USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1904-1905 > Part 3
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Rule 4. The bodles of those dead of diseases that are not contaglous. infectlous or communicable, may be received for transportation when encased in a sound casket or overbox, provided that they reach their destination within thirty hours after death. If the body cannot reach its des- tination within thirty hours after death it must be prepared for shipment by filling the cavitles with an approved disinfectant, washing the exterior of the body with the same, stopping all orifices with absorbent cotton, and the body must be arterially embalmed by a licensed embalmer of the State of New York, and the same encased in a coffin or casket and outside wooden box.
Rule 5. In cases of contagious, infectious or communicable diseases, the body must not be accompanied by persons or articles which bave been exposed by the infection of the disease, unless certified by the Health Officer as having been properly disinfected; and before selling passage tickets agents shall carefully examine the transit permit and note the name of the passenger in charge, and of any others proposing to accompany the body, and see that all necessary precautions have been taken to prevent the spread of disease. The transit permit in such cases shall specifically state who Is authorized by the local Board of Health to accompany the remains. In all cases where bodies are forwarded under Rules 1 and 2, notice must be sent by telegraph to Health Officer at destination, advising the date and train on which the body may be expected. This notice must be sent by or in the name of the Health Officer at the initial polnt, and Is to enable the Health Officer at destination to take all necessary precautions at that point.
Rule 6. Every dead body must be accompanied by a person in charge, who must be provided with a passage ticket and also present a full first- class ticket marked "Corpse" for the transportation of the body, and a transit permit-with undertaker's certificate, name of deceased, date of death, age, place of death, cause of death, and if of a contagious, infectlous or communicable nature, the point to which the body Is to be shipped. And when death is caused by any of the diseases specified in Rules 1 and 2. the name of the person or persons authorized by the local Board of Health to accompany the body. The undertaker's certificate and paster shall be detached from the transit permit and pasted on the coffin box. The transit permi: shall be handed to the passenger in charge of the corpse. The first coupon shall be sent to the official in charge of the baggage department of the initial line, and by him to the secretary of the local Board of Health of the municipality from which sald shipment was made.
Rule 7. Every disinterred body, dead from any disease or cause, shall be treated as infectious or dangerous to the public health and shall not be accepted for transportation unless said removal has been approved by the local health authorities having jurisdiction where such body is disinterred, and the consent of the health authorities of the locality to which the corpse Is consigned has first been obtained; and if the death was from causes specified in Rule 1 the approval of the State Commissioner of Health must likewise be obtained. All such disinterred remains shall be enclosed in a hermetically sealed (soldered) zinc, tin or copper lined coffin or box. Bodies deposited in receiving vaults shall be treated and considered the same as buried bodles.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX female
COLOR What
SINGLE, MARMED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Elizabeth Caurl
HUSBAND'S NAME Ť
BIRTHPLACE +
Ireland
NAME OF FATHER
1 Verne Canal
BIRTHPLACE OF FATHER +
Ireland
MAIDEN NAME OF MOTHER
not known
BIRTHPLACE OF MOTHER +
I cloud
OCCUPATION
INFORMANT S
Utm Ding ley. Von
PLACE OF BURIAL OR REMOVAL U If Patura century
DATE OF, BURIAL Mail 28 004 190.
UNDERTAKER James J. ON muel Im 324 maist St ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY, CERTIFY that I attended deceased during last illness,
from aful 24 190 % to arne 26 190
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 :
Prieumenia
Two days
tion) Days
Contributory :
(Duration) Days
(Signed;
F. E Vanily
M. D.
april 26
.190.> (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 april 28 1904 Edward J. Robbins Com 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.
į State or country; also city, town or county if known.
§ Name and address of person giving statistical details.
|| Name of cemetery.
r-c 8178
189
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Place of Death *
Date of Death
April 26
1904
Age ...... 83
Registered No.
22
-
years
months.
days
RETURN OF Å DEATH Elizabeth, Branch Of. With Chelinford
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Oliver Hiske
Registered No.
23
Place of Death *. north Chelmsford Muss
Date of Death May 2 1904
Age 84
years
months. days
STATISTICAL DETAILS
SEX m
COLOR
SINOLC, MADIED, WIDOWED, AR DIVORESD
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE + Holliston Muss
NAME OF FATHER Lewis Giska
BIRTHPLACE OF FATHER +
Hatberton mall
MAIDEN NAME OF MOTHER metitable K Knowles
BIRTHPLACE OF MOTHER + Chowwood MH
OCCUPATION
INFORMANT S Mes Metro & Cameron his miele
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness,
from
July 1
190% to May 2
1908
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 :
Senility
( Duration) Days
Contributory :
(Duration) Days
(Signed;
JE Varney
M. D.
4May 2
190 % (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 May 4 1904 Canard J. Robbing
Tom Clerk
PLACE OF BURIAL OR REMOVAL !
Lawell esmilly Lowell
UNDERTAKER
DATE OF BURIAL
May 5 1904
ADDRESS
* 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.
Į State or country; also city, town or county if known.
§ Name and address of person giving statistical details.
| Name of cemetery.
0-C >178
190
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
·
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
FULL NAME
Place of Death *
Arth Chelunsford Mass
Date of Death.
May 39, 190 4
Age ...
40
years.
months
days
STATISTICAL DETAILS
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
any Bradley Why F Callahan
BIRTHPLACE # Duland
NAME OF FATHER
John Bradley
BIRTHPLACE OF FATHER# Juland
MAIDEN NAME
OF MOTHER
Uun Mistamex
BIRTHPLACE
OF MOTHER #
Queland
OCCUPATION at Home
INFORMANT §
John F. Callahan
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Mark
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 :
3 mr y mentreDURATION).
DAYS
Contributory :
(DURATION). DAYS
(Signed).
FE Varney
M.D.
May 4
.1903 (Address) H. Chilunken
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 Than 4 1904 Canard . Robbins
1
Com
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. | Name of cemetery.
PLACE OF BURIAL OR REMOVAL I
If Peluches secretary que May 5
DATE OF BURIAL
190.
4
UNDERTAKER
ADDRESS
.I Dwell [ Jan. 324 Mais HI
191
COMMONWEALTH OF MASSACHUSETTS
Can Callahan 1 smn
Registered No. ..
24
1909 to May
4
192
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Terrence Me Enaney
Registered No.
25
Place of Death *
North chelmsford was
Date of Death
May 7
1904
Age.
65ª
.. years
4
months
days
STATISTICAL DETAILS
SEX m
COLOR
SINGHE MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME Ť
BIRTHPLACE + Ireland
NAME OF FATHER Over de Ermey
BIRTHPLACE OF FATHER + Juland
MAIDEN NAME OF MOTHER mary decry
BIRTHPLACE OF MOTHER +
Ireland
OCCUPATION
Laborer
INFORMANT S
Kre Patrick Me Enancy
PLACE OF BURIAL OR REMOVAL II
OATE OF BURIAL
It Patrick
May 8 .190 4
UNOERTAKER
ADDRESS
I.H. elle Dermott To content
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness,
from
1904 to May 7
1904
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 :
Cinhosis
-
(Duration) Days
Contributory :.
(Signed;
Amaca toward.
Days
.. M. D.
May 7 1904 (Addres).
1
SPECIAL INFORMATION ouly 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 may ? 190 % Edward J. Roffi
Vom 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.
Į State or country; also city, town or county if known.
§ Name and address of person giving statistical details.
Name of cemetery.
c-c 817F
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
E
-
COMMONWEALTH OF MASSACHUSETTS
193
RETURN OF A DEATH
FULL NAME
Benjam
.
Judson Shoulding
.Registered No.
26
Place of Death *
Chelmsford, Westford Road
Date of Death
May 12 1904
Age ...
80
years
5
... months
6
days
STATISTICAL DETAILS
SEX
COLOR
w.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE İ
Chelmsford
NAME OF
FATHER
Benjamin
BIRTHPLACE OF FATHER# chelmsford
MAIDEN NAME
OF MOTHER
Patty Day
BIRTHPLACE
OF MOTHER#
Nelson, M.H.
OCCUPATION
Harmen
INFORMANT §
thank Spaulding (Sou )
PLACE OF BURIAL OR REMOVAL II Hart Pred Cemetery
DATE OF BURIAL
May 15 904
UNDERTAKER
Halter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .: -190. May 10 190 × 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 :
(DURATION) 304
DAY8
Contributory :
Senility
(DURATION).
. DAY8
(Signed)
JE Varney
M.D.
May 12 1904 (Address) JEVarer
Tinck Clientand
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 May 14 1904 Edward J. Rotring
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. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
1
F
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Place of Death *
Date of Death
Divay 19 1904
Age
63
years.
months.
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME T
Elizabeth Jockey
HUSBAND'S NAME Ť
Frederick Dawson
BIRTHPLACE + Ireland
NAME OF FATHER William Tooley
BIRTHPLACE OF FATHER + Jufand
MAIDEN NAME OF MOTHER Margaret Magnet
BIRTHPLACE
OF MOTHER +
Juland
OCCUPATION at Home
INFORMANT $ Justin Dawson
PLACE OF BURIAL OR REMOVAL !! It Paluck
DATE ÖF BURIAL
May 21 190 .. 4
UNDERTAKER
ADDRESS
IH Me Dermott 70 yorkban St
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness,
from.
May 16 1904 to.
May 19
1904
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 :
Bronchitis
Several months.
(Duration)
..... Days
Contributory :
anaemia
(Duration) Days
1
(Signed;
M. D.
1.1,20
190 .. 4 .! (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 May 20 1904 Eduard J. Korting Jean Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Inforination." 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.
TT Name of cemetery.
c-c :178
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
194
RETURN OF A DEATH
Elizabeth Dawson
North Chelmsford Acass
Registered No.
270
Y
5
1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Place of Death *..
Date of Death
May 22.
19840 Age.
years.
months. 19 days
STATISTICAL DETAILS
SEX The
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME T
HUSBAND'S NAME +
BIRTHPLACE + thelunsford
NAME OF FATHER
Nelson/ Lawcraft
BIRTHPLACE OF FATHER +
Cannan
N.H.
MAIDEN NAME OF MOTHER
Mary M. Riley
BIRTHPLACE OF MOTHER + Ireland
OCCUPATION
INFORMANT §
Father
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
St. Patricks May 23004
ADDRESS
UNDERTAKER @ finally
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness,
from 190 ..... to May 20 1904 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 :
prematien beach
Contributory :
(Duration) Days
(Signed;
7 E Varney
M. D.
May 23
190 % (Address).
2. Chilcurtea
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 May 2.3 1904 Edward J. Rohtma storm Tom 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.
li Name of cemetery.
Dre Varney
North Concluded
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Mary
Registered No. 285
Chelmsford!
1.95
(Duration)
13
Days
1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Lathering ACHara
FULL NAME
Place of Death *
Center Road East Chelmsford
Date of Death.
Lung 2019 1904
.Age
46
years ..
months
.days
STATISTICAL DETAILS
SEX
COLOR
JINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
Catherine A Jonatas
HUSBAND'S NAME +
Et Lahus M O Hara
BIRTHPLACE
Lawell
NAME OF
FATHER
Bathanaly Donahue
BIRTHPLACE
OF FATHER#
Ireland
MAIDEN NAME OF MOTHER Cathrine Mahoutume.
BIRTHPLACE
OF MOTHER#
Ireland
OCCUPATION
at Hance
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL I! St Patricks
DATE OF BURIAL
UNDERTAKER ADDRESS CA. Molloy Lowell
-
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from Oct.
190.3 .. to.
Jan 20 1904,
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 :
Diabetes
1
.(DURATION).
8 mos.
ADURATION). DAYS
(Signed)
Quase toward.
M.D.
June 20 1904 (Address).
Chelmsford.
SPECIAL INFORMATION only for Hospitais, 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
Ame 20 1904
Edward & Robbing,
Cierk
* 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.
Ore Howard
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
196
CITY OF LOWELL
Registered No. .
29
. MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
COLOR
what
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
muy
HUSBAND'S NAME t
John C. Khuhan
BIRTHPLACE# .
NAME OF FATHER wat June, Barry
BIRTHPLACE OF FATHER# Nuland
MAIDEN NAME OF MOTHER nut Kunu
BIRTHPLACE
OF MOTHER #
Unland
OCCUPATION
INFORMANT § John C. Thus han
Nus land
PLACE OF BURIAL OR REMOVAL I
Of Saturés cuenten peux fumo 20 50 LL
UNDERTAKER
ADDRESS 324 Mars Not
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 June 22 1904, that to the best of my knowledge and belief death occurred on the date stated abovegand that the CAUSE OF DEATH was as follows : Primary : Child-birth
.. (DURATION) .. .. DAYS
Contributory :
anaemia ?
.(DURATION). 30 DAYS
(Signed) .....
Amara Je
- forward' M.D.
Jun 24 1904 (Address).
Chelmsford:
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
June 24 1904
Edward J. jeffin
Vorm 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.
197
?
RETURN OF A DEATH
Muhan
.. Registered No. 30
FULL NAME
Place of Death * : Chelleus ford
Date of Death.
Num =zd / 1904 Age 3J
months .days
. years ..
Tour of Klubufag CITY OF LOWELL
COMMONWEALTH OF MASSACHUSETTS
DATE OF BURIAL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
198
STATISTICAL DETAILS
SEXA I huela
COLOR
whit
SINGLE, MARRIED, WIDOWED, OR DIVORCEB
MAIDEN NAME +
HUSBAND'S NAME t
1
BIRTHPLACE#
NAME OF FATHER
John C. Shuhan
BIRTHPLACE
OF FATHER#
Ireland
MAIDEN NAME OF MOTHER Analy Balls
BIRTHPLACE OF MOTHER Juland
OCCUPATION
INFORMANT § John C. Whelan
Unland
PLACE OF/BURIAL OR REMOVAL II
DATE OF BURIAL If Palux, cuentan gary une 25. 190 4
UNDERTAKER
-
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. June 22 1904 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 : Still-Gor
(DURATION). DAYS
Contributory :
-. .... (DURATION). DAYS
(Signed) ..
Award . M.D.
Jana 23, 1904 (Address).
Chelmsford
SPECIAL INFORMATION only for Hospitais, 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
Vare 24 1904
Quand J. Fartons
Toon 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. me of cemetery.
ALL NAMES TO BE IN FULL
FULL NAME
Setill Down
Registered No. 31
Place of Death *
Cheles ford
Date of Death ..
June 224 1964
Age
years.
.months .days
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
-
-
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX COLOR female White
SINGLE MARDIED, WIDOWED OR
-DIVORCED
MAIDEN NAME t
Sarah mccabe
HUSBAND'S NAME + Patrick Mc nalley
BIRTHPLACE#
Ireland
NAME OF FATHER Patrick Me Cabe
BIRTHPLACE
OF FATHER#
Ireland
MAIDEN NAME OF MOTHER Bridge Mccabe
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION
at Home
INFORMANT §
Patrick Phillys
PLACE OF BURIAL OR REMOVAL I St Patricks
UNDERTAKER
ADDRESS
tas H Mc Dermott Jo lyerhan
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last on 8-1964 .190 .. illness, from . 6.198 to. ....... 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 :
one day
.: (DURATION).
... DAY8
Contributory :
.. (DURATION) .. DAYS
(Signed)
M.D.
Sala 10
1904 (Address).
SPECIAL INFORMATION only for Hospitais, 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 Only 11 1904 Edward Rating
0
Iam 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.
199
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Sarah Mcnally
FULL NAME
Place of Death *
-
Date of Death
Highland ave Ho Chemsford 9.19044 Age 5% .. years
CITY OF LOWELL
Registered No.
32
.... months
.days
1
DATE OF BURIAL
.
......
٠r
200
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Riley Davis
.Registered No.
33
Place of Death *
Chelliator Centre
Date of Death.
July 171904
Age
62
years.
8
months
days
STATISTICAL DETAILS
SEX
Male
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Canterbury M.H.
NAME OF
FATHER
Lowell Davis
BIRTHPLACE
OF FATHER #
MAIDEN NAME
OF MOTHER
Sarah a. Smith
BIRTHPLACE
OF MOTHER #
mame
OCCUPATION
Mechanic
INFORMANT §
Mro Riley Davis .
PLACE OF BURIAL OR REMOVAL II Edson Cen, Lowell
DATE OF BURIAL
July 20
1904
UNDERTAKER Walter Perham
ADDRESS Chelmsford.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from June 28 1 190 2 to July 17, 1904. 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 :
Left Himupligia
2 yr
(DURATION) ..
20
DAYS
Contributory :
(Signed)
Auchun colonia
M.D.
Andy 20.1
7. 1904 (Address).
,Chelafor mais.
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 July 20, 1904/ Edward J. Rolling
Town. 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.
MARGIN RESERVED FOR BINDING® FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.(DURATION).
. DAYS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME
1.1 1
Place of Death *
Date of Death ..
/1904
Age ..
82
. years.
6.
.months
.days
STATISTICAL DETAILS
SEX
to
7
COLOR
SINGLE, MATHIEU,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Martha Stattrical.
-
HUSBAND'S NAME t
Thomas il'annava.
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