USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1904-1905 > Part 10
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Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts callod for under "Special Information." If in a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
(OURATION).
.. DAY 8
.(DURATION). .. DAYS
COMMONWEALTH OF MASSACHUSETTS
38
FULL NAME Ella es
RETURN OF A DEATH Brigant
(CITY OR TOWN.)
Registered No. 52
Place of 1 Wist Chelmsford
Death * S
Death
Residence
1
Age
.years.
.. months ..
.days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
tella & Carlson
HUSBAND'S NAME + Gustav a Buspant
BIRTHPLACE # Sunder.
NAME OF
FATHER
Erich Carlson
BIRTHPLACE OF FATHER#
MAIDEN NAME
OF MOTHER
augusta Cachan
BIRTHPLACE
OF MOTHER #
Sveder.
OCCUPATION
at tia
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from Jehl-17 190 as to Sell,20 19005 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Pulmonary Tuberculosis
one year
(DURATION) .. DAYS
Contributory :
.
.(DURATION). DAYS
(Signed)
JE Varney
M.D.
Del-2
190 5 (Address)
M. Challenges of.
SPECIAL INFORMATION only for Hospitais, Institutlons, Transients, or Recent Residents.
How long at
Place of Death 7
years ..
months. days
Where was disease contracted,
If not at place of death ?
Filed
Oct 2
1905 Edward J. Robbins
Join Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
INFORMANT § Husband
DATE OF BURIAL
PLACE OF BURIAL OR REMOVAL II
Medran Cem Lona Och. 2
1905
UNDERTAKER
ADDRESS
Lowall mare
28
Date of Sefil 30m 19051
COMMONWEALTH OF MASSACHUSETTS
39 bily of Lerwell
RETURN OF A DEATH
FULL NAME
Ellen M. Driscoll
Registered No.
1517
Place of Death *
At Johns Hospe Lowell Mais
Date of Death.
Orto q 1905
Age ..
43
. years.
.months
... days
STATISTICAL DETAILS
SEX
7.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
S.
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
Chelmsford mars
NAME OF
FATHER
Michael Driscoll
BIRTHPLACE
OF FATHER#
Freland
MAIDEN NAME
OF MOTHER
Mary Haley
BIRTHPLACE
OF MOTHER #
Ireland,
OCCUPATION Operative
INFORMANT § Michael Driscoll
PLACE OF BURIAL OR REMOVAL II
Dr Patrick Gen. Lowell Och
DATE OF BURIAL
5
-
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Cinq 8 1909 to Vetro 9
5.
1905 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Tuberculosis ofthe Hip 0
.. (DURATION).
DAY8
Contributory :
2:0
(Signed)
Francis a. Grega
M.D.
Oct. 10 90.5 (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents,
Former or
Usual Residence
Chelmsford
How long at
Place of Death 2 2 MarsDays
Where was disease contracted,
If not at place of death ?.
iled Oct. 11 9 0 5 Girard @Halowars biter Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give its NAME instead of street and number,
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
ALL NAMES TO BE IN FULL
UNDERTAKER
I. H. M. Dermott
ADDRESS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
7
(DURATION) ...
DAYS
.
:
COMMONWEALTH OF MASSACHUSETTS
40
RETURN N'OF A, DEATH Edward Ho Super
(CITY OR TOWN.)
54
Registered No.
Date of l
act- 12.
Death
. Age.
... years ..
.. months.
19 .days
STATISTICAL DETAILS
SEX
niale
COLOR
2thite
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE ±
Vectford, HARRY
NAME OF
FATHER
William Dufree
BIRTHPLACE
OF FATHER#
Frencham
marc.
MAIDEN NAME
OF MOTHER
Catherine ufte
BIRTHPLACE OF MOTHER # *Billerica In LaCR
OCCUPATION
Far
-
armer
INFORMANT §
Me. Comund & Dulce
PLACE OF BURIAL OR REMOVAL !! Hereford
DATE OF BURIAL
Oct. 15
1900
UNDERTAKER
Did P(Spam)
ADDRESS
Souche
helmets
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from act-16 190 .... to. Cect 1290J. that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Paralysis.
... (DURATION) 2
.. .. DAYS
Mitral Disease
Contributory :
ofstraty
(Signed).
.M.D.
1900 (Address).
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at Place of Death ? years.
months . days
Where was disease contracted,
If not at place of death ?
Filed
Oct 14
1905
Edward J. Roffing
John
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If in a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME
Place of 1
No Chelunsford!
Residence
Death * Jo. Chelmsford
79
41
COMMONWEALTH OF MASSACHUSETTS
RETURN OF. A DEATH
FULL NAME Waltin R logs
Place of Death *
Date of Death. Ceci 13" 1905
Age ...
years.
months
13
days
STATISTICAL DETAIL
SEX
Male
COLOR white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE Ť Chelmsford selma
.
NAME Of FATHER Valoir Cars
BIRTHPLACE OF FATHER #
It John IN Po
MAIDEN NAME OF MOTHER Lizzie Miller
BIRTHPLACE OF MOTHER # Lawere mars
OCCUPATION
INFORMANT S Lizzie Miller
PLACE OF BURIAL OF REMOVAL II dean To Rowall
DATE OF BURIAL Ceat 14 90
UNDERTAKER
ADDRESS
Jalur Aweinbach comedelusione
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. - .. 190 .... to. . . 190 ..... that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATHI was of follows : Primary : Premature firth
. (DURATION) .. DAYS
Contributory
(Signed) oppurea) .. (VWRATION) ... .. DAYS
.. M. D.
Oct 13 .... 190.5 (Address) .. 253 Central
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence. . Place of Death ?.. Days
How long at
Where was disease contracted, if not at place of death ?..
Filed Oct 14 1995 Edward f. Robbins
Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL, RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number. + In case of married or divorced woman, or widow. # State or Country ; also city, town or county, if known.
& Name and address of person giving statistical details.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL.
CITY OF LOWELL
Registered No.
55
COMMONWEALTH OF MASSACHUSETTS CITY OF LOWELL
42
RETURN OF A DEATH
FULL NAME Yethan marqueur Cudown
Place of Death * Woods Copper with Chelmsford
Date of Death Oct. 15, 1965.
Age.
10
. months
19
years.
days
STATISTICAL DETAIL
SEX Irmalı
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Jworth Chelmsford
NAME OF FATHER
Gabriel Audien
BIRTHPLACE OF FATHER # England
MAIDEN NAME OF MOTHER ada maver anglaise
BIRTHPLACE OF MOTHER # England
OCCUPATION
INFORMANT § Gabriel audin
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL If Patricks Cometer Oct 1!"10 5
ADDRESS
UNDERTAKER stor 1 Savage 169 Worthernst
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from.
Oct- 12 1000 to Cel-15
..
190.5
that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Jubercular Menuplo
200 3 works
.(DURATION).
DAVS
Contributory
(Slgued)
+ E Varney
.- (DURATION). . . DAYS
.
M. D.
Del.15 2000 (Address) M. Cheretony
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence. . . Place of Death ?. Days
How long at
Where was disease contracted, if not at place of death ?.
Filed
Oct. 16 190 5. Eduardo S. Robbins
Town Clerk,
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
+ In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
| Name of cemetry.
56
Registered No ..
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
43
RETURN OF A DEATH
57
Registered No.
years months
days
STATISTICAL DETAIL
SEX female
COLOR White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # into Thelistorna
NAME OF FATHER
BIRTHPLACE OF FATHER Į A Chilisford
MAIDEN NAME OF MOTHER
Vaial m. Coy
BIRTHPLACE OF MOTHER #
Forth Chelmsford
INFORMANT § father. 1
PLACE OF BURIAL OR REMOVAL I rural It latures winter
DATE OF BURIAL Oct19 .... 190 ..
- 1905
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
Oct-16 illness, from .. Fyll-12 1905 to 19005 that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Meningitis
one une
(DURATION). DAYS
Contributory 4 works a . . (DURATION). . DAYS
(Signed)
JEVanyy
~...... M. D.
Del -16 90 ((Address) M. Chilassen
.. 19
. .
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence. Place of Death ?.. Days
How long at
Where was disease contracted, if not at place of death ?.
Filed. Oct. 17 1905 Edward J. Robbins Joan Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
I Name of cemetry.
CITY OF LOWELL
FULL NAME Mac, madelin Ovreil
Place of Death *
Date of Death
oct 14 1955
1
Age.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
OCCUPATION
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
Matthew UM
FULL NAME
Place of Death *
Date of Death .. Oct = 9
1900 Age 09
years
months
days
STATISTICAL DETAIL
SEX
COLOR
mal that
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
PIRTHPLACE Chelwo ford
NAME OF FATHER
Michael fakulty
BIRTHPLACE OF FATHER Į uland
MAIDEN NAME OF MOTHER
Bridget Barrett
BIRTHPLACE OF MOTHER # Ruland
OCCUPATION
INFORMANT § Michael All Faults
PLACE OF BURIAL OR REMOVALOD
DATE OF BURIAL ref31 .. 190.5
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ...
.190 .... to.
190 ... .,
that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows : Primary : шампань
(DURATION) 11/200 .... DAYS
Contributory
.. (DURATION). .. DAYS
(Signed) . M. D.
.. 190 .... (Address) ..
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence Place of Death ?. Days
How long at
Where was disease contracted, if not at place of death ?...
Filed
Oct, 30, 1900- Edward Ju Rodibring
Down Clerk.
.City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
+ In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
1| Name of cemetry.
44
CITY OF LOWELL
RETURN OF A DEATH Culte
Registered No ..
5-8
East Witholives ford/
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
Brother
45
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
marcia Hunt Him
Registered No.
59
Place of Death *
Chelmsford mass
Date of Death
Det. 28
1905
.Age
86
/
.. months
days
STATISTICAL DETAILS
SEX
7.
,
COLOR,
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Salem, mass.
NAME OF
FATHER
BIRTHPLACE
OF FATHER
Salem, mass
MAIDEN NAME
OF MOTHER
Sally Flinch
BIRTHPLACE
OF MOTHER #
Salem, mas.
mass.
OCCUPATION
INFORMANT §
mary Winn
PLACE OF BURIAL OR REMOVAL II Harmony Salem, mass
DATE OF BURIAL
nov. 1
190 5
ADDRESS
UNDERTAKER
Walter Fecham Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY OERTIFY that I attended deceased during last illness, from Sept. 16 1905 to Oct, 28, 1905, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Valmean Atsauthereare
(DURATION).
DAYS
Contributory :
Senilità
.(DURATION).
DAYS
(Signed)
Arthur Y. Scobina"
M.D.
(Oct. 30
1905 (Address) Celularfad Maxi,
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
How long at
Place of Death 7.
.Days
Where was disease contracted,
If not at place of death ?
Filed
Oct. 31
95 Edward J. Robbing
Clerk
Jörn
* City or town, street and number, if any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical details, || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
years.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
46
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death
how 10th 1905
Age 81
years
months
days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR Widow DIVORCED
MAIDEN NAME + Manly Tale
HUSBAND'S NAME + George & Gilchrist
BIRTHPLACE #
Buxton The
NAME OF FATHER Jamuse Jale
BIRTHPLACE OF FATHER # Buoption Me
MAIDEN NAME OF MOTHER Annie Harmon
BIRTHPLACE
OF MOTHER #
Buy love , He
OCCUPATION
At Home
INFORMANT §
Grandson
PLACE OF BURIAL OR REMOVAL !! Lowell Cemetery
DATE OF BURIAL
Nov. 12.
.... 190.3.
UNDERTAKER ABC unier
ADDRESS
58 Theseatt st-
derwell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. Nor 4 .1900 to. 1905 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows :
Primary : neu monia
6
. (DURATION) ..
DAYS
Contributory
(Signed)
JE Varney
..... M. D.
nor 10
n. Chelmain
.... 190 .... (Address)
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
How long at
Former or
Usual Residence .
Place of Death ?.
Days
Where was disease contracted, if not at place of death ?. .
Filed
Nov. 11
...
Edward J. Robbing
Town Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
|| Name of cemetry.
barney
. (DURATION). .. DAYS
huis Chancy Gilchrist-
Worth Chellesfor Mass
Registered No.
60
:
COMMONWEALTH OF MASSACHUSETTS
47
RETURN OF A DEATH
FULL NAME
Harrie Howard Stre
Registered No.
61
Place of Death *
Date of Death
November 12 1905
Age ....
16
years
1 5
.. months
18
.days
STATISTICAL DETAILS
SEX
Mal
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
X
MAIDEN NAME 1 HUSBAND'S NAME }
BIRTHPLACE # Chelmsford
NAME OF
FATHER
Willard & Stone
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER Enama Lepine
BIRTHPLACE
OF MOTHER #
London Lang.
OCCUPATION
INFORMANT §
Mro Tomma Stars.
PLACE OF BURIAL OR REMOVALI Cheff
DATE. OF BURIAL Un 13 190.0 **
UNDERTAKER Walter Perla.
ADDRESS
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that i attended deceased during last illness, from. Nov. 9, 1901 to nor. 12, 1905, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary : Cerebro-somal meningitis
Contributory :
... (DURATION) ..
.. DAYS
(Signed)
tiThan 2, Scotoma
P .....
.. M.D.
nov.12 905 (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death ?.
Days
Where was disease contracted, if not at place of death ?
Filed Nov. 12 1905 Edward & Robbins
Clerk
* City or town, street and number, If any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If in a Hospital or Institution, give Its NAME Instead of street and number,
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
Il Name of cemetery.
. (OURATION). .. DAYS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death
Senzaun , Mona han Forth Chilis ford Age
Registered No.
62
years ..
1
months
days
STATISTICAL DETAIL
SEX male
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # North Philcoford
NAME OF FATHER
BIRTHPLACE OF FATHER #
Jawor N. Monahan uland
MAIDEN NAME OF MOTHER
Margaret Lynch
BIRTHPLACE OF MOTHER # refund
OCCUPATION Vion Mulder Vicon
Moulder
INFORMANT § father
PLACE OF BURIAL OR REMOVAL I nord
DATE OF BURIAL
.... 190.
)
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
.. 190J ... to illness, from nor 12 Har 13 . 1905.
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Pneumonia
5
.(DURATION) .. DAYS
Contributory
.(DURATION). . DAYS
(Signed) ..
Yor.13
... 190.(Address).
7. Chelcurious
..
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Former or Usual Residence. Place of Death ?. Days
Where was disease contracted, if not at place of death ?.
Filed Nov. 14. -Edward J. Rotting
Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
+ In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
" Name of cemetry.
CITY 48 OF LOWELL
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
49 Chelmsford (CITY OR TOWNY
RETURN OF A DEATH
FULL NAME
Persis M.David
.Registered No.
63
Place of )
Chichesford, Mass.
Death * S
Residence
Chehnedfunch Mass. Age.
.. years.
6
.. months.
12 days
STATISTICAL DETAILS
SEX
7.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t
Persis M. Griffin
HUSBAND'S NAME +
Henry P. Davis
BIRTHPLACE+
Methuen, Mass.
NAME OF
FATHER
Josiah Griffin
BIRTHPLACE
OF FATHER#
Methuen
MAIDEN NAME
OF MOTHER
Lydia Baker.
BIRTHPLACE OF MOTHER #
OCCUPATION
at Home
INFORMANT §
Gilbert He. Davis
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
to fathers, Chelmsford. nov. 20 1905
UNDERTAKER
ADDRESS
Walter Perham Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Supr.
190.0.to
1905,
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Heart disease
.. (DURATION).
. DAYS
Contributory :
(Signed)
Que Apartir
.. (DURATION).
DAYS
M.D.
Nov.18 1905 (Address).
253 Central
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months.
days
Where was disease contracted,
if not at place of death ?.
Filed
Nov. 19
1903 Edward . Rolling
Tom
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If in a Hospital or Institution, give Its NAME instead of street and number.
t in case of married or divorced woman, or widow. # State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. || Name of cemetery.
Date of
Nov. 17
.. 1903
Death
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COLOR
SINGLE, MARRIED, WIDOWED OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER Edward D. Juck
BIRTHPLACE OF FATHER#
fayette Me.
MAIDEN NAME OF MOTHER
20
BIRTHPLACE OF MOTHER # Ferrell OCCUPATION
INFORMANT § Father
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL St. Patricks Lowell MV 27 1905
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190 ...... to .. 190. .. , 7000 26 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
No medical attendance
no Lemon Law child die
Futable deachder to Cavaliere
. (DURATION). DAYS auth must, Mais teen Builder
Contributory :
(DURATION). DAYS
(Signed)
JE Varney agt-Bound Heures
.. M.D.
Nos 26,90 J (Address / Chemcenter
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? years.
months. days
Where was disease contracted, if not at place of death ?
Filed Nov. 27 1905 Edwards Robbins
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, glve facts called for under "Special Information." If In a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person glving statistical detalls. || Name of cemetery.
50
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Amy Beatrice Vuche
.Registered No ..
64
Death * S
Place of
Brouillette Str. No. Chemustard
Date of l
Nov. 26
Death
Residence 11
"
Age
.. years.
.. months.
.. days
STATISTICAL DETAILS
1
1
COMMONWEALTH OF MASSACHUSETTS
CITY 51 OF LOWELL
Registered No.
65
Place of Death * North Chelmsford Mast
Date of Death Chou 27. 1905
Age 92
years
/
months
4
days
STATISTICAL, DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME 1
Secoan Macfarlane Busker
HUSBAND'S NAME + Daniel 4cloud
BIRTHPLACE # Belfast Ml
NAME OF FATHER Joseph Buskle
BIRTHPLACE OF FATHER Į
Canalhay
MAIDEN NAME OF MOTHER
Deborah Welch
BIRTHPLACE OF MOTHER # (Unknown) maine
OCCUPATION At home
INFORMANT §
Jon
PLACE OF BURIAL OR REMOVAL 11 Belleview masa
DATE OF BURIAL
.... 1905
UNDERTAKER
ADDRESS 58 Presente st Lowell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. time to time 1900 to Sept . 19005. that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Old age- gradual
failure of all the fact
ulties
. (DURATION) .. DAYS
Contributory
.(DURATION) ..
. . DAYS
förre
(Signed)
forrest martin.
.M. D.
Nov. 27 19005 (Address) 19 Lange St.
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence ..
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