USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1898-1899 > Part 9
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Occupation, ..
at Home
Husband's Name Amariah Van Scoy
Place of Death-No.
Street, (or Corporation), Ward
Patterson Nl
Birthplace of Deceased,
Father's Name,
John Clark
Father's Birthplace,
Scotland
Mother's Name,
Buran au
Mother's Birthplace,
Bruch
Mother's Maiden Name,
Place of Interment,
, Lot.
., Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
12-12
day of
Jaw
189.9
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Jan 11
189.9
Name and Sex of Deceased, Louise Le Man Sory
male.
Place of Death -- No. Polensford Man
Street, (or Corporation).
Disease or Cause of Death,
Paralysis
, When the Chikt is still-born, so specify.
duration of
*
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title,.
maia toward m. D.
Residence, No.
Chelmsford
Street,
Dated at Lowell, this .
12 "
day of.
Jan.
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,
RETURN UF UDMIn
OF
... 189
55
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
-Undertakers miyst make this return before the burial os removal of the deceased.
Date of Death,
11
1899 Name.
Lucy H Learns
Maiden Name,
Sex, female; Color,
Single, Married or Widowed,
Age, 79 years, 10 months, 27 days.
Name of attending Physician,
Howard
Residence of Deceased-NO).
Evlenshund Maskeet, (or Corporation), Ward
Occupation,.
at
Ham. Husband's Name Careful Lewis
Street, (or Corporation), Ward
Birthplace of Deccased,
Casliste
Man
Father's Name, Lasich Hangoneither's Birthplace, Merrimack NK
Mother's Name, Lucy / 1
Mother's Birthplace,
Carlisle Mais
Mother's Maiden Name,
Shantching
Place of Interment,
Cemetery, Range ...
Lot
.......... , Grave, ......
Signature of Undertaker or Informer, 13 Currcia
Dated at Lowell, this.
12 th
day of.
Jan
...... 1899
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Yan
1
189.9.
Name and Sex of Deceased, Lucy off Lewis male.
Place of Death-No.
Street, (or Corporation).
When the Chill is still-born, so specify.
Disease or Cause of Death,
Heart Paralysis ~ duration of *.
Complications,
I certify that the above is a true return to the best of my recollection and belief.
Name and Professional Title, Umara Haward, M.D.
-
Residence, Ne ...
1
Street,
1200)
day of
Jan.
189.9
Dated at Lowell, this
*Reckoned to the time of death.
[Be very particular to fill the blanks, and strike out words that are not correet, 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.
Place of Death-No.
Rec
RETURN OF DEATH
OF
1
189
1
-
6
Rel
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
M- Undertakers must make this return before the burial or removal of the deceased. Date of Death January 11.
1899 Name. Corrigan
Maiden Name,
Sex,. male ; Color,
Single, Married or Widowed,
Age, 7 7 years,~ months, -. .. days.
Name of attending Physician, ...
Vamuy
Residence of Deceased-No. North Sthelensford
Street, (or Corporation), Ward
Occupation,
at Hor
Husband's Name
Freunde, borgan
Place of Death-No.
North Chalutrod
Street, (or Corporation), Ward
Birthplace of Deceased,
Preland
Father's Name Posso Conley
Father's Birthplace, place, Plaid
Mother's Name, Arin
Mother's Birthplace,
not linow
Mother's Maiden Name,
Place of Interment,
Lowich Mais.
Cemetery, Range
., Lot
...... Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
12
day of
man.
1899
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death, -
189
Name and Sex of Deceased,
male.
Street, (or Corporation).
Place of Death -- No.
When the Child is still-born, so specify.
Disease or Cause of Death,
Brunchity
duration of
*
Complications,
I certify that the above is d) true return to the best of my recollection aud belief.
Name and Professional Title,
Residence, No. Hate 58
Street,
Dated at Lowell, this
day of .
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.]
Approved,
BOARD OF HEALTH.
1.
RETURN OF DEATH
OF
189
RETURN.
A
Name,
Date of Deatlı
Jan 16 th 1899
Age, 15. .Years, 3 Months, 8 Days.
Single, Married or Widowed,
Single
Maiden Name,
Physician,
Dr Hearton-
Residence No
West Chehusband
Occupation,
Place of Death
Nest leheladora
Husband's Name, Sweden
Birthplace,
Father's Name
Anchew&@mist
Mother's Maiden Name
Eugene Johnem
Father's Birthplace,
Sweden
Mother's Birthplace
Sweden
Place of Intermen
Mert Chelmsford
Range
Lot
Grave
d.A. Wennbeck P.B.J.
Reu No.
Commonlocalth of Massachusetts.
58
RETURN OF A DEATH. To the Clerk of the City or Town in which the Death occurred.
1. Date of Death,
tan 21-1899 James Handlet
2. Name,
(Maiden Name),*
(Name of Husband), *
3. Sex, and whether single, Married, or Widowed,
4. Color, t
5. Age, X3 Years, Months, Days. Alcoholic Paralysis
Disease or Cause of Death, (Primary and Secondary), #
6. Duration of Sickness, . By whom certified,
7. Residence,
8. Occupation, .
Efnews ford Valorar
9. Place of Death, .
Buenofora)
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, .
R
1 Walter Perham.
DATED at Chems ford , on
Jan 21 189%.
* 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. Dec., 1896. - 5,000.
[ Public Statutes, Chapter 32, as amended by Acts of 1888, Chapter 306 ; Acts of 1889, Chapter 224; Acts of 1893, Chapter 263.]
SECTION 3. A physician who has attended a person during his last illness shall, when requested, forthwith furnish for regis- tration, a certificate stating, to the best of his knowledge and belief, the name of the deceased, his age, the disease of which he (lied, the duration of his last sickness, and the date of his decease; and a physician who has attended at a birth of a child dying immediately thereafter, or at the birth of a stillborn child, shall, when requested, forthwith furnish for registration a certificate. stating to the best of his knowledge and belief. the fact that such a child died after birth or was born dead. If a physician neg- lects or refuses to make a certificate as aforesaid, or makes a false statement therein, 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 a human body 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 sueh 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 violenee the medical examiner shall, if requested, make the sanie. When such satisfactory statement and certifieate are delivered to the board of health or to its agent, the board or agent shall forth- with couutersign 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 seetion shall be punished by a fine not exceed- ing fifty dollars.
Rec
Commonwealth of Massachusetts.
NNo.
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,
Hillard S. Stone
Sex.
Male Color,
Date of Death,
January 22
1899 ; Age, 46 Years,
Months, 19 Days.
Maiden Name, { If married, widowed ) or divoreed.
Husband's Name,.
Single, Married, Widowed or Divorced,
Married
Occupation,
Saber
*Residence, {If out of town, )
? also state fully. §
Chelmsford
Place of Birth,
Jaffery 7L.H
*Place of Death, .
Chelmsford
Name of Father,
Jonas Spalding Store
Birthplace of Father,
(Perhaps Billerica)
Maiden name of Mother,
Saray Elizabeth Miller
Birthplace of Mother,
Billerica
Place of Interment, (Give name of Cemetery),
Chelmsford Center
Dated at
behalveford
Halten Perhane
on
January 23
1899
Signature and
place of business
of Undertaker.
3
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Age, 46%.
M.
D.
Place and Date of Death,#
died at.
Disease or Cause of Death, §
Brighton Mardi \Chunic)
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
8. St. Chambulur
1
M. D.
Signature and Residence of Certifying Physician.
Thelma me,
max 2
-
Date of Certificate,
January 22%
1899.
Give aiso 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.
.... 189 1
No.
RETURN OF THE DEATH
OF 1
1
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 liis 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. (Sec 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. (Scc 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. (Sce 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 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.
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,
Francis W Robinson
Sex Mal Color,
Date of Death,
Jun 24
1899 ; Age, 61 Years,
6 Months,
Days.
Maiden Name, {Ifmarried, widowed ) or divorced.
Husband's Name,
Single, Married, Widowed or Divorced,
Widged Occupation,
Retired
*Residence, { If out of town, }
¿ also state fully.
Place of Birth,
Sante Sandnes
Chelmsford
*Place of Death,
Fredrick W Robinson
Name of Father,
Maiden name of Mother,.
Mary Le Damon
Birthplace of Mother,
Lankaster mars
Place of Interment, (Give name of Cemetery), Lowell Cemetary
Dated at
Chechueford
Signature and
Walter Penthaus
on
January 24
1899
place of business
of Undertaker.
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, t
Trance W. Robaron
Age, 61 Y. 6 M. OD.
Place and Date of Death, }
died at
Chelmsford, January 24, 1899
Disease or Cause of Death, §
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Paward It, Chambulin
of
Certifying Physician.
Chelmsford
M. D.
Date of Certificate, Primary 24,
.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.
60
Birthplace of Father,
Gilford
Vermont
No.
RETURN OF THE DEATH
OF
Francis W Robinson
at Chelmsford
Date, January 24
1899.
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 thercof to the board of health or to the clerk of the city or town in which the death occurred. (Sec 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 tlic 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 forthi the required facts. (Sce section 10.)
Penalty for refusal or neglect, ten dollars. . (Sce section 11.)
Any percen havi charge of binary to the interment of a human body shall obtain the physician's certificate made in acco . ce with sweet it, together with the facts required by section 1, to the board of health or to the clerk of the city or town in la death occurred.
Red
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowcht,
Town of Chelmsford
Undertakers must make this return before the burial or removal of the deceased.
Date of Death,
Jan 29th
1899 Name. Samuel Proctor Perham
Maiden Name,
Sex ........ male ; Color, Age, 83 years, 1 months, 24 days.
Single, Married or Widowed,
Name of attending PhysicianDa. Howard
Residence of Deceased-No. Chelmsford
Street, (or Corporation), Ward
Occupation,
Husband's Name
Place of Death-No.
Chelmsford
Street, (or Corporation), Ward,
Birthplace of Deceased,
Wilton hilft
-
Father's Name,
Samuel
·
Father's Birthplace,
Symbols / HH
Mother's Name,
Maney
Mother's Birthplace,
Milford ",
Michals
Mother's Maiden Name,
Place of Interment,
Chelmsford
Cemetery, Range
Lot
... , Grave,
Signature of Undertaker or Informer, ABC unier
Dated at Lowell, this
C.day of
189
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Jan 29
189.9
Name and Sex of Deceased,
Samuel P Perham
Place of Death-No.
Chelmsford
Street, (or Corporation).
Disease or Cause of Death,
Paralysis of Heart
When the Child to still-born, so specify.
duration of *.
Complications,
Old
age
I certify that the above is y true return to the best of my recollection and belief.
Name and Professional Title,
Umara Howard ,D.
Residence, No.
Chelmsford Class.
Dated at Lowell, this
30 000
day of
Jan .
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,
BOARD OF HEALTH.
----
male.
RETURN OF DEATH
OF
189
+ Y
--
62
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,
Fiel 4
IS9 9
Name
Adele Magnanh
Maiden Name,
Sex, Female, Color,
While
Single, Married or Widowed, ...
Age 6 years. - months .. days.
Name of attending Physician,
Varley
Residence of Deceased-No. Trond CheneyfordStreet, (or Corporation), Ward
Occupation, Husband's Name
Place of Death-No. North Chendelad
.Street, [or Corporation], Ward
Birthplace of Deceased,
Canada
Father's Name Authen Magnank
Father's Birthplace,
Canada
Mother's Nam
Philomena
Mother's Birthplace,
Mother's Maiden Name, -
Place of Interment, New Bedford metery, Range ..
.,Lot ..
............ , Grave,
Signature of Undertaker or Informer, Juseph Albert
Dated at Lowell, this
day of.
Jieba
189.9 ..
Physician's Certificate of the Cause of Death.
(SEE EXTRACTS FROM ACTS OF LEGISLATURE BELOW.)
Date of Death,
Fiby 4th
189.9.
Name and Sex of Deceased: adele Magment female:
Place of Death-No.
North Chelikefond
Street, (or Corporation.)
Disease or Cause of Death,
Pneumonia
When the Child is still-born so specify .
duration of*
one week
Complications,
I certify that the above is a true return to the best of my recollection and belief. Name and Professional Title, F.E. Varney nix .
Residence, No.
north Chelmsford,
'Street.
Dated at Lowell, this
Feb. 42
day of.
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,
A Physician who ben affi
BOARD OF HEALTH.
RETURN OF DEATH
OF
89
1
63
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,
1899% Name Margaret Sevilla1
Maiden Name,
Sex, male; Color,
Single, Married or Widowed,
Age, ......... years, 3ª
months, .. days.
Name of attending Physician,
Residence of Deceased-No. 48 Stiret
Street, (or Corporation), Ward
Occupation,. Husband's Name
Place of Death-No. / Onelinehard
Street, (or Corporation), Ward,
Birthplace of Deceased, Laquelle
Father's Name, Gravity Strictds Father's Birthplace,
Mother's Birthplace,
Mother's Maiden Name,. Lorani
Place of Interment, St Patrick1
A. Cemetery, Range .... , Lot .. , Grave,
Signature of Undertaker or Informer,
Dated at Lowell, this
8:45
day of ... Feb 189.9
Physician's Certificate of the Cause of Death.
William M. Jones, . M. V.
Date of D
219 Central Street, Ewell, Masa. male.
R Hours, 2 to 4 and of to 9.
Name and Place of Disease o Complicat I Name an Residence Dated at *Reckone [Be very insert " fe " bu
'poration). This infant, margaret Shields, was removed from the City Fam, Lowell has. ef. Fab, 3, 1899, at the Time of noval the clubit was doing will. Isaw it last one ... 189. ...... the above date and know nothing of r widowed, and to condition subsequently,
726. 9, 1899
GOODALE'S DRUG STORE, 217 CENTRAL ST., LOWELL.
Mother's Name, Margaret
OF
189
€4
Rec
PLEASE FILL OUT WITH INK.
UNDERTAKER'S RETURN
To the Board of Health and the Clerk of the City of Lowell.
na Undertakers must make this return before the burial or removal of the deceased.
Date of Death, February 17" 1899
Name Watter BB The Vaugter
Maiden Name,
Sex, .... male ; Color, Hitrite
Single, Married or Widowed, Widowed
Age, 71 years, months,. ......... days.
Name of attending Physician, Dr Varmer
Residence of Deceased-No ... North Chick Dansford
Street, (or Corporation), Ward
Occupation,. Husband's Name
Place of Death-No. with Chelmsford
Street, (or Corporation), Ward,
Birthplace of Deceased, festland
Father's Name,. Dothe MC Naughton Father's Birthplace,.
Mother's Name, mary
Mother's Birthplace,
Mother's Maiden Name, Mary Prace ..
Place of Interment,. Punktenauch
Cemetery, Range ., Grave,.
Signature of Undertaker or Informer, to The Young Seo
Dated at Lowell, this 18 th
day of!
1 February
1899
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased,*
Date and Place of Death, i -
Disease or Cause of Death, - (Primary and Secondary.)} Duration of Sickness,
of Sem plegia
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, F. E. Camere North Chebusfest.
Date of Certificate, Feb. 18ch
1899:
* Or Sex of Infant (not named). If stillborn so state. t If chill died immediately after birth so state. Plate. Ed. December, 1996 .- 5,000.
# If a soldier or sailor who served in the War of the Rebellion.
BOARD OF HEALTH.
Walter B Mc Naughton
Age, 7!
died at North Chilenafort. Feb. 17th
1899,
Scotland
OF
189
Ree
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,
VAYA 18
1899
Name
Maiden Name
Sex, Amale, Color,
Single, Married or Widowed,
Age 3 years.
.... months ....
days.
Name of attending Physician
A chamberlain
Residence of Deceased-No querquen
Street, (or Corporation), Ward ....
Occupation,
Husband's Name
Place of Death-No .... Premotora Mas. Street, [or Corporation], Ward ...
Birthplace of Deceased,
Dorland
Father's Name,
Father's Birthplace,
Josland
Mother's Name,
Mother's Birthplace, ...........
Mother's Maiden Namen (ferrihan
Place of Interment,
Lawale()
Cemetery, Kange Lot „.,Grave, .....
Signature of Undertaker or Informer,
Dated at Lowell, this. 1800
day of. 1899
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, ** o
This. and Money Age, 85
Date and Place of Death, t - died at Chelmsford, Mass, INmany 17, 189
Disease or Cause of Death, - of
(Primary and Secondary.) }
Duration of Sickness,
I certify that the above is true, to the best of my knowledge and belief.
Signature and Residence of Certifying Physician, Garrard It. Chanchulin Chelmsford, Mark.
Date of Certificate, february 18% 1899
* Or Sex of Infant (not named). Jf stillborn so state. { If child died immediately after birth so state. Plate. Ed. December, 1896 .- 5,000.
# If a soldier or sailor who served in the War of the Rebellion .
Gill
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,
adeline Parkhunch Spalding
Sex, HEmale Color,
Date of Death,
Heb. 19
1899; Age, 84 Years,
.Months,
.Days.
Maiden Name, { If married, widowed )
Adeline Parkhurst
or divorced.
Husband's Name,
Elbridge P Spalding.
Single, Married, Widowed or Divorced, ..
Widout
Occupation,
*Residence, { If out of town,
also state fully.
Chelmsford
Place of Birth, Chelmsford
*Place of Death,
Chelmsford
Name of Father,
John Parkhurst
Birthplace of Father,
....
Chelmsford
Maiden name of Mother,
Surviak Manning
Birthplace of Mother,
Billerica
Place of Interment, (Give name of Cemetery),
Chelmsford Center
Dated at
Chelmsford
Signature aud
Halten Perhar
on
February 20
1899
place of business
of Undertaker.
The Inford
PHYSICIAN'S CERTIFICATE.
Name and Age of Deceased, f
Place and Date of Death, #
Disease or Cause of Death, §
died at
Chelmsford Mass, Hilary 19, 1899
Paralisez
Duration of sickness,
I certify that the above is true to the best of my knowledge and belief.
Signature and Residence
Edward St, Chambalice
M. D.
of Certifying Physician. Chiliusing Mari
Date of Certificate,
Jahrwar 20th, 1899.
1
Give also street and number, if any ..
t Or sex of infant not named. If stifl-born, so state. + If child died immediately after birth, so state.
§ If a Soldier or Saflor in the War of the Rebellion, give both Primary and Secondary Cause.
66
addie P. Skaldans
Age, 84 Y.
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 oecurs, 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 oeeurred. (See section 6.)
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