USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1904-1905 > Part 7
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illness, from ... .190 .... to. Meh 21 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 :
Cyancoxis
oneday
.(DURATION). DAYS
Contributory
(Signed)
JE Varney
.M. D.
Mech 22 1905(A)
(Address ) .
1. Chefrafin Has
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 mar. 23 Edward J. Roffing
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.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
242
CITY OF LOWELL
.. (DURATION). . DAYS
243
COMMONWEALTH OF MASSACHUSETTS
CITY OF. LOWELL
RETURN OF A DEATH
FULL NAME
colbert I Collier
Registered No ....
13
Place of Death *
Chelmetne Gras,
Date of Death ..
May 23rd 1905
Age 17
.. years.
9
months
8
days
STATISTICAL DETAIL
SEX COLOR Male White
1 SINGLE, MARRIED, WIDOWED, ORD DIVORCED Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # England
NAME OF FATHER Thomas Siyon
BIRTHPLACE OF FATHER New Jule
MAIDEN NAME OF MOTHER THE Game Buster
BIRTHPLACE OF MOTHER # England
OCCUPATION Cheractive
INFORMANT S Lelizabeth Collier
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
ADDRESS
UNDERTAKER det Nembech Middlezes
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 :
Commebro- Spinal Meningitis
Contributory
.. (DURATION). . DAYS (Signed): Ab Mickhuck-Et- .. M. D. Juf 24 - 190.5 (Address) 21Elcentral EL-
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 mar. 25 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.
· (DURATION) 12 horas
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
فيسس
01-1-1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
Elizabeth & Spaulding
Place of Death * north I Chelmsford mass
Date of Death.
march 23. 1905
Age ...
69
years
5-
months
25-
days
STATISTICAL DETAIL
SEX COLOR female white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Hodow
MAIDEN NAME + Elizabeth & bate
HUSBAND'S NAME + albert H Spaulding
BIRTHPLACE # Hooksett n. H.
NAME OF FATHER Thomas& bate
BIRTHPLACE OF FATHER #
untenour
MAIDEN NAME OF MOTHER Viccy Williams
BIRTHPLACE
OF MOTHER ±
unknown
OCCUPATION at- home
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
Tyngsboro mass march 26 10.5
ADDRESS
UNDERTAKER G.M. young tho 33 /mescothyme of cemetry.
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from
Mich 15 1900 to Mich 23
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 :
Eight-
..... (DURATION). DAYS
Contributory
.(DURATION) .. . DAYS
(Signed)
JE Varney
... M. D.
Mich 24
.190 5 ( Address) H. Chilufford
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. 25. 190 5: Edward J. Rolling
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 couuty, if known.
§ Name and address of person giving statistical details.
244
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
. Registered No. 14
ALL NAMES TO BE IN FULL
DATE OF BURIAL
Varney
A B C D E
F
G
=
- J K -
L M Mc N
0
P Q R
S T U V
W
×>N
alderton Dcliam andoin, Lillian marguerite 42
16
andrews Elyah 115
allard
222
Butterfield Philena f. 3. Bickford Daniel H. 11
Bryant Ella S. 38
Barlow Betty- 55 Bachelder mart Ellen 57
Bradley -. 59
By am John 63
Blown Nellie a.
8%.
Bearce Elijah Sammon 108
Blanchard Sarah G. 12.2.
Blaisdell Mary M. 123
Rowley tamés R 130
Bruno Georgiana 133
Bellerose Marie B.J. 139
Buxton Roy Stilliam 152
Bradley Sohn John
155
Bourget Joseph arthur 158
Butters Horace 161
Buzzelli Henry 7. 179
Brotherston andrew KJ 181
Brennan Johanna 224
W X Y Z
Crosby Caroline M. 22
Coughlin Marie Emilee
36
Cour Walter B 41
Cook Charles B 56 Cochrane William O. 60
Chandler Harren 86
Constantino Jane Lenice 102
Connell Sarah M. 113
Blingan Evelyn 114
Conillard aurelie 121
Coté Joseph 124
Coburn Henry a. 138
Crowley Julia
15-3
Collier Beatrice 174
Cole Charles B. 178
Coughlin Borneline 18.0
Clark Rose alma 203
Cheney Lloyd 7. 205
Carleton Andrew Th. 208
borr
219
Clark Charles Danforth 225
.
A B C D E J F G H 1 - J K L M Mc
0 P Q R S T U V
N
DECarterett George alfred 33
Driscoll Ellen In 39
Dufee Edmund F.
40
Davis Persis M. 49
Dodge Janet Say
67
Dutton Eugene I. S.
70
Dunigan Frank /06
Duncan Nathaniel .
11%
Driscoll Michael
129
Duncan Frances m.
200
Emerson addie & 157
Farrow Varna Ruth Floyd Susan M. Frechette annize Hay Louise a. 101 131 Fletcher Benjamin Ihr. Fish Charles F, M, 142
37 Grant Bessie Parnel 1.
Greenleaf mary & 2. 7. F
Your Movil Chave
G
Garrity Nellie
Genesterrine Gilchrist Francy
46 1 Gillam Charles 1251 Greenwood Lamerce a. 144 K Goodell Jotham
Gervais Joseph
187
Gifford Marion G.
189 M
Gervais Joseph arthur
199 M N
0
P
R
S T U
V
W X Y
Z
51 75 Gilman Fannie 8. 18 24 35
D
E
H
146
L
Hunt Ellen Celia 9
Hall martha
Hood Emmal.
19 61
Harrington Michael 62
Hazen Sarah et 8.7
Hunt
91
Hunt Olive C.
96
Hegarty mary
97
Hodges Julia, a
99
Holt Mary Ir.
110
Hadley Persis M.
120
Hyde George 140
Hier Henry 147
Hoyt Rhodal
154
Handley Faustina 176 Holt Nancy & 183
Heuremy M. Beatrice L.
209
Hunt Susan Baron 223
Hodgman malvina
228
Jones Rela Jones annie Ihncon Jesse 71. Gordon Charles
6 182 191 216
Kennedy James Foyer ThangS. Knowles John a. King James P. Kendrick John 221
27 150 156 210
H 1
- J K L
M
M N 0 P
R
S T £ U
V
W X Y Z
Loker Loring Locke George F.
81
21
Lovering Sarah ann
2.6
Liman Clarence
3 1x
Lec William M.
Lewis Esther To
Lambert. 107
Regrow Tharsile
141
Lynch Sarah R. 186
Livingston Margaret 188
manchot Hazel Louise 196
Lovigny Marie Louise 204
Lundgren William, 211
Lunt augusta H. 2/3
Lillis Thomas Larkin 226
Murphy alice 13.
manning Mary a. 17
morris Jennie B. 32 Monahan Benjamin Mayberry Eliza .48 76 Mackay Stewart 85 89
moran John Mansfield John R. Morton William M.
132. 194
Macnutt Vinton B 195 Monahan Margaret 220 227
Martin William
74
84
Mr Quillan Margaret mcQuillan Margaret Q mcmahon Quan mcnulty matthew mc Quillan Charles mcQuade Janet
mcgrath Elizabeth R.
79
mccabe Henry P. 98
mccabe mary ann 103
Mcnulty michael 126
mcSaved John P. 127
MEnancy Mary a. 137
MaCabra James E. 151
MEnancy Patrick N.
160
Mccluskey ann
167
mcnally David P. 173
McGarry Rose
McSee Elizabeth J.
185 197
MElomay Rose
201
MEEnamen Laurence F. 207
mcadoo matthew it. 214
25 Noyes Margaret V. 28 roble Cacil H. 31 Trickles Edith a.
4. 80 136 44 rickles Elijah 2. 68
229
L M M N
1
0 P
R S T U V
W X Y Z
71.
O'neil Mary Madeline O'neil Patrick & O'Connor Peter
43 72 135
Pickard allen 5
:
Parle Theodore Sidney 10. Parkhurst Joseph . 20 52 69
Plouffe Perham Henry S. Primean Rita
Park Oblerander John Philbrick Olive .
Prescott Oscar Everett
Pickard Daniel &
100 145 171 177 184 190
Feed alonga
Page BarnceL. 193
Prescott Frank 198 Prince Calvin F. 202
Perry Susan abbott
206
Singley Mary 66
· A
1
1
Robbins Benjamin Osgood Roberts John 2. Russell Katherine Ready Mary & Robbins martin
Robinson mand angusta Polert Joseph
Robert Evar
Sandlett Susanna I.
Reardon Thomas
Robbins 192
65 73. 78 88 92
95- 112 116 134 170
0 P Q R
S T U V
W X Y Z
Sullivan Thomas Sweet Ed yar Clos. Stewart Benjamin S. Stone- Harrison Howard Snow Salmon 2.
12 Jucker amy Beatrice - 50
Jansy Catherine- 53
14 29 Thompson John adelbert 54 58
47 Given William
77 Chubby Emily M. 159
Sampson antoinette & 82 Thompson John R 162
Soderberg Charles
93
Juche Samuel Raymond 172
Sweet Almond & H.
105
Jucker Effie Margaret 175
Sanderson Samuel Q.
117
Szivky Undro
118
119
Smith Eunice E.
148
Smith mary ann
164
Shorey Mary !
212
Sevigny marie Louise
204.
Talbot Stalline 217
grambley Velia 218
Shanking Solomon
1
alton Celer Kimball 169
S T U V W X Y Z
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX y
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Biscie Parzell
HUSBAND'S NAME + Theodore y Grant
BIRTHPLACE # Goatecook Canada,
NAME OF
FATHER
Charles to Gamle
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
Marcha allen
BIRTHPLACE
OF MOTHER #
Hooksett n. H.
OCCUPATION
INFORMANT § Husband.
PHYSICIAN'S CERTIFICATE
| 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 as follows :
Peritonitis following
-
Primary :
operation (Gastro entro Sterny
.. (DURATION).
3
DAYS
Contributory :
A. ... (DURATION).
. DAYS
(Signed).
À arthur lage
M.D.
0
.190 ...... (Address).
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents,
Former or
Usual Residence 0.
So Chehan ford.
How long at
38
.Place of Death ?.
Days
Where was disease contracted,
If not at place of death ?
Filed
april 4/1905
City
Clerk
PLACE OF BURIAL OR REMOVAL II
Jaconi
na n. H.
Cifre. 3
1905
ADDRESS
UNDERTAKER Walter Perhana.
DATE OF BURIAL Unicera City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, glve facts called for under "Speclai 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.
...
-
1
2.1.
COMMONWEALTH OF MASSACHUSETTS
City of Lowill, Reg. $ 15
RETURN OF A DEATH
FULL NAME
Bessie Parnell Grant
Registered No. 481
Place of Death * Gowell Mind Warpt, Lavill Mais
Date of Death.
abril 3. 1905
Age.
27
.. years.
.. months
days
الــ
3
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
ensure Butterfreit
Registered No .. 17
FULL NAME
Place of Death * West Chelmsford
Date of Death awin 7. 1905
Age 78
years 11
months
.days
STATISTICAL DETAIL
SEX COLOR Female Morte
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Philina Dinsmore Fuller
HUSBAND'S NAME + Youas Polwine Houtterken
BIRTHPLACE # Horudawock I Mane.
NAME OF FATHER
alden Fuller
BIRTHPLACE OF FATHER +
MAIDEN NAME OF MOTHER Thelinda Fuller
BIRTHPLACE OF MOTHER # Notknown
OCCUPATION
INFORMANT § Laurale Haut.
DATE OF BURIAL
PLACE OF BURIAL OR REMOVAL !! West Helsefore with 10lt.06.
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from april 3 100 % to april> 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 :
Organic beclass , Svart
Auch sechows 5 days DAYS
Contributory
old age
.. (DURATION). .. DAYS
(Signed)
7 E Varney
.MMI. D.
af 1 / 1905 (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
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.
UNDERTAKER Let Meinbech
Michelledy Name of cemetry.
CITY OF LOWELL
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
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, GR DIVORCED
MAIDEN NAME + Margaret T. Bradley
HUSBAND'S NAME +
BIRTHPLACE İ quincey mass
2
NAME OF FATHER James
Bradley
BIRTHPLACE OF FATHER # Ireland
MAIDEN NAME OF MOTHER 1
- Mary , Aller
BIRTHPLACE
OF MOTHER #
Precard,
OCCUPATION at Home
INFORMANT §
PLACE OF BURIAL OR REMOVAL II StPatricks leam aps 13 ..... 190.
ADDRESS
445 Forambe-
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Jan. 8, 1903 to apr. 9, 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 Septicemia.
(DURATION). DAYS
Contributory :
Juman
(DURATION). DAYS
(Signed).
Volon Bartlett,
.... M. D.
Cfr. 11 1905 (Address) Sowell, Mass
. .
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 april 12, 1905, Edward J. 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.
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.
4.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
18
Registered No. ...
Place of Death *
Carlisle It Sakt Chelmsfordst
Date of Death
abril 10
Age 44 00.
years
months
days
FULL NAME Margaret. I Noves
ALL NAMES TO BE IN FULL
UNDERTAKER John Flojera
DATE OF' BURIAL
How long at
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 OF LOWELL
19
Registered No ..
Place of Death * Chelmsford mais
Date of Death
april
16- 1905
Age
1
years.
/1
.. months.
20 days
STATISTICAL DETAIL
SEX male
COLOR
whe
Lité
1
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Chelmsford mais
NAME OF FATHER George W. Pickard
BIRTHPLACE OF FATHER # Littleton mass
MAIDEN NAME
OF MOTHER
Bertha f. Wilson
BIRTHPLACE
OF MOTHER #
Boston mass
OCCUPATION
INFORMANT § father
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from.
apr. 2 1905 to
apr. 16 1.90.5
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 :
Convulsions
(DURATION)2
DAYS
Contributory .
measles
... (DURATION) 14
... DAYS
(Signed)
Camara Stoward
.M. D.
a/s. 17 1905 (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
apr. 18
5-Edward Rollins
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.
G. m. Thing for 33 Prescott Name of cemetry.
DATE OF BURIAL
PLACE OF BURIAL OR, REMOVAL II Cheloyal noford mags april 18 905
UNDERTAKER
ADDRESS
FULL NAME
allen
Rickard
1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
FULL NAME
Reba Done
Place of Death *
North Chelmsford
Date of Death.
april 18'
1905
Age 25
years.
7
months
days
STATISTICAL DETAIL
SEX banal
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Simples
MAIDEN NAME 1
HUSBAND'S NAME +
BIRTHPLACE # mers Mass
NAME OF FATHER
17 Chanas
BIRTHPLACE OF FATHER Į England
MAIDEN NAME OF MOTHER Elizabeth Caddell
BIRTHPLACE OF MOTHER
OCCUPATION Operativa
INFORMANT §
Jahn.
PLACE OF BURIAL OR REMOVAL II
Erson teeneben
Low
DATE OF BURIAL april 19 1005
ADDRESS
UNDERTAKER
Jahn A Wembed to middles
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ...
april 16 1905 to april 18
. 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 :
Cerebro Spinal Meningitas
2 days
. (DURATION). DAYS
Contributory
.. (DURATION) .. ... DAYS
(Signed)
JE Varney
... M. D.
april 18
.... 190 ... (Address)
SPECIAL INFORMATION only for Hospitals, Institucions, 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 18 19
.1905
Edward J. Robbin
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. e of cemetry.
Jahn Robert
6
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
Registered No .....
20
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
FULL NAME
Morrill Chars Sove
Registered No .: 21
Place of Death *
Chelmsford Centre
Date of Death.
april 21 1905
Age 81
years ...
10
.months
21
.days
STATISTICAL DETAILS
SEX
istale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
married
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
Weare TI.H.
NAME OF
FATHER
Moro Love
BIRTHPLACE
OF FATHER#
Weare U.H
MAIDEN NAME
OF MOTHER
Sarah Chase
BIRTHPLACE
OF MOTHER#
Heave n.H.
OCCUPATION
Engineer
INFORMANT § Mrs. M.C. Bone
PLACE OF BURIAL OR REMOVAL II
Edson Com. Lowell
DATE OF BURIAL
april 23
1905
UNDERTAKER Halter Parte.
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Yan, 30, 190 Sto April 21, 1900J.
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 :
6 Didunia Influenza
0
. (DURATION).
DAYS
Contributory :
Inanition
about Linin
-this -
... (DURATION) ..
DAYS
(Signed).
Antren de Scolari,
M.D.
April 22 90 ( (Address) NAchina, Seabona.
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 abril 23
1905
Eduard J .- Robbing
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. Il Name of cemetery.
£
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME , varing poker
Place of Death *
Date of Death th 28tt 1905.
Age.
94
years
3
months
8
days
STATISTICAL DETAIL
SEX
COLOR Male Alite
SINGLE, MARRIED WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Wayland mas
NAME OF FATHER
Ebenezer Lafeu
BIRTHPLACE OF FATHER + Maryland Quan
MAIDEN NAME OF MOTHER Betrey lenkein
BIRTHPLACE OF MOTHER # article Quase
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ...
apres. 19, 190 5 to apr, 28, 1005
.. 190.2,to.
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 : plume Influenza
Primary : ..
and loro ronchitin t.
(DURATION) 13
DAYS
Contributory
Senilità
..... (DURATION) . DAYS
-€
(Signed)
derborn
.M. D.
apr. 29, 1905 (Address).
Theboston, Mais
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 (v. 29 190 5 Eduard ). Robbins
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 andass of person giving statistical details.
AtHembeck Madlese Name and dyes
Howwell
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD -
PLACE ØF BURIAL OR REMOVAL II
DATE OF BURIAL /1/4 30 ... . 190. 5.
ADDRESS
Registered No. 22
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
FULL NAME
Ellen Celia Hunt
Registered No.
23
Place of Death *
Chelmsford Contre
Date of Death.
May 17/1905
Age ....
76
years
4
... months.
10
days
STATISTICAL DETAILS
SEX
HEmale
COLOR
White
SINGLE MARRIED,
WIDOWED, OR
DIVORCED
wordnot
MAIDEN NAME + Ellen Parkhunt
HUSBAND'S NAME t
Seo To. fruit
BIRTHPLACE Chelcuatrod
NAME OF FATHER John Parklunes
BIRTHPLACE
OF FATHER
MAIDEN NAME
OF MOTHER
Celia Burrows
BIRTHPLACE
OF MOTHER#
New Ipswich M.H.
OCCUPATION
INFORMANT § Mrs. JE warren
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL Concord Mais City Hola, May 17
190.5 ...
UNDERTAKER Halten Perhan
ADDRESS
Chelustige
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 as follows :
Primary :
Endocarditis
.(DURATION).
DAYS
Contributory :
(Signed)
Camara Howard
DAYS
May 18 :00
.190 5 (Address).
Chilmatite
SPECIAL INFORMATION oniy for Hospitais, Institutions, Transients, or Recent Residents,
Former or
Usual Residence
How long at
Place of Death ?.
Days
Where was diseass contracted, if not at place of death ?
Filed May 19 1905 Edward J. 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.
10.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Theodore Sidney Harlee
Carinae
Registered No.
24
Place of Death *
Chelmsford Mars.
Date of Death.
May 1by the
Age ..
/
years
months
29
.. days
STATISTICAL DETAILS
SEX
mala
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER
BIRTHPLACE
OF MOTHER#
England
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL May20, 1905
Thomas A Green Carlisle Mas
PHYSICIAN'S CERTIFICATE
¡ HEREBY, CERTIFY that I attended deceased during last illness, from. May 7 1905 to May 17 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 congestion
URATION 1 4 DAYS . DAYS
Contributory :
(Signed) ..
Amara How
1 (DURATION).
DAYS
toward
.M.D.
May 20 190.5 (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 1905 Eduard Politie
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