USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1904-1905 > Part 6
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
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
Hartford Com, So Cheluat DEC.14
190.5 ....
UNDERTAKER
Halter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. He-2 1904 to Ane-11-1904. 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 : Ineconomia Primary : /Pleurici
9
{DURATION ) ...
.. DAYS
Contributory :
Valvular Disease
of thanh
( DURATION ).
months
(Signed)
Malicher.
..... M.D.
De-12- 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
Dic. 13 1904 Edward 9.08at
farting
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, glve 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
22%
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
228
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
FULL NAME
Michael R. Drnahol
Registered No.
6/
Place of Death *
Chelunsford Muss.
Date of Death
Dac 14, 1964
Age 86
years
months
days
STATISTICAL DETAIL
SEX Male
COLOR
Mate
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Meland
NAME OF FATHER
BIRTHPLACE
OF FATHER #
Ireland
MAIDEN NAME OF MOTHER
BIRTHPLACE
OF MOTHER #
Treland
OCCUPATION
Peterid
INFORMANT §
Diference Donahoe
PLACE OF BURIAL OR REMOVAL W
St Patricks Toral Mas
DATE OF BURIAL
Arc 17
190
ADDRESS 324
UNDERTAKER 74.0 Dorul &Sons, Master St.
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ..
Dec. 6
.. 1905%.to ... Dec 14 ... 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 :.. Bronchitis
. (DURATION).
. DAYS
(Signed).
Amare Howard.
.M. D.
Q.14 1904 (Address)
Chelmsford
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence.
Place of Death ?.
. Days
Where was disease contracted, if not at place of death ?...
Filed DEC 15 190 4 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 cemetery.
8
Contributory :
Old age.
y (DURATION) ..
.DAYS
How long at
Sou .
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
=
COMMONWEALTH OF MASSACHUSETTS
229
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death
Nee 15th
1904
12 hours
.Age
. years ...
months. .days
STATISTICAL DETAILS
SEX
P
COLOR White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Simple
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # north Chelmsford
NAME OF FATHER
BIRTHPLACE OF FATHERİ Ireland
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER # Jowell.
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
UNDERTAKER
ADDRESS North Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 190 to De 10th 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 : Cuandocio
(DURATION). DAYS
Contributory :
.(DURATION) .. DAY8
(Signed)
YE Janney
M.D.
Nee 15 1904 (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
Dac. 16
.190.
Edward J. 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 details. || Name of cemetery.
Registered No.
62
230
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
FULL NAME Robert
Sur El-
Registered No.
63
Place of Death * -hast Chelmsford Inars
Date of Death
Dec 29, 19041
Age 37
years
2
months 22 day6
STATISTICAL DETAIL
SEX male
COLOR
while
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME 1
HUSBAND'S NAME +
BIRTHPLACE # England
NAME OF FATHER unknown
BIRTHPLACE OF FATHER # Markenown
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER #
unknownz
OCCUPATION Laborer
INFORMANT § Windows-
PLACE OF BURIAL OR REMOVAL HI Edson Cestoval
DATE OF BURIAL Dcc 03 /100 4
ADDRESS
UNDERTAKER 6.M. Young 2 33 Prescott
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illnes Que 25 1904 to Dex 29 190 4. 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 :..
albuminous
NEphinicio
.(DURATION). DAYS
Contributory :
. (DURATION). DAYS
(Signed) ..
C. Te Leland
M. D.
Dee 29 190 4 (Address) ..
Lawell Mass
...
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 DEC. 31 1904 Edward ). Raffin 802222
. 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 cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT. WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
2.31
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Harrison Warren Cheche
Registered No.
1
Place of Death *
Date of Death.
Jan 13" 1905
Age 64
... yea
.years ...
10
months
15
.days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED Married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE+
Gilford 21 12
NAME OF
FATHER
Zuai Chcelen
BIRTHPLACE OF FATHER# Pitafield Ult
MAIDEN NAME
OF MOTHER
Jusan HI Leleppard
BIRTHPLACE
OF MOTHER #
OCCUPATION
Carpenter
INFORMANT § Harry Chesia
PLACE OF BURIAL OR REMOVAL ! DATE OF BURIAL Lamlle Edson Gemeten Jan 18" 190 40 UNDERTAKER ADDRESS Jahn AWeinbeck so muldles ! Name of cemetery.
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from Qct 190.3 .. to 1905, fan 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 :
Miocarditis
-
(DURATION). . DAY8
Contributory :
(Signed)
Anhn G. Scoboria, .M.D.
.(DURATION) ... .. DAY8
Jan . 14 905 (Address).
Celebro ford, Mars
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 Jan. 14 1905 Edward J. Korting
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.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.
二
٦
232
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Barn
am
.Registered No. 2
Place of Death *
Date of Death.
Jan 22 and
Age ....... 16
.years
... months
220
.days
STATISTICAL DETAILS
SEX Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE İ
NAME OF FATHER
Alex Barn
BIRTHPLACE OF FATHER# England
MAIDEN NAME OF MOTHER Edith MU Thath
BIRTHPLACE OF MOTHER #
England
OCCUPATION Student
INFORMANT §
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL
Hesterly K- Shand Jan 24 1905
UNDERTAKER
ADDRESS
James & WoTtonto Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .190 .. Manly 2 2905 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 : Decever of Steart
died suddenly 3 k5 minuta
.(DURATION) .. .. DAY8
Contributory : ..
Organis desene I heard
(DURATION) Oflace DAYS
(Signed).
JE Vaney
M.D. Jay 23,905 (Address) Dono ChelundaMo
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 Var 23
Edward J Rotting Tor 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. # Stato or country ; also city, town or county, If known.
§ Namo 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
233
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Stille
( Hubbert
Registered No.
3
Place of Death *
Chelmsford.
Date of Death.
Habe 2 1905
.Age.
years ..
months
.days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Chelmsford
NAME OF
FATHER
allen Hulbert
BIRTHPLACE
OF FATHER#
Seniztavan Com.
MAIDEN NAME
OF MOTHER
marguerite In. monta
BIRTHPLACE
OF MOTHER #
Montreal Can
OCCUPATION
INFORMANT § Laura Putiny
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from Baly ...... 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 as follows : Primary :
Contributory :
(DURATION) .. DAYS
(Signed).
Anton M/ Scoton.M.D.
190 (Address) 2
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, 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 pcb. 3
1903-
Quand J. Rolling
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Horfactura Com. Chalupand Delete 3
190.5
UNDERTAKER Walter Parhan
ADDRESS
Chelmsford
* 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 marrled 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.
.. (DURATION). . DAYS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
1
234
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
Registered No. 4
Place of Death *
Last Chelmsford
Date of Death Teley 320
913 Age 28
years
months days
STATISTICAL DETAIL
SEX
make
COLOR
W
SINGLE, MARRIED, WIDOWED, OR DIVORCED Suigh
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Freland
NAME OF FATHER andrew Murray
BIRTHPLACE OF FATHER # Jeland
MAIDEN NAME OF MOTHER Many Coffey
BIRTHPLACE OF MOTHER # Fueland
OCCUPATION
INFORMANT §
Sister
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 :
(DURATION) 24 hours
Contributory :
.. (DURATION) .. .. DAYS (Signed) Ab. rick Lived-CMD Feb3 190 5(Address) 219 Central Sr.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Lowall
Usual Residence. .
How long at
. Place of Death ?.
Days
Where was disease contracted, if not at place of death ?..
Filed tel. 4. Quand JRobbing
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.
That Downeller@road antal Yame of ce(TY
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVALO
DATE OF BURIAL
UNDERTAKER
1
RETURN OF A DEATH
FULL NAME
Patrick Murray
235
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Lizzie A. S. Vinal
Registered No.
a
Place of Death *
north Cheluns ford, mass
Date of Death.
Frb 6, 1905
Age.
35
. years
months
.days
STATISTICAL DETAILS
SEX female
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť
Lavier
HUSBAND'S NAME t
charles E. Viual
BIRTHPLACE #
northbord, mass.
NAME OF
FATHER
Richard Davies.
BIRTHPLACE OF FATHER# England
MAIDEN NAME
OF MOTHER
Richardson.
BIRTHPLACE OF MOTHER # northbord
OCCUPATION At Home.
INFORMANT § Charles E. Vinal
PLACE OF BURIAL OR REMOVAL II n. Chelmsford tomb
DATE OF BURIAL Fab. 9 1903
UNDERTAKER
ADDRESS James J. Watton n. chebusford med.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 1904 to Feber 6 ago 6, 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 :
Consumption of tubercule.
.. (DURATION). DAYS
Contributory :
.(DURATION). DAYS
(Signed) ..
Feb 7 1905 (Address) No Chelmsford
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 Fel. 8 1905 Edward & Bathing
Tom 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 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
236
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
FULL NAME
Mathilda Lussur
Registered No. 6
Place of Death * Chelmsford mass
Date of Death
Feb. 13 - 05
Age
8%
years .
10 months
days
STATISTICAL, DETAIL
COLOR
Female While
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Mathilda Barbeau
HUSBAND'S NAME + Louis Lussier
BIRTHPLACE ± Canada
NAME OF FATHER
BIRTHPLACE OF FATHER # Canada
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER # Canada
OCCUPATION ar HornE!
INFORMANT § r $ f. B. Roberge
PLACE OF BURIAL OR REMOVAL II Ir Joseph Cemetery
DATE OF BURIAL
... 190.
UNDERTAKER -Przefelv albert
ADDRESS
/ Cheever.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jau 2 .. 1905 to diet 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 :. .
·(DURATION) .. 2 4 DAY
Contributory :
. (DURATION) .... ....
... DAYS
Di Pachetto
(Signed). 8
M. D.
de et 14 190 5 (Address) 334 Merrimack
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
tel 14
1905 Edward J. Bobbing
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.
# State or country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
Nh.Name .of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
Michelle.
!
6
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
STATISTICAL DETAIL
SEX fe
COLOR
SINGLE, MARRIED, WIDOVED, OR DIVORCED
MAIDEN NAME +
Celine Bastian
HUSBAND'S NAME + David Bellerose
BIRTHPLACE # Canada
NAME OF FATHER
Godfroid Barten
BIRTHPLACE OF FATHER Į Canada
MAIDEN NAME OF MOTHER Vente Prudhomme
BIRTHPLACE OF MOTHER #
(Canada)
OCCUPATION
House Proper
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL II Patrick
DATE OF BURIAL
20 Feb 1
. .. 190.62.
UNDERTAKER ADDRESS 738 A Archambault Merrimack
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ....
Jeb 17 1902 to Ster 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 of follows :
Primary : Influenza -
13
.. DAYS
Contributory DAYS Panalysis of the Heart 1 hour
(Signed) . In. Trudeau .. M. D. Felmay 18 190 5 (Address) 464 Normal
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 1.26. 18 Edward& Rafting Conn 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.
237
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
7
FULL NAME
„RETURN OF A DEATH Oliving Belleras
Place of Death * Chelmsford Center
Date of Death
17 Feb 1905
Age ..
44
.. years.
Registered No .. Mars
months days
-
239
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL 9
FULL NAME
Place of Death * 1, Melonsford Inaes
Date of Death. March 8- 05
Age 19
years
.months
days
STATISTICAL, DETAIL
SEX Female Ml;
COLOR 1
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME 1 - Maria
Roberge
HUSBAND'S NAME +
BIRTHPLACE # Lowell mass
NAME OF FATHER Frau DS. Roberger
BIRTHPLACE OF FATHER # Canada
MAIDEN NAME OF MOTHER Caroline Lucir
Lucius
BIRTHPLACE OF MOTHER #
Canada
OCCUPATION Honde- worfe
INFORMANT § Joseph Hulphond
PLACE OF BURIAL OR REMOVAL !! Chelmsford
DATE OF BURIAL Franch 10 05 190.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ..
Fick 15 1905 to March 8 190 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 :... мигльний.
(DURATION) 20 DAYS
Contributory :
(DURATION) .. DAYS
(Signed) ..
WRochette
M. D.
Karel 3 1905 (Address) 334 Marswach
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence ..
Place of Death ?..
. Days
Where was disease contracted, if not at place of death ?..
Filed
mar. 8
1905 Edward J. Robbing
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.
# 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 1.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Registered No.
How long at
Tochetto
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Louisa
6: Hall
Registered No.
Place of Death * West Chelmsford mass
Date of Death
march
6.1945
Age 48
years
6
months
dnys
STATISTICAL DETAIL
SEX
temale
COLOR white
SINGLE, MARRIED, WIDOWED, QR DIVORCED
married
MAIDEN NAME +
Louisa & Jeffrey
HUSBAND'S NAME + John & stall
BIRTHPLACE # West Chelmsford
NAME OF FATHER John geffroy
BIRTHPLACE OF FATHER # Canada
MAIDEN NAME OF MOTHER Harriet Sterwood
BIRTHPLACE OF MOTHER ± England
OCCUPATION
at home
INFORMANT § Suobund
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL West Chelmsford march 9.105
UNDERTAKER
ADDRESS
b.m. young to 33 Prescott of Name of cemetry,
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from funny .190/ ... to
March 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 : .. Hodgkins Desean Four years
Contributory
. (DURATION) .. . . DAYS
(Signed)
JE Varney
.M. D.
Mich 8- 1005 (Address
Ly
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 mar. 9 1905- Canard J. Rolling 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.
+ 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 ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
240
CITY OF LOWELL
10
.... (DURATION). DAYS
241
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME albert At.
Place of Death * north Chelmsford mars
Date of Death march 14.1905 Age. 10 years. 8
months
days
STATISTICAL DETAIL
SEX
male
COLOR white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ± Chelmsford mais
NAME OF FATHER
Steven Spaulding
BIRTHPLACE OF FATHER + Chelmsford marc
MAIDEN NAME OF MOTHER Sabry Blodgett
BIRTHPLACE OF MOTHER #
Tyngsboro mais
OCCUPATION
Store Cutter
INFORMANT § Widour
PLACE OF BURIAL OR REMOVAL !!
Tyngsboro maso
UNDERTAKER b.M. youngter
ADDRESS 33Prescott
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Mar 9 1905 to Mar 14 190.5; 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 :
Pneumonia.
(DURATION) 5
.DAYS
Contributory
Old age and
Pleurilie y ... DAYS Situace (DURATION). Harlow (Signed) .. M. D. mar 14 1903 (Address) Tyngaber ..
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 Mar. 16 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.
+ 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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
DATE OF BURIAL
March 16.100 5
Spaulding
Registered No 11
COMMONWEALTH OF MASSACHUSETTS
RETURN , OF A DEATH
FULL NAME
Albert
Morrell
Registered No. 12
Place of Death * Ho Chelmsford
Date of Death
Mielo 2/ St-1
Age.
years ..
months
30 Lers days
STATISTICAL DETAIL
SEX Male
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Ho Chelin, Lord mais
NAME OF FATHER John B Howell
BIRTHPLACE OF FATHER Į
MAIDEN NAME OF MOTHER
rich
BIRTHPLACE OF MOTHER # Lowale Mars
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
County
DATE OF BURIAL Ich 23 . . 1901 ..
UNDERTAKER
ADDRESS no Chelunsford
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
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.