USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1904-1905 > Part 9
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
Former or Usnal Residence. Place of Death ?.. Days
Where was disease contracted, if not at place of death ?.
Kilech July 19
1905
5. Edward Jr 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.
f 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
24
CITY OF LOWELL
38
Registered No.
... M. D.
How long at
COMMONWEALTH OF MASSACHUSETTS
24.1
RETURN OF A DEATH
FULL NAME .... Ella Wheeler
.Registered No. 411
Place of Death * State Hospital, Tewksbury, Mass.
Date of Death ...
July201905
Age
56
years
.months
.days
STATISTICAL DETAILS
SEX Female
COLOR
White
HUNGKEY MARRIED,
WINOWEDTORX
DIVOKOEK
MAIDEN NAME +
Ella Gleason
HUSBAND'S NAME Ť
Otis Wheeler
BIRTHPLACE # Chelmsford, Mass.
NAME OF
FATHER
Humphrey Gleason
BIRTHPLACE
OF FATHER#
U. S.
MAIDEN NAME
OF MOTHER
Cornelia Adams
BIRTHPLACE
OF MOTHER
U. S.
OCCUPATION
Housework
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from July 7
1905 -July 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 as follows :
Primary :
Cerebral Hemorrhage followed
by Hemiplegia ( left )
4 years
(DURATION).
.DAY 8
Contributory :
Cerebral Hemorrhage
5 hours
.(DURATION) ..
.. DAYS
(Signed)
Carl J. Hedin
SAM.D.
July 21 1905 (Address).
State Hospithl
0
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or
Usual Residence
atb ?.
.Days
1
Where was disease contracted,
If not at place of death ?.
Filed
JJuly 21
190.5
Clerk
PLACE OF BURIAL OR REMOVAL II
Chelmsford, Mass.
UNDERTAKER
John A. Weinbeck
DATE OF BURIAL
July 21
1905
* City or town, street and numberof 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 ofistreet and number.
t In case of married or divorced woman, or widow. ADDRESS # State or country ; also city, town or county if known. 88 Middlesex gt$ Name and address of person giving statistical details. Cip Name of cemetery. Lowell, Massi
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
-
COMMONWEALTH OF MASSACHUSETTS
25
CITY OF LOWELL
39
FULL NAME
Place of Death *
COOL Chelmeforal
Date of Death
18 01905
Age
years
months
23 hours
days
STATISTICAL DETAIL
SEX female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MA MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # East Chelmsford
NAME OF FATHER
Charlie 30
BIRTHPLACE OF FATHER Į
MAIDEN NAME OF MOTHER
Hargary Withully?
BIRTHPLACE OF MOTHER # Gast Chelmsford
OCCUPATION
INFORMANT Shirtoff. Maillan
PLACE OF BURIAL OR REMOVAL !
DATE OF BURIAL
.
.... 190.2. ..
UNDERTAKER
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. July 1) 1905 to July 15 190 5, that to the best of my knowledge and bellef death occurred on the date stated above, and that the CAUSE OF DEATH was of follows : Primary : Cembilical Hemonday2
Contributory
(DURATION). ... DAYS (Signed) Lammers P. nuledans .... M. D.
fully 15 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 July 18 1903 Edward), Robbing 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. 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.
ADDRESS 16/ Worthand Name of cemetry.
.(DURATION). DAYS
RETURN OF A DEATH Quillan.
-
26
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Sarah Unng
overing
.Registered No.
110
Place of Death *
Chelmsford Masst
Date of Death ..
Varle 26
/1905
Age ..
09
years.
months
13
.. days
STATISTICAL DETAILS
SEX
COLOR
w.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Sarah am Word
HUSBAND'S NAME Ť
minst Levering
BIRTHPLACE ±
Lawrence, mass.
NAME OF
FATHER
Jarvis Wood
BIRTHPLACE OF FATHER# Eengland
MAIDEN NAME
OF MOTHER
marylidando
BIRTHPLACE
OF MOTHER #
England
OCCUPATION
Housewife
INFORMANT § Minst & overing
PLACE OF BURIAL OR REMOVAL !! The Ridge Clenching lefichusfund, mass!"
DATE OF BURIAL
July 3 0 1905
ADDRESS
UNDERTAKER
Walter Derhan Chelmeted
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. aug .
190. .. to July 26 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 :
Uterine Cancer
.....
2 years. . (DURATION). DAVB cause.
Contributory :
no other
(DURATION). .. DAYS
(Signed)
Amara 1 toward
M.D.
Que 28 190 1 (Address) Chulatre
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 July 29,
1905
Edward J. Rothing
Clerk
0
Town
* 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
حديج فيبـ
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME lames
Kennedy
Registered No ..
41
Place of Death * East Chelmsford maas
Date of Death. July 27, 1905
Age ..
78
. years.
N
months
.days
STATISTICAL DETAIL
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED Widowed
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Ireland
NAME OF FATHER
James Kennedy
BIRTHPLACE OF FATHER Ireland
MAIDEN NAME OF MOTHER margret
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION bf narmer
INFORMANT § Daughter
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL Edson Cemetery July 29 905-
ADDRESS
UNDERTAKER b. m. young Ved 33 Trescott sf
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
Cerebral Nemamhage
... DAYS
Contributory
· (MURATION). . DAYS (Signed) AG tack Led ELMED. July 24 To. (Adress) 219 Central SC.
SPECIÁL 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 July 29, 1905 Edward J. Robbins
Town Clerk.
"City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
| Name of cemetry.
SHT NHỊ HTIW TUO JJIT
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
RETURN targary
OF
A. CDEATH A Soullans
Registered No. 42
Place of Death *
Date of Death July 29-1905
Age ....
25
years.
months
days
STATISTICAL DETAIL
BEX
7
female
COLOR white.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
mª Multy
HUSBAND'S NAME f Charles F.
BIRTHPLACE # ·
tel
NAME OF FATHER
BIRTHPLACE OF FATHER Į
Arland
MAIDEN NAME OF MOTHER
Briagifts, avitt David
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT §
Ivastro F.
PLACE OF BURIALOR REMOVE
LATE OF BURIAL
. . 190.5. .
1
UNDERTAKER aler Tarage/ 64 Worthed
PHYSICIAN'S CERTIFICATE
.. .
I HEREBY
CERTIFY ,that I attended deceased during last
illness, from ..
....
afines 190 5 to July 29 1908
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 :
7
Primary :
Contributory
.. (DURATION). .. DAYS (Signed) Lawns Pim Pams ... M. D. july 31 1900 (Address) 225 entre288
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 ?.
YHed Stinky: 29 1905 Edward JRoferty
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 Micase 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.
28
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
FULL NAME
. (DURATION) .. .. DAYS
How long at
50
ADDRESS
COMMONWEALTH OF MASSACHUSETTS
CITY 29 OF LOWELL
RETURN OF A DEATH
FULL NAME
Benjamin S Stewart
Place of Death *
auth Chelnifard
Date of Death august 2" 1905
Age ...
78
years
months
days
STATISTICAL DETAIL
SEX
COLOR
mal White
SINGLE, MARRIED, WIDOWED, OR DIVORCED FordowEd
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Huderri
NAME OF FATHER Francis Stewart
BIRTHPLACE OF FATHER ₺ not Known
MAIDEN NAME OF MOTHER.
11
BIRTHPLACE OF MOTHER #
OCCUPATION Engeen
INFORMANT Min Bell Stewart
PLACE OF BURIAL OR REMOVAL || Auburn N/
DATE OF BURIAL Cena 5 1005
ADDRESS
UNDERTAKER Jahr A Wennberg so middle cemetry.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, f
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 :
Intestinal Indigestion
Contributory
(DURATION).
.. . DAY.
(Signed)
Aug 2
190.5 (Address) Lawell Man
SPECIAL INFORMATION only for Hospitals, Institucions, Transients,
or Recent Residents.
How long at
Former or
Usual Residence.
Place of Death ?.
Days
Where was disease contracted, if not at place of death ?..
Filed
Cing. 3
5 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.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
and address of person giving statistical details.
43
Registered No.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
.(DURATION). AVS
COMMONWEALTH OF MASSACHUSETTS
CITY 30. OF LOWELL
RETURN OF A DEATH
FULL NAME norman & Helharna. Place of Death * Hoult Chelmsford
-
Date of Death aug 3' 1905
Age.
26
years
8
months
days
STATISTICAL DETAIL
SEX male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME 1
BIRTHPLACE Howell mass
NAME OF
FATHER
George H Willvann
BIRTHPLACE OF FATHER # Corsiich NH
MAIDEN NAME OF MOTHER Harrah Hle Ervan
BIRTHPLACE OF MOTHER # lcanada
OCCUPATION
telek
INFORMANT § raf & Williams)
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Edson Leewilly aug 6 g.
S.
UNDERTAKER
ADDRESS .
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
Single - 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). DAYS
Contributory
.(DURATION). DAYS
(Signed)
Cungty 190 % (Address) 219 Contrat En
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or
Usual Reside
270 Dimanche St
How long at
Lowill maïs
. Place of Death? 2
.... Days
Where was disease contracted, if not at place of death ?.
Filed ang. 5 19015 Edward ). Robbery
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.
Jahr, A Weinbeen so Wichde 20 Cemetry et
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
44
Registered No.
an Bahist Pand
1
90 Prescin de
COMMONWEALTH OF MASSACHUSETTS
3
CITY OF LOWELL 45
RETURN OF A DEATH MC Mahon Mt. Pleasant Sand Bank North Chilinsford
Place of Death *
Date of Death 11. 1905
Age 55 years
months
days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME T
HUSBAND'S NAME +
BIRTHPLACE # Ireland
NAME OF FATHER
Patrick Miala how
BIRTHPLACE OF FATHER İ Ireland
MAIDEN NAME OF MOTHER Catherine Hughes.
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION
Fareman
INFORMANT § Brother
PLACE OF BURIAL OR REMOVAL |I DATE OF BURIAL St Patricks Zwed Aug 13
UNDERTAKER 1. Amalloy
ADDRESS
Lowell
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 :
Suffocation by Sand Bank.
Sweden cleanthe AYS
Contributory
(DURATION) .. ... DAYS
(Signed) ...
any lit 1905 (Address) 219 Central SE
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 ang /2. 5-Eduard J, Rafting
Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
+ In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
# Name of cemetry.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
:
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
1
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
1
FULL NAME
Place of Death *
Middlesex Street Station
Date of Death ..
Age ..
38
. years.
months
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Service .B. m Naughtin
HUSBAND'S NAME Ť
~
George & morris
BIRTHPLACE #
called.
NAME OF
FATHER
Halter Mr Naughtin
BIRTHPLACE OF FATHER
Scotland
MAIDEN NAME
OF MOTHER
Jane Black
BIRTHPLACE
OF MOTHER #
scotland
OCCUPATION Cut home
INFORMANT § Rioler
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
1 1905
ADDRESS
UNDERTAKER b. m Young & 60 13 Prescott 2
PHYSICIAN'S CERTIFICATE
1 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 : Vistal Rhat Hornada
Sudden death
...... (DURATION) .. DAYS
Contributory :
(DURATION) .......
DAYS
(Signed) ..
A. I Fresh med OX M.D.
Ling 10 1905 (Address) 219 Central 21.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents,/1
Former or
Usual Residence
How long at
Place of Death ?. ....... Days
Where was disease contracted, If not at place of death ?
Filed (Lug 11 190 5 Gerard PH L.
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 detalls. Il Name of cemetery.
32
Registered No.
1148
1
-
...
COMMONWEALTH OF MASSACHUSETTS
33
RETURN OF A DEATH
FULL NAME George alfred De lastereit
47
Registered No.
Place of Death *
No Chelmsford Dunstable
road
Date of Death.
Cinqual-
121, 1900 Age.
years .. 6 months 7
.. days
STATISTICAL DETAILS
male
COLOR
SINGLE, MARRIED, WIDOWED, OR- DIVORCED -
MAIDEN NAME t HUSBAND'S NAME Ť
BIRTHPLACE # no Chelmsford
NAME OF FATHER Alford DE Carteret
BIRTHPLACE OF FATHER#
Ho Shibut food
MAIDEN NAME OF MOTHER Nota Swanwick (lug 2/ 1905 (Address).
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL 1
Mulino Lord.
ADDRESS
UNDERTAKER OD Hethou rachelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Aug 16 1903" to Dung, 21 1903; 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 : acculé meningitis
.. (DURATION) 3 .DAY8
Contributory :
Chefeva infantino
(DURATION) DAYS
(Signed)
& afarlowo
M.D.
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 Rug 22 1905 Edward & Robbing
Form 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. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
34
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Clarence Temay.
Registered No.
48
Place of l
north Chelmsford
Death * S
Residence
North lebelansford.
Age.
... years.
~5
.months. 10 .days
STATISTICAL DETAILS
SEX male
COLOR
While-
SINGLE, -MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME+
BIRTHPLACE # West Chelmsford
NAME OF
FATHER
Joseph Lemay
BIRTHPLACE OF FATHER# Canada
MAIDEN NAME OF MOTHER Susie Zonaw
BIRTHPLACE OF MOTHER # North Mare Mars
OCCUPATION at Home
INFORMANT & Jeseph Lemay
PLACE OF BURIAL OR REMOVAL II St Joseph's
DATE OF BURIAL
Ceny 23 1905
UNDERTAKER
ADDRESS
57 Cheever
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. aug 18h .190J .... to. Greg. 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 as follows :
Primary :
(DURATION) .. . DAYS
Contributory :
... (DURATION) .. DAYS
(Signed)
JE Varney
M.D.
Caug. 22 90.
( Address).
-
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at Placa of Death ? years
months days
Where was disease contracted, If not at place of death ?.
Filed
aug. 23
1905 Gerard J. Robbing
Tom
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalls. | Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Date of ¿
Death aug22nd- 1900
-
ـرية
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
35
CITY OF LOWELL 49
FULL NAME Grine
Place of Death *
Date of Death
Sept. 17
Age
years
months
14 days
STATISTICAL DETAIL
SEX
COLOR
A Female White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Chelmsford
NAME OF FATHER JOA medie Senest
BIRTHPLACE OF FATHER + Canada
MAIDEN NAME OF MOTHER Georgiana Provencher
BIRTHPLACE OF MOTHER # Rhode Island
OCCUPATION
INFORMANT § Father
PLACE OF BURIAL OR REMOVAL !! St. Joseph
DATE OF BURIAL
Sep. 18
.... 190.5-
ADDRESS
UNDERTAKER Nap. Bilodeau Powell Mass.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
-
illness, from 190 ... that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATHI was of follows :
Primary : Broncia-p
.. (DURATION). DAYS
Contributory
.. (DURATION). .. DAYS
(Signed) .......
M. D.
sept.
.190(Address) Chelmsford Man.
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 Sift 181 90 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 county, if known.
§ Name and address of person giving statistical details.
| Name of cemetry.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
. Registered No. Chelmsford Centre Warren Que.
- + سبير .
-
COMMONWEALTH OF MASSACHUSETTS
36
CITY OF LOWELL 50
FULL NAME
Marco Cemilie Coughlin
Registered No ..
Place of Death * It worth Chelmsford mars
Date of Death. Sept 17
05
Age
years.
months
10
.. days
STATISTICAL DETAIL
SEX
COLOR
W.
SINGLE, MARRIED, WIDOWED, OR DIVORCED-
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ± North Chelmsford.
NAME OF FATHER
martin J. Coughlin
BIRTHPLACE OF FATHER İ
cowell.
MAIDEN NAME OF MOTHER Rosie Gauthier nove
BIRTHPLACE OF MOTHER # foule.
OCCUPATION
Hat Home
INFORMANT § TS Martine I. Coughlin
PLACE OF BURIAL OR REMOVAL II It toseph's
DATE OF BURIAL Sept 18 10 5
ADDRESS
UNDERTAKER Roselow albert 57 Cheever.
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ..... .. 190 .... to ..
vil-16 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 : ..
malnutrition
.(DURATION) .. DAYS
Contributory
(Signed)
YE Var"
. DAYS
.. M. D.
1 .. 190 !.. (Address).
& Chillussend
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
Sept 18
...
Edward Jo Robbing
Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information." If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
|| Name of cemetry.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
RETURN OF A DEATH
COMMONWEALTH OF MASSACHUSETTS
37
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Verna Ruch Farrow
Registered No.
5/
Place of )
Death." $S ...
Death 1
Date of l Af+20
190 3-
Residence
1.1
Age
.. years.
.. months.
.days
STATISTICAL DETAILS
SEX female
COLOR Whit
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER Jacquel tamron
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER Lina Laundry
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL !! Riverside Cama 210
DATE OF BURIAL Juht 2/ 1905
UNDERTAKER
ADDRESS Varchelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY, CERTIFY that I attended deceased during last illness, from h-18 1905 to wh/ 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 as follows : Primary : Maras mus
Contributory :
.
(Signed)
· FE Varney
M.D.
Jeff-21
.190 ...... (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at
Place of Death ?
. years.
months. days
Where was disease contracted, if not at place of death ?.
Filed
Sept. 21
1905
Edwards Robbins
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.