USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1904-1905 > Part 11
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How long at
Place of Death ?. Days
Where was disease contracted, if not at place of death ?.
Filed Nov. 28 190 5- Edward J. 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.
If Name of cemetry.
Da Martin
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
RETURN OF A DEATH
FULL NAME
Ans Jusan In Floyd
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Still Born.
Plouffe
Registered No.
66
months
.. days
STATISTICAL, DETAIL
SEX COLOR/ male While-
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
-
BIRTHPLACE # helmsford Cen
NAME OF FATHER
Sam Plouffe
BIRTHPLACE OF FATHER
Canada
MAIDEN NAME OF MOTHER Cupchemie Bernier
BIRTHPLACE OF MOTHER Canada
OCCUPATION 1 at. How
INFORMANT § Sam Souff
PLACE OF BURIAL OR REMOVAL !
DATE OF BURIAL
Nec?
.... 190 ..
UNDERTAKER Joseph albert
AADDRESS 5/ Chaves
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ..
190 ...
.t
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 :
Shel Burn
. (DURATION). . DAYS
Contributory
.. (DURATION). .. DAYS
(Signed) .....
.M. D.
820.6 1905 (Address) 510 Maninack
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 DEC. 6. 190 5 (Anand) Robbins 50
Clerk.
"City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facis 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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
Date of Death
Place of Death *
Chelmsford Center To
Dec 51
05
Age
years ..
CITY 52 OF LOWELL
.
chiller.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
STATISTICAL DETAIL
SEX
female that
SINGLE, MARRIED, WIDOWED,OR DIVORCED
MAIDEN NAME +
Catherine mccabe
HUSBAND'S NAME Jatur Dansy
BIRTHPLACE #
Queland
NAME OF FATHER
Herence M. Cabe
BIRTHPLACE OF FATHER #
Leland
MAIDEN NAME OF MOTHER aun mc Cabe
BIRTHPLACE
OF MOTHER #
Queland
OCCUPATION at Home
INFORMANT Vister anny M & Baby
PLACE OF BURIAL OR REMOVAL II
St Palack. Tweeti, Fre
DATE OF BURIAL
Du 9
5
.190.9
UNDERTAKER-
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from Nor 27 1905 to Dec 6 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
6
. (DURATION) ..
DAYS
Contributory
3 a4 units
.(DURATION).
DAYS
(Signed)
7 E Jamey
.. M. D.
Dee 7 1905 (Address)
M. Chelette
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 DEv. 8 1905 Edward & 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.
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.
53
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
atherine & raney
Place of Death *
Date of Death. December 6th
1
CITY OF LOWELL 67
Registered No.
mt Pleasant Nitrat haft Cheveuxford 1900 Age 38 years .. months
days
1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
John adelbertThompson
Registered No.
68
Place of )
Chelmsford Centre
Date of l
Death - December 15 1905
Death * S
Residence
Chelmsford .
Age
0
.. years.
month 26 days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Chelmsford
NAME OF
FATHER
John E. Thompson
BIRTHPLACE
OF FATHER#
Chelsea, Nova Scotia
MAIDEN NAME
OF MOTHER
Mariah D. Bolsar
BIRTHPLACE
OF MOTHER #
Mount Hanley, U.S.
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL I Receiving Tomb Chelmsford Con Removed to Carlisle
DATE OF BURIAL DEe 17 190.05
UNDERTAKER Walter Perhour
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Livec. 15 190 5 :00 490 ...... 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 : accidental asphyxia. (Smothered while adech
... (DURATION).
DAYS
Contributory :
{DURATION)
.. DAYS
(Signed) Dinara toward M.D.
Det.10 902 (Address).
Chilmato dias
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 DEc. 18, 19015 discard Rolling
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.
..
54
COMMONWEALTH OF MASSACHUSETTS
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
CITY 55 OF LOWELL
RETURN OF A DEATH
FULL NAME
Betty Barlow
Place of Death * West Chelmsford Mass
Date of Death December 18, 1905.
Age
83
years
5
months.
..
days
STATISTICAL, DETAIL
SEX
COLOR Female White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widow
MAIDEN NAME +
Betty Lunn
HUSBAND'S NAME + Villiano Barlow
BIRTHPLACE # England
NAME OF FATHER
David Lunn
BIRTHPLACE OF FATHER İ England
MAIDEN NAME OF MOTHER ·
Not known
BIRTHPLACE OF MOTHER # England
OCCUPATION
at Home
INFORMANT § Jas. E. Marshall
PLACE OF BURIAL'OR REMOVAL [I West Chelmsford
DATE OF BURIAL
Dec. 20 190 5
UNDERTAKER J. a. Heinbeck
ADDRESS
8 Middlesey
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from Dec 9 190 0 to Dec 17 .. 1900 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 :
aprflexy
(DURATION) 8
Ys
Contributory
Senility.
.(DURATION). DAYS
(Signed)
+ Evarney
.. M. D.
.... 1904 ... (Address
21. Chellodias
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 DEc. 19 1905 Edward & Rafting
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.
69
Registered No.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
1.56 tily of thewall,
RETURN OF A DEATH
FULL NAME
Charles K . Dick
Registered No.
1828
Place of Death *
Date of Death.
Dec. 17 1405
Age ..
1) 8
. years.
1
.months
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER nelsur bank
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT §
1 Med in book
PLACE OF BURIAL OR REMOVAL II Chelmsford hraw
DATE OF BURIAL
r
Liec: 11
190.05
UNDERTAKER 1 I. It Bricks
ADDRESS
dirvill.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
190
.190.
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 : ...
suicide by illuminating
Cia2.
.. (DURATION) .. DAYS
--
Contributory :
(DURATION) ....
DAYS
(Signed) .F.
.M.D.
211/16) 1903 (Address) 160 Mermirack Rt
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
hemis fere Place of Death?
.Days
Where was disease contracted, If not at place of death ?.
Filed Dec20 19015
lity
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.
Hobbihanford
How long at
٢
57
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mary Sollen Dachelder
Registered No ..
71
Place of )
Chinastund Fase
Date of Dec. 25
190 5
Death
5
.. months ..
1
.days
STATISTICAL DETAILS
SEX
COLOR
W
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Mary E. Dennett.
HUSBAND'S NAME + Frank H. Bachelder
BIRTHPLACE$
Litte fields n. He.
NAME OF
FATHER
Jeremiah W. Dennett.
BIRTHPLACE
OF FATHER
Filmaton. H.H.
MAIDEN NAME
OF MOTHER
Tablica nelson
₹
BIRTHPLACE
OF MOTHER+
listemouth, n.A.
OCCUPATION
at Home
INFORMANT §
Frank H. Bachelder
PLACE OF BURIAL OR REMOVAL II Tower Cemetery. Lowell, Mass.
DATE OF BURIAL
Dec. 27 190.5
UNDERTAKER
Walter Pecham
ADDRESS
Chelmsfordh
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
190
DEC 24/ 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 :
Pulmonary Inforculous-
Sudefinitely- Those thew 3 mms-
... DAYS
Contributory :
almost a year.
.. DAYS
(Signed)
Antun M. Lesomã
..... M.D.
OG626 905 (Address). Chelmsford mais.
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
DEC 27 1905 Eduard ) Rolling
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
Death *
Residence
Chelmsford
Age ..
50
.years ..
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
William
am
Tiver
Registered No ..
72
Place of )
Death * S
Concord
.
ver
Residence
Billerica
masa
Age 11
6
... years.
months 20
.days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # England
NAME OF
FATHER
Robert Tivey
BIRTHPLACE
OF FATHER#
England
MAIDEN NAME
OF MOTHER
Jane Richard
BIRTHPLACE
OF MOTHER #
England
OCCUPATION School
INFORMANT § father
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
.190
.. 190 .. .... , 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 : ...
ac. Drowning
Succedere Chealth
DAYS
Contributory :
... (DURATION).
DAYS
(Signed).
Die28 1906- (Address) 219 Central El-
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
Dec 29
195 Edward . Robbins
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.
UNDERTAKER ADDRESS b.m. Showing Her 33 Prescott soll Name of cemetery.
dwell
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
borner Cemetery Dec 30
19057
58
Date of l
Dec
27
.190
Death
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FRENCH OFTE COMMONWEALTH OF MASSACHUSETTS
DEC 26 1905
FULL NAME
Place of Death * 18 Evergreens Street Dec. 22, '05 . Date of Death
Age ..
years
months. days
STATISTICAL DETAIL
COLOR
SEX Fecmal Weil
SINGLE, MARRIED, WIDOWED, OR ( DIVORCED A Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Chelmsford
NAME OF FATHER
Space Bradley
BIRTHPLACE OF FATHER #
Belekmantown 7.4
MAIDEN NAME OF MOTHER
Elizabeth Burlack
BIRTHPLACE OF MOTHER # Bridgewater, Mr.
OCCUPATION
INFORMANT § Isaac Bradley
PLACE OF BURIAL OR REMOVAL II Edson Temeta
DATE OF BURIAL $20.24 1905
WWeinbeck 80 Middlesuff
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from.
Dec 22 1905 to 22022: 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 :
.(DURATION) .. DAYS
Contributory
(DURATION) .. . DAYS
(Signed)
M. D.
Dec 24 1905 (Address) 16 Kun St
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 DEC. 24 1905 Edward J. Robbing
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.
CITY 59 OF LOWELL 73
RETURN OF A DEATH Child of Isaac+ Elizabeth Bradley
Registered No ..
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
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