USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1904-1905 > Part 8
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* 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
FULL NAME
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
11.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Daniel Wyatt Bickford,
Registered No.
25
Place of Death *
So Chelmsford mark
Date of Death
May 22-1905
Age 19
.. years.
3
.. months
26
.days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
married
MAIDEN NAME +
HUSBAND'S NAME t
Daniel Wyatt Beckford
BIRTHPLACE ±
Campiton N.N.
NAME OF
FATHER
Joseph Bickford
BIRTHPLACE
OF FATHER#
Peacham Vt.
MAIDEN NAME
OF MOTHER
Unknown
BIRTHPLACE
OF MOTHER #
Unknown
OCCUPATION Retired
INFORMANT §
Floyd. C. Beckford.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
about Oct.
1906 to Mary 25, 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 :
Carditis
Indefinite
. (DURATION).
0AY8
Contributory : Dephate.
about 9met.,
(DURATION) ... DAYS
(Signed)
Archiv & Serfora, M.D.
Thay 23 905 (Address).
Chelucotros, 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 May 24 1905 Guard J. Robbins
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 Institutlon, 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.
UNDERTAKER ance
ADDRESS
Do Chelmsford | Name of cemetery.
mais
-
ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR, REMOVAL II Hart Fond Con do Chelmsford
DATE OF BURIAL
May 25 ,90 5)
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Sullivan
Registered No ..
26
Place of Death *
Date of Death
May 28 1900-
Age ...
32
years .. -
months
days
STATISTICAL DETAIL
SEX male
COLOR White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME 1
HUSBAND'S NAME +
BIRTHPLACE # Boston mare
NAME OF FATHER Thomas & Sullivan
BIRTHPLACE OF FATHER # Ireland
MAIDEN NAME OF MOTHER Ellen a. Stauton
BIRTHPLACE OF MOTHER # teland
OCCUPATION
INFORMANT § father
PLACE OF BURIAL OR REMOVAL II Сетевая DATE OF BURIAL Calvary Boston masa May 31
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 : alcoholism
Sudden death DAYS
_Contributory
.(DURATION). . DAYS
(Signed)
A6 Inch fed Ex.
Maybe- 19050 (Address) 267 hesbuth St.
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 deathı ?.
Filed May 30, 1905 Edward J. Robbing
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.
+ 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.
12.
CITY OF LOWELL
FULL NAME
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
UNDERTAKER Let Molloy
٣.
1
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
Place of Death * Princeton + Church
Date of Death.
1905
Age ..
13/
years
months ... day
STATISTICAL DETAIL
SEX Fem -
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME 1
alice whitworth
HUSBAND'S NAME + michael # Murphy
BIRTHPLACE # 00
Lowell man
NAME OF FATHER
Thomas Whitworth
BIRTHPLACE OF FATHER + England
MAIDEN NAME OF MOTHER Elisha Dorsey
BIRTHPLACE OF MOTHER # England
OCCUPATION
at home
INFORMANT § husband
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from flere 2 1901 June 4 .. 1905 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 : . .
Qx baulerin pregnancy
.. (DURATION) . DAYS
Contributory
0
.. (DURATION).
.. DAYS
(Signed)
JEvaney
.M. D.
tamo 1900 (Address) H. Chiliasfera)
...
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 June 6 1905 Edward J. Robbins 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 lustitution, 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.
13
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
alice Murphy
CITY OF LOWELL- 27
Registered No ... north Chelmsford
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL 11 St. Patrickas
DATE OF BURIAL
ADDRESS
UNDERTAKER John JoConnell @ 100 Centeral Si
Lowell
How long at
-
4
COMMONWEALTH OF MASSACHUSETTS
14
RETURN OF A DEATH
FULL NAME
Edgar Elos Sweet-
Registered No.
28
Place of Death *
Chelmsford, Mass
Date of Death
June 5, 1905
Age
16
.years.
10
.. months
5
days
STATISTICAL DETAILS
SEX
m
COLOR
w
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Nashua, D.H.
NAME OF
FATHER,
almon, W. Sweet
BIRTHPLACE OF FATHER+ D Pottsdam n.4.
MAIDEN NAME
OF MOTHER
alice Warren
BIRTHPLACE
OF MOTHER #
Searsfort, Maine
OCCUPATION
at Home
INFORMANT §
a. J. W. Sweet.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that ! attended deceased during last illness, from. June 3: 1905 to June 5 190.0 ... .. , 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 Spinal
meningitis."
. (DURATION). . DAY8
Contributory :
.(DURATION) ..
. . DAYS
(Signed).
Amara Howard.
M.D.
190.5 (Address).
Chelmsford Trans
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 June 6
1905
Edward J. Rattine
Gown
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.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
BURIAL OR REMOVAL II
DATE OF BURIAL
PLACE OF
line fre
Chelmsford, mars June 6- 190 5
UNDERTAKER
Walter Perham
ADDRESS
Chelmsford.
:=
(
15
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Maria Zanchi
.Registered No ...
2%
Place of 2
Week The hunters Mare
Date of )
June 6
1905
Residence
Weet Chilenagond Wan Age 27
.years.
.months.
.. days
STATISTICAL DETAILS
SEX
Timale
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
married
MAIDEN NAME +
Maria Farzialo
HUSBAND'S NAME +
Domenico Zanchi
BIRTHPLACE#
Italy
NAME OF
FATHER
Unknown
BIRTHPLACE
OF FATHER#
Italy
MAIDEN NAME
OF. MOTHER
Unknown
BIRTHPLACE
OF MOTHER#
Italy
OCCUPATION at Home
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL !!
Nest Ceret
West Chelmsford
DATE OF BURIAL
une ?
190.5
UNDERTAKER
George & Snow
ADDRESS
great Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. May 20 .1900 to Jerne 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 as follows :
Primary :
Phlebitis
One work.
.. (DURATION).
.. DAYS
Contributory :
Mamman abacess
two work
1
(DURATION).
.. DAYS
(Signed)
J Ellamey
.M.D.
km 4 190.5 (Address) 2. Cheleatherx
SPECIAL INFORMATION only for Hospitais, Institutions, 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
Jime 7
1905 Edward J. Noffine
Clerk
John
* 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 statisticai 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 *
Death
-
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Delia M. Alderton
FULL NAME
Place of Death * North Chemsford
Date of Death June 10, 1905
Age 25
years
months. days
STATISTICAL DETAIL
SEX Female
COLOR White
SINGLE, MARRIED, WIDOWED, OR DIVORCED"
MAIDEN NAME 1
HUSBAND'S NAME +
Delia M. Shields Robert alderton
BIRTHPLACE # Ho Chimsfra
NAME OF FATHER
John Shields
BIRTHPLACE OF FATHER İ Ireland
MAIDEN NAME OF MOTHER Alice Canell
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION
INFORMANT § Robert abduction
PLACE OF BURIAL OR REMOVAL IL DATE OF BURIAL A Jatuck Lowell finns 12 10 5
UNDERTAKER the. I Denmitt
ADDRESS To Gnkami Nagy
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. aful 3 1905 conforme 10 . 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 :
tuberculosis
Four manche
(DURATION). DAYS
Contributory
(Signed)
De Vannes
.(DURATION). .. DAYS
June10 1905 (Address).
1. Chalmação
... M. D.
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 June 12 190$ 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 Couptry ; also city, town or county, if known.
§ Name and address of person giving statistical details.
CITY -16 OF LOWELL
Registered No ....
30
How long at
٠
1%
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME Mary in Manning
Registered No.
31
Place of Death *
East Chelmsford
Date of Death June- 18 1900V
Age.
78
years
6
months
12
.days
STATISTICAL DETAIL
SEX Heril
COLOR
While
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + Mary a Baldwin
HUSBAND'S NAME +
vom manning
BIRTHPLACE # East Cheerhard
NAME OF FATHER
BIRTHPLACE OF FATHER # & chelmsford
„ MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER # Undlover
OCCUPATION
al .
INFORMANT § E. aoBartlett
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
.... 1906 ...
ADDRESS
UNDERTAKER Horace cela 12 Hard se
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last
illness, from. to fuer 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 : ..
1
.(DURATION) .... . DAYS
Contributory
(Signed) M. D. Jemez 20 19005 ( Address) Yor Med alisul)
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 21 190 5: Conard ) Pallina
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
.(DURATION). .. DAYS
18
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Husmie & Gilman
Registered No ..
Place of Death * Lehetnebord Ques
Date of Death
June 21x 19082.
.. Age ..
30
years ..
9
months
18
.days
STATISTICAL DETAIL
COLOR
Female White
SINGLE, MARRIED, WIDOWED, ØP DIVORCED Marica
MAIDEN NAME +
Hannie re Shannon
HUSBAND'S NAME + Hawla W Silman
BIRTHPLACE #
NAME OF FATHER Richard Sharon
BIRTHPLACE OF FATHER # lanad
MAIDEN NAME OF MOTHER Cordelia lennier
BIRTHPLACE OF MOTHER # Hanchung Vx
OCCUPATION Athome
INFORMANT § Harold W Gilman
PLAGE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Iml 24 0 5.
UNDERTAKER JA Membeck
ADDRESS Andeller
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from ..... Just 15 190 4 to 14/0 20 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). DAYS
Contributory
.(DURATION). . DAYS (Signed) Sus P. M adam M. D. 9 rue 2 1905 (Address) 245 Centret22
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 June 23 1900 Odward J. Robban
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. A Name of cemetry.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
CITY OF LOWELL
32
:
How long-at. .
-
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COLOR
Muito
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
Martha Stall
BIRTHPLACE # chelmsford, Mas ,
NAME OF FATHER
BIRTHPLACE OF FATHER #
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT § Bathur P. Brown
PLACE OF BURIAL OR REMOVAL W Edson bem
DATE OF BURIAL ferre 27 005
UNDERTAKER & N Brooks
ADDRESS Lowell
mass
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
1905
.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 :
Arterio selevoces
Contributory : .. Senility -
.. (DURATION) ... . DAYS
(Signed).
Anhun & derdona,. .... M.D.
Junto 100% (Address)
Chelmsford Maar.
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 26 1005 Eduard 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.
1| Name of cemetery.
19
COMMONWEALTH OF MASSACHUSETTS
FULL NAME Martha Itall
RETURN OF A DEATH
CITY OF LOWELL
Registered No.
33
Place of Death *
Chelmsford, almshouse
Date of Death
June 2 st 1900
Age
years
months days
STATISTICAL DETAIL
SEX Ferrari
(DURATION). DAYS
Maria Stall-97- Chelmsford- 79- - me Been an rummetog
20
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Joseph a. Parkural-
Registered No ..
34
Place of )
West Chelmsford Mass Date of
Death * S
Residence
Westchelmsford mass Age.
72
.. years.
6
.months ..
.. days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED married
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE Dunstable Mass
NAME OF
FATHER
americas Parkhurst-
BIRTHPLACE
OF FATHER#
Dunstable Mars
MAIDEN NAME
OF MOTHER
Sally Roby
BIRTHPLACE
OF MOTHER #
Dunstable masi
OCCUPATION Retired
INFORMANT §
Widow
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last illness, from farne 17 1905 to Anne 29 19055 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) 12 . DAY 8
Contributory :
.(DURATION). DAYS
(Signed)
JE Vany
M.D.
by 2 190 (Address).
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 July 1
0
1905
Edward J. Jobbing
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 detalis.
UNDERTAKER b.M. Showing flo 33 Pescatore of cemetery,
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL !! DATE OF BURIAL Mart West Chelmsford July 1 190,5 Ce
ADDRESS
Death ¿ June 29, ..... ... 190,5
سيب
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Serge Franklin Locke
Registered No. ..
35
Place of Death *
CheluxAnd Centre
Date of Death.
June 30 1905
Age ....
64
. years ...
3
months
22
days
STATISTICAL DETAILS
SEX
Male
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED Married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Barrington D.H.
NAME OF
FATHER
alfred Looks
BIRTHPLACE
OF FATHER#
Barrington M.H.
MAIDEN NAME
OF MOTHER
Mary a Scary
BIRTHPLACE
OF MOTHER #
Rochester n.t.
OCCUPATION
Hammer.
INFORMANT §
Mo Se .. F. Locke.
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Hart ford Com, Socheli July 3
19005
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. May-10- 1906 to June 30-1905 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 : Cerca ofRectum
.. (DURATION) ..
DAY8
Contributory :
... (DURATION).
.. DAYS
(Signed)
M.D.
Il-1-1900 (Address).
-
Mathora
1
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Piace of Death ?.
Days
Where was disease contracted, If not at place of death ?
Filed July 1 0
1905 Godward thing
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.
2/
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
UNDERTAKER Natur Perhow
-
IF Name
二.
ים רוחב
ـيه يه
N
22
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Caroline 221. Crosby
Registered No.
36
Place of Death *
Chelmsford
Date of Death.
712/905
Age 95
6
. years ..
months
6
days
STATISTICAL DETAILS
SEX
Hernala
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
widowed
MAIDEN NAME +
Caroline Taylor
HUSBAND'S NAME + Ephriam Crosby .
BIRTHPLACE #
n.H
NAME OF
FATHER
Taylor
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
munroe
BIRTHPLACE
OF MOTHER #
OCCUPATION
Retired
INFORMANT §
Jason Crosby
PLACE OF BURIAL OR REMOVAL II Lowell Cemetery
DATE OF BURIAL
July 14
190.06
UNDERTAKER
Walter Perham
ADDRESS
Chetrusting
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last illness, from July 2 190.5 to July 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 : Cento Rheumatien
(DURATION) 10 . DAY 8
Contributory : Old age,
.(DURATION) .. .. DAYS
(Signed).
AmberHoward M.D.
Anh 13 1905 (Address) Chilnatural
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 13. 0
1905
Edward & Rolfing
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
0
23
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
George Parrott Winn
Registered No.
37
Place of Death *
Chelistino. mars
Date of Death.
July 16, 1905
Age ..
66
. years.
.months
.days
STATISTICAL DETAILS
SEX
m
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Salem, mass
NAME OF
FATHER
John Winn
BIRTHPLACE
OF FATHER#
Salem, mass
MAIDEN NAME
OF MOTHER
Sally Flink
BIRTHPLACE
OF MOTHER #
Salem, Mais
OCCUPATION
Retirer
INFORMANT §
Marcia Wann
PLACE OF BURIAL OR REMOVAL Il Salem, Mass
DATE OF BURIAL
July 20 19.5
0
ADDRESS
UNDERTAKER Walter Perham Chelinefor
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. July 15, 190 5, to July 16, 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 :
Insolation
1
.. (DURATION).
. DAYS
Contributory :
Arterio seleroves.
Indefinite
.. (DURATION).
DAYS
-
(Signed)
.. M.D.
July 17, 1905 (Addres
Chelmsford Mack,
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, of 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 17 1905 Edward 9 Robbing 0ftms
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
L
8P1.04
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Nellie Garrity
Place of Death *
Date of Death
July 18 # 1905
Age.
.years
months
days
STATISTICAL DETAIL
SEX Fie
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
-
MAIDEN NAME +
HOSPANO'S NAME L
BIRTHPLACE #
Lowell
NAME OF FATHER Philip S. Garrity
BIRTHPLACE OF FATHER # Ireland
MAIDEN NAME OF MOTHER Eller ate leave
BIRTHPLACE
OF MOTHER
P.E. 2.
OCCUPATION
INFORMANT S Fattur
PLACE OF BURIAL OR REMOVAL !! DATE OF BURIAL It Patricks July 1955
UNDERTAKER ADDRESS CAmalloy Lawell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
July 19 190 to Jeely 19 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 : Cholera infuntura
(DURATION). DAYS
Contributory
.. (DURATION) . DAYS
(Signed) .
7-14 60 (Addres)
Source hay
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
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