave
Signature of Undertaker or Informer, Joseph Albech
Dated at Lowell, this
24
day of
June
189 ... 9.
Physician's Certificate of the cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
189
Name and Sex of Deceased,
Place of Death, No.
When the Child is still-both, surpecity.
duration of*
Complications,
Dentition
. I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title en. Richard molim
Residence, No. 3.07 Middleis Street,
Dated at Lowell, this
25 day of ..
Lune
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,
WITH
male.
Street, (or Corporation.)
Disease or cause of Death,
Ganha Enteritis
Mother's Birthplace,
RETURN OF DEATH
OF
189
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,
Emma Louisa Buzzelli
Sex, Hemale Color,
white
Date of Death, June 22
1899 ; Age,
62
Years,
Months,
Days.
Maiden Name! { If married, widowed )
or divorced.
Emma Louisa Paine
Husband's Name,
David a Bussell
Single, Married, Widowed or Divorced, Oceupation,
*Residenec, also state fully. ) { If out of town, { Chelmsford Mare
Place of Birth,
Eastport Maine
*Place of Death, Chelmsford Mark
Name of Father,
a. a. Paine
Birthplace of Father,
Standish Maine
Maiden name of Mother, Margaret Stevens
Birthplace of Mother,
Parteland Marine
Place of Interment, (Give name of Cemetery), Eastport chile.
Dated at
Chelmsfords Mask Signature and
Walter Perhow
011 June 22
189
place of business
of Undertaker.
Chelmsford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ¡
Emma
Touca Purcell Age, 625.
M.
D.
Place and Date of Death, # died a Chelmsford, Masc, June 22 189.9 Cancer
Disease or Cause of Death, §
Duration of sickness,
several months:"
I certify that the above is true to the best of my knowledge and belief.
Amara Howard
Signature and Residence S of Certifying Physician. Chelmsford Marx.
M. D.
Date of Certificate,
Jame 23'
189 9.
Give also street and number, if any. t Or sex of infant not named. If stiil-born, so state. # If child died immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebeliion, give both Primary and Secondary Cause.
89
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 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 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 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 facts. (See section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.) Any person having charge of tl.
certificate made in accordance with sec
health or to the clerk of the city or tor
all chain c physician's ction 1, to the board of
90
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, ...
Willie Chandler
Sex,
Color,
Date of Death, June 20
1899; Age, 20 Years,
1
Months,
Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
Harrer
*Residence, { If out of town, }
Chelmsford
? aiso state fully. §
Place of Birth,
Cheliford
*Place of Death,
Name of Father,
Warren Chandler
Birthplace of Father,
Westford
Maiden name of Mother,
Francis & Ingalls
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
north Chelmsford
Dated at
Signature and
Walter Perhan
on June 20
189 7
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death, #
Disease or Cause of Death, §
died at
Chelmsford
Mass. June 201899
Pleuritis with fechatized Sung
Duration of sickness,
6
months
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S of Certifying Physician.
Chili And.
Date of Certificate,
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 Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Willie Chandler
Age, 20 Y. / M.D.
M. 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 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 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. (Sec 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 thic death of said person, upon request, furnish for registration a certificate setting forth the required facts. (Sec section 10.)
Penalty for refusal or neglect, ten dollars. (See section 11.)
Any person having charge of the f vary to the interment of a human body shall o'the ohrainion's
certificate made in accordance with secti 't, together with the facts required by section of
health or to the clerk of the city or town .. rred.
91
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,
Edes P Stevens
Sex,
Color, M.
Date of Death,
July 14
1897 ; Age
78
Years,
4 Months,
4 Days.
Maiden Name,
{ If married, widowed }
or divorced.
Edis P Wright
Husband's Name,
Samson
Stevens
Single, Married, Widowed or Divorced,
Married Occupation,
Vouswate
*Residence, also state fully. S
§ If out of town, }
Cheliveford
Place of Birth,
Meatford
*Place of Death,
Chelmsford
Name of Father,
asa Wright
Birthplace of. Father,
Westford
Maiden name of Mother,
Bathsheba Dad mums
Birthplace of Mother,
....
Chelmsford (Probably
Place of Interment, (Give name of Cemetery),
South Chelmsford
Dated at
Signature and
Walter Pertam
on
Sub 14
1899
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Place and Date of Death, }
died at
Chelmsford
Jul 14 th
1899
Disease or Cause of Death, §
Senile degeneration and
mivous Exhaustion.
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
Cimara Howard.
' M. D.
of
Certifying Physielan.
Chelmsford Mais
Date of Certificate,
18967
Give also street and number, if any.
t Or sex of Infant not named. If still-born, so state. * If child dled Immediately after birth, so state.
§ If a Soldier or Sailor in the War of the Rebellion, give both Primary and Secondary Cause.
Edie P. Stevens
Age
78 %.
4 1. 4 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 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 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 sections 6 and 7, five dollars. (Sec section 8.)
A physician who lias 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. (Sce 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 certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
92
Commonwealth of Massachusetts.
No.
RETURN OF A DEATH. To the Clerk of the Town in which the Death occurred.
1. Date of Death, .
1877
2. Name,
(Maiden Name),*
Lucy 4, fuller
(Name of Husband) ,*
Contar of thord
3. Sex, and whether single, Married, or Widowed,
Wido wed
4. Color, t
5. Age,
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Siekness, . By whom certified,
F. E. Varmes Zu , I
West Chelmsford
Housekeeper
9. Place of Death, .
West Chelmsford
10. Place of Birth,
Norridge work
11. Name of Father,
Alden Fuller
Thelinda Goula
12. Name of Mother, (Maiden Name),
13. Birthplace of Father, .
Norridge-wock The
11. Birthplace of Mother, .
West Chelmsford
15. Place of Interment,
Signature of Undertaker or other person making the Return, .
AG Parkhurst
DATED at Test- Chiedoford, on July 17th 1899
* 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. September, 1892 .- 5,000.
71 Years 2 Montlis, 2 Days. Exhaustion from Hemi Plegia 11 months
7. Residence,
8. Occupation, .
Fairfield The.
[Public Statutes, Chapter 32, as amended by Acts of 1838, Chapter 305; Acts of 1889, Chapter 224.]
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 punished by a fine not exceeding fifty dollars. In case the deceased was a soldier or a sailor who served in the war of the rebellion, the physician shall give both the primary and the secondary or immediate cause of death as nearly as he can state the same. If a physician refuses or neglects to make such certificate he shall forfeit to the treasurer the sum of ten dollars for the use of the town in which he resides.
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 statement 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 delivered 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.
)
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,
nathan B. Lapham.
Sex Male Color, White.
Date of Death,
July 24
1899; Age, 61
Years, 0 Months, O Days.
Maiden Name, { If married, widowed ) or divorced.
Husband's Name,
L
Single, Married, Widowed or Divorced, Married Occupation, farmer
*Residence, { If out of town, )
South Chelmsford mass
¿ also state fully.
Place of Birth,
Groton mass.
* Place of Death,
South Chelmsford.
Name of Father,
Wm. Lapham.
Birthplace of Father,
Boston.
Maiden name of Mother,
Elizabeth C. Brown
Birthplace of Mother,
Littleton Mass.
Place of Interment, (Give name of Cemetery),
Hart Pond Cemetery
Dated at. So Chelmsford.
Signature and
Daniel 4 Buum
on
July 24,
189 9
place of business
of Undertaker.
So Chefmolded Mars
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Place and Date of Death, ;
Disease or Cause of Death, §
died at
So. Chehusfond, Mase., July 24,1899.
Chronic Nechritis, Cystitis
Heart-
hypertrophy about three years.
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
Arthur & Leolina
M. D.
of Certifying Physician.
Chelmsford
mack ..
Date of Certificate,
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.
nathan B Jakham
Age, 6/ Y
M.
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 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 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 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. (Sec 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 facts required by section 1, to the board of health or to the clerk of the city or town in which the death occurred.
Rec
FORM C.
Commonwealth of Classachusetts.
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,
Warner & Smith
Sex.
Color,
VEchite
Date of Deathı,
Cinq 2"
1899; Age, 14 Years,
........ Months,
2 Day's.
Maiden Name, { If married, widowed )
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Occupation,
*Residence, {If out of town, )
¿ also state fully.
Nightman 25
Chelmsford
Lawere Muss
Place of Birth,
*Place of Death,
Chelmsford
Name of Father,
Gea a both
Birthplace of Father,
Maiden name of Mother,
Harriet Scackman
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Edson Lawell
Dated at.
Lawere Mars
Signature and
& M Maning Mr
on
aug 2 ..
189
9
place of business
of Undertaker.
33 PrescaWAT
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t Warner of Smith Age, 14%. M. 2 D.
Place and Date of Death,
died at Nightmare It Rung 2nd. .. 1899
Disease or Cause of Death,
Paralysis
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence S
of
M. D.
Certifying Physician. 2
Date of Certificate,
3
1899%.
* Give also street and number, if any.
t Give 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.
92.
No.
RETURN OF THE DEATH
OF
at
Date,
.189 ..
Filed,
189
Acts of 1897, Chapter 444. [EXTRACTS FROM SECTIONS 6, 7, 8, 10, 11 AND 12.]
SECTION 6. Every householder in whose house a deatlı 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 healthi or to the clerk of the city or town in which the death occurred.
SECTION 7. 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 deatlı. SECTION 8. Penalty for neglect to comply with the requirements of sections 6 and 7, five dollars.
SECTION 10. 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 forthi the required facts.
SECTION 11. In case the deccased was a soldier who served in the war of the rebellion, give both the primary and the secondary or immediate cause of death as nearly as lic can state the same. Penalty for refusal or neglect, ten dollars.
SECTION 12. Any person having charge of the funereal rites preliminary to the interment of a human body shall obtain the physician's certificate made in accordance with section 10, and return it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in whieli the death occurred.
93
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. 15 1899 Name Elisa Woodroffe Woods
Maiden Name Elisa W. Darby
Sex Female, Color, WV
Single, Married or Widowed married
Age 3-7 years / 0 months 20 days.
Name of attending Physician, E. H. Packer
Residence of Deceased, No. Worth Chelaufen Street, (or Corporation), Ward
Occupation, Husband's Name.
Place of Death, No. north Chelunsford Street, (or Corporation), Ward.
Birthplace of Deceased, They Worcestershire England
Father's Name, Charles Daily
Father's Birthplace,
England
Mother's Name,
Mother's Birthplace,
1.1
Mother's Maiden Name, . whitlock
Place of Interment, To thelinefor Cemetery, Range
, Lot .. .............. , Grave
Signature of Undertaker or Informer, John a. mrunback
day of august
IS9 9
Dated at Lowell, this
Physician's Certificate of the cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death, august 15 1899.
Name and Sex of Deceased, Chia hoodraffe hoods
Place of Death, No. North Chelmsford
Street, (or Corporation.)
duration of#
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title @Ar Tacker ne.D.
Residence, No.
Street,
Dated at Lowell, this
17
day of
auquel
-
1899
*Reckoned to the time of Death. [Be very partienlar to till 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,
BOARD OF HEALTH.
Cmale.
Disease or cause of Death, Cancer
When the Child is still born, so specify.
RETURN OF DEATH
OF Glige W. Woods lucs 3
0 1899
Ref
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
Cinq 23 rd
1899
Name Moses C Huntoon
Maiden Name
Sex
male, Color,
Single, Married or Widowed
Widowegl
Age
80 years 7 months
days.
Name of attending Physician
the Howard
Residence of Deceased, No.
Chelyn ford stars
Street, (or Corporation), Ward
Occupation,
Merchant
Husband's Name
Place of Death, No.
Chelmsford Mars
Street, (or Corporation), Ward
Father's Name,
Daniel Huntoon Father's Birthplace,
Mother's Name,
Betsey
Mother's Maiden Name,
Cales
Place of Interment,
Edson Cemetery, Range
Lot , Grave
Signature of Undertaker or Informer,
Dated at Lowell, this
24
day of
189.9.
Physician's Certificate of the cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.) Cinq 23rd ISO 9
Date of Deatlı,
Name and Sex of Deceased,
Moses
C.Huntoon
male.
Place of Death, No.
Cheful ford
Mark Street, (or Corporation.)
Disease or cause of Deathı,
Paralysis
Ayben the Child is still-born, so specify.
duration of*
Complications,
old
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title amaral toward M.D.
Residence,No:
Chelmsford
Street,
Dated at Lowell, this
240
day of
aug
189.7,
*Reckoned to the time of Death.
[Be very partienlar 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,
BOARD OF HEALTH.
94
W. Brooks
Mother's Birthplace, ..
Birthplace of Degeased,
Warner
RETURN OF DEATH
OF
1
FORM C.
Commonwealth of glassachusetts.
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,.
1
Julide Sex,
Color,
Date of Death, Sieff 7th
189 7; Age, V. 4 Years,.
Months,
........ Days.
Maiden Name,
{ If married, widowed }
or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
„. Occupation, Oteu
*Residence, { If out of town, }
¿ also state fully.
Place of Birth,
"
*Place of Death,
Name of Father,
Birthplace of Father,
cetauch
Maiden name of Mother,
Birthplace of Mother,
Place of Interment, (Give name of Cemetery),
Dated at
Signature and
Inwest to ( Rennes
on
Sept 7
189
9
place of business
of Undertaker.
ES } 324 HEUTE LX
PHYSICIAN'S CERTIFICATE.
Thomas A. Faire
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.