USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 12
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Cheluceford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from fre . 1906 to Jefl-25 1907 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. tuber culores
Two years
... (DURATION).
.. DAYS
Contributory :
... (DURATION). .. DAY8
(Signed).
JEVarney
M.D.
Jeff. 26 1907 (Address).
Hontchelungen
1.
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 Sept. 27 1907 Edward, Raffin
Jown
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. li Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
211
Chelmsford
Date of l
Sekt 25
Death
1
.190 7
29
0
COMMONWEALTH OF MASSACHUSETTS
212
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME mary d.
Registered No.
65
Place of l
South Chelmsford Mars
Date of l
Death
Left 2 5 1907
Death * S
Residence
South Chelmsford mass Ag
63
.years ..
.months.
.days
STATISTICAL DETAILS
SEX
COLOR
Female white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # amsbury mass
NAME OF
FATHER
Moses Shorey
BIRTHPLACE
OF FATHER#
austin
7. 11
MAIDEN NAME
OF MOTHER
agnes Grieves
BIRTHPLACE
OF MOTHER #
Scotland
OCCUPATION at home
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Edson Cemetery Sept2.8 1907
ADDRESS
UNDERTAKER I'm. Young Hes 33 Prescott.
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from. Sep. 22 1907 to Sep. 22 1907, 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 : Aproplety
(DURATION). . DAYS
Contributory :
Epilepsy
Driver childhood (DURATION).
... DAYS
(Signed).
Cantropo M.D.
Sep. 27 1907 (Address).
21
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 Sept 28 190% Edward Robbing 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 caso 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.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FULL NAME augusta Il Junto
Place of Death * East Chelmsford class
Date of Death. Vept, 29, 1907
Age ..
73 years.
months
10
.. days
/
STATISTICAL DETAIL
SEX COLOR Female White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
augusta H. Rich
HUSBAND'S NAME + John CU. Runt
BIRTHPLACE # Jackson, de.
NAME OF FATHER
Levi M. Rich
BIRTHPLACE OF FATHER I
Jackson Me.
MAIDEN NAME OF MOTHER C Judith a. Pich
BIRTHPLACE OF MOTHER # Sandy River, Maine
OCCUPATION
INFORMANT § Miss alice Sunt
PLACE OF BURIAL OR REMOVAL !! Edson Cemetery
DATE OF BURIAL
Oct. 2 .1907.
UNDERTAKER l. a. tunbeck
ADDRESS
Soliddr. St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ...
Kept 300 190 7 to Sept 26th 1907.
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) . Lefl. 3och .190.7.(Address) ..
... 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
Oct 1
190
07 Edward f Rafting
Jom 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.
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.
I! Name of cemetry.
213
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
1
1
RETURN OF A DEATH
Registered No 66
How long at
COMMONWEALTH OF MASSACHUSETTS
214
North Chelmotril Muss.
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of )
North Chelerstorch Muss.
Date of l
021- 14
.190>
Death S
Residence
Church Si-
Age
36
.. years ...
.months ..
.. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
White
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Ashland ORuss
NAME OF FATHER Robert-ME Cedar
BIRTHPLACE OF FATHER#
helauch
MAIDEN NAME OF MOTHER Bridget Flaherty
BIRTHPLACE
OF MOTHER #
Telauch
OCCUPATION Settore of Church
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190 ...... to Oct/S 1907, 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) .. . DAY8
Contributory :
(DURATION) .. DAY8
(Signed) ..
M.D.
Oct. 14 1907
wall Thank
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
Oct 15
907 Edward Rotting
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.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
PLACE OF BURIAL OR REMOVAL II
Marlboro Muss
DATE OF BURIAL 021-16 190X
UNDERTAKER
ADDRESS
INFORMANT §
.Registered No.
67
Death * S
-
منالا حم
=
COMMONWEALTH OF MASSACHUSETTS
CITY 215 OF LOWELL
RETURN OF A DEATH
FULL NAME Susan & Green
Place of Death *
Chelmsford mars.
Date of Death Ort, 154.0 1907
Age ..
74
years.
8
months
4
days
STATISTICAL DETAIL
SEX female
COLOR white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Whitney.
HUSBAND'S NAME + Isaac Green.
BIRTHPLACE # Westford Mars
NAME OF FATHER nathanice Whitney
BIRTHPLACE OF FATHER # unknown
MAIDEN NAME OF MOTHER Susan E. Odwar ards 6 .
BIRTHPLACE OF MOTHER + unknown.
OCCUPATION at home.
INFORMANT §
Fredinin S. Green
PLACE OF BURIAL OR REMOVAL !! Textfrid Man Oct. 17 007 ..... 190/
UNDERTAKER I.a. Weinbeck
ADDRESS
Sowell Mann
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ..
ad. 1
.190 ... to. Oct 15% 100%. 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 : .. myo carditis
Contributory
asthma
(DURATION) 14 ... DAYS
(Signed) .....
Cimara Itoward
.... M. D.
Oct. 15 1907 (Address) Chelmatora:
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 Oct 15 0 . Edward J. Frthing
..
Cle
.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
DATE OF BURIAL
Registered No.
68
..... (DURATION). DAYS
COMMONWEALTH OF MASSACHUSETTS
216
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Charles
Jordan
Registered No ..
69
Death * S
Place of 1
West to helinsford Vaso
Date of l
10 cf 20 190
Death S
Residence
West Chelmsford mars Age.
67
.years ..
.months.
.. days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED, WIDOWED, (OR DIVORCED
married
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # England
NAME OF
FATHER
William Jordan
BIRTHPLACE
OF FATHER#
England
MAIDEN NAME
OF MOTHER
Elizabeth
BIRTHPLACE
OF MOTHER#
Unknown
OCCUPATION
Garnier
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ang.
1907 to Oct.
190.2,
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 :
Enlarged Sinddate
(DURATION).
DAYS
Contributory :
(Signed).
A. E. Vane
.. M.D.
Ich. 21 1907 (Address) No. Chels ford
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Piace of Death ?
years.
months days
Where was disease contracted,
If not at place of death ?
Filed
Oct. 23 1907 Edward . Robbing
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts caliod 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.
both young theo 23 Prescott Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II West Chelmsford
DATE OF BURIAL Oct23 1907
UNDERTAKER
ADDRESS
INFORMANT § Daughter
.(OURATION).
DAYe
COMMONWEALTH OF MASSACHUSETTS
217
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Vitalline hallof
Place of 1
Death * S
North Chelunsford Mass.
Date of l
Diav. D.St.
Death
.190
Residence North Glilunsford Mars
Age
years.
3
.months.
.. days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Vitalline Martel
HUSBAND'S NAME +
Edouard Ballot
BIRTHPLACE #
Lanada
NAME OF FATHER Tyrique Fallet Martel
BIRTHPLACE OF FATHER# Canada
MAIDEN NAME
OF MOTHER
Vitalline Grenier
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
House kuper
INFORMANT § Edouard Talbot
PLACE OF BURIAL OR REMOVAL II It Joseph
DATE OF BURIAL
Mar. 4
190 ...
UNDERTAKER Joseph albert
ADDRESS
5% chiwen
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Och. 28 . 1907 to Oct. 28, 1907, 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 : interculous
Three Irs.
...... (DURATION).
DAYS
Contributory :
(Signed)
The Gags
M. D.
Nov. 1. 1909 (Address) Ha. enelnes ford pass.
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
Nov. 1 1907 Edward Q. Hoffs
Join
Clerk
* Clty 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 Institutlon, 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.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
70
.. Registered No.
E ..... (DURATION) ..
DAYS
Lage. где.
COMMONWEALTH OF MASSACHUSETTS
218
RETURN OF A DEATH
(CITY OR TOWN.)
.. Registered No. 71
Place of 1
Date of l
Death
S ..
Residence
...... Age ..
44
.years ...
.months ..
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Delic Caquello
HUSBAND'S NAME + auguste Tranblog
BIRTHPLACE# Canada
NAME OF FATHER farah Paquelli
BIRTHPLACE
OF FATHER#
Ganade
MAIDEN NAME OF MOTHER Eatherme Marchand um 2 1907 (Address) 732 Merrimack
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL II It Joseph
DATE OF BURIAL
190, 3
UNDERTAKER ADDRESS 438 To Archambault versaceName of cemetery.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Oct- 29 907 to 2/00/ 1907 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 :
Paralessis
(DURATION) ..
3
DAY8
Contributory :
(Signed).
Whochette
M.D.
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
Nov. 2,
.190/
7. Edward J. Rothing
Clerk
Tom
* 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, glve Its NAME Instead of street and numbor.
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 detalls.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME Delia Framt
Death * S
Thelinkand Center
.190
(DURATION). .. DAYS
219
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of )
Date of l
Nov. 4 190
>
Residence
Age
.years.
.months. .. days
STATISTICAL DETAILS
-
SEX male White.
SINGLE,-MARRIED, .WIDOWED, OR DMOROLD
MAIDEN NAME +
1 HUSBAND'S NAME t
BIRTHPLACE ± Chelmsford Sintra
NAME OF FATHER John Gorz
BIRTHPLACE OF FATHER# St. John, N. Q.
MAIDEN NAME OF MOTHER Elizabeth miller
BIRTHPLACE OF MOTHER # Sowell Mare
OCCUPATION
-
INFORMANT § father
PLACE OF BURIAL OR REMOVAL I Edson Sametery
DATE OF BURIAL
Vov.6
1907
UNDERTAKER John Higgme ff, Sowill Masi ADDRESS
PHYSICIAN'S CERTIFICATE .
I HEREBY CERTIFY that I attended deceased during last illness, from .. Not. 4 1907 to Mor 4, 1907 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary : Still- born
(DURATION)
. DAYS
Contributory :
....... (DURATION) ..
DAYS
(Signed)
Autun Y. Seobna
M.D.
Nov. 5, 1907 (Address) Celles find More.
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
Nov. 6 1907 Edward . Holfing
Clerk
run
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Informatinn." 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.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Still Do
.Registered No .....:
22772
Death * S Chelmsford Centre
Death
١
临
COMMONWEALTH OF MASSACHUSETTS
220
RETURN OF, A DEATH
(CITY OR TOWN.)
FULL NAME Margaret Monahan Registered No.
73
Place of 1
forth Chelleo Lord
Date of l
Death 1
.190 7
Residence
c
Age 05-6
.years.
.months.
.. days
STATISTICAL DETAILS
SEX COLOR Jamal that
SINGLE; MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
margaret Ty refch
HUSBAND'S NAME +
BIRTHPLACE#
Juland
NAME OF FATHER
BIRTHPLACE OF FATHER$
Vueland
MAIDEN NAME OF MOTHER
not & unin
BIRTHPLACE OF MOTHER#
Jeland
OCCUPATION at Home
INFORMANT § Daughter ~manis Minahan
PLACE OF BURIAL OR REMOVAL !! Ut Palmares center
DATE OF, BURIAL Lowell May 13 1907
UNDERTAKER ADDRESS JOS muell Vous 324 Marget VE
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Cler. 20, 190 % to Nov. 11 1907. 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 : Carcinoma of Stomach
. (DURATION). DAYS
Contributory :
.... (DURATION) .. .. DAYS
(Signed).
Lage. M.D.
Nov. 11, 1907 (Address) No. Quelwar ford Pass
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 Nov. 12
07 Edward . Jobbing
Town Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical detalis. Il Name of cemetery.
-
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL "NAMES TO BE IN FULL
Death * S
COMMONWEALTH OF MASSACHUSETTS
221
RETURN OF A DEATH
(CITY OR TOWN.)
John
Kendrick
Registered No ..
74
FULL NAME
Place of )
North Chelimafor
Chelmsford Mass Date of |
Death
nov 15
.190
7
Death * S
Residence
Trorthe Chelmsford AB
6x
.years ..
.months.
.days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED,
WIDOWED, (
DIVORCED
-
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # England 1
NAME OF
FATHER
Kendrick
BIRTHPLACE
OF FATHER$
England
MAIDEN NAME
OF MOTHER
unknown
BIRTHPLACE
OF MOTHER #
unknown
OCCUPATION Black Smith
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from nov 11 1907 to Nov 150 1907, 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
-
... (DURATION) ..
... DAYS
Contributory :
age
... (DURATION) ..
DAYS
(Signed).
Amasa toward
M.D.
nov. 15 1907 (Addres)
Chelmsford, Maso.
SPECIAL INFORMATION only for Hospitais, Institutlons, Transients, or Recent Residents.
How long at
Place of Death ?
. years ..
months.
days
Where was disease contracted,
If not at place of death ?
Filed
Nov. 17 1907 (Award ) 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 detalls.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
INFORMANT § Miss Votre a Kendeich
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL Edson Cemetery nov 17 907
ADDRESS
UNDERTAKER P. m. Young
33 Prescott Il Name of cemetery.
"Widowed
١
222
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
c. IUlf Barry
Registered No.
Place of )
Date of l Pas 23
Death 5
Residence
.. months ....... .days
STATISTICAL DETAILS
SEX 7
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER William allard
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER r
1
1
BIRTHPLACE OF MOTHER#
->
OCCUPATION
INFORMANT §
1
PLACE OF BURIAL OR REMOVAL !!. "
DATE OF BURIAL
190 ..
UNDERTAKER
ADDRESS
/
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190 to 11010-23 1907, 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 : J
Contributory :
.(DURATION) .. DAYS
(Signed)
Il'Rochette
M.D.
Nov-24 1909 (Address) 732, Mersin R ,
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 Nov. 26 190° Odred VRAFting
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. II.Name of cemetery.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
75
Death *!
.190.
.years ..
(OURATION). DAYS
)
-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Susan Baron Hunt
.Registered No.
Place of 1
Chelmsford
Date of l
Dre 7
1907
Residence
Thelmaford
Age ..
69
.. years.
3
months.
4.
.. days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Charlestown
NAME OF
FATHER
Samuel G. Hunt
BIRTHPLACE
OF FATHER#
Carlisle
MAIDEN NAME
OF MOTHER
Elizabeth a Warren
BIRTHPLACE
OF MOTHER #
Medford
OCCUPATION
at Home
INFORMANT § Wino mead
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Horefathers Com Chelmsford Dre 8
..... 190.7
UNDERTAKER Halter Pertam
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. nov.30 1907 to Deciy- 1907. 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 :
Enteritis
. (DURATION).
DAY8
Contributory :
are
..... (DURATION).
. DAYS
(Signed) ..
Amara toward
M.D.
Da 7 1907 (Address).
Chelmsford Mars.
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
Dec. 7 1907 Guard Robbing
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If In a Hospital or Institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
223
Chelmsford
(CITY OR TOWN.) 76
Death * S
Death
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from.
nor 26th 90) to Dee 7 1907, 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 : Hemiplegia
(DURATION) 12
DAYS
Contributory :
... (DURATION) .. DAYS
(Signed).
JE Varney
M.D.
Lee7 1907 (Address) North Chilhunting
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
Dic. 9
190% Edward 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 details. || Name of cemetery.
224
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Pharma Biennani
(CITY OR TOWN.) 77
Registered No ..
Place of 1
south Chelmsford Mass
Date of l
Death * S
Death
1
Residence
Age.
80
... years ..
.months.
.days
STATISTICAL DETAILS
SEX
COLOR
white
WWWOLEJ
WIDOWED, ONT
DIVORCED
MAIDEN NAME + Johanna Ivory
HUSBAND'S NAME + George Brennan
BIRTHPLACE # Busline class.
NAME OF FATHER
BIRTHPLACE OF FATHER# Ireland !
MAIDEN NAME OF MOTHER not Know
BIRTHPLACE
OF MOTHER $
Teland
OCCUPATION at-Home
INFORMANT § mys Petis bonus Daughter
PLACE OF BURIAL OR REMOVAL i Tattico Cenutuo Mas 10mill
DATE OF BURIAL
ABC 9
190.7
UNDERTAKER
F. F. Normal Vous
ADDRESS Forall Mass
North thelength
COMMONWEALTH OF MASSACHUSETTS
225 Chelmsford
RETURN OF A DEATH
FULL NAME
Charles Danforth Clark
(CITY OR TOWN.) 78
Registered No.
Place of l
Death * S
Residence
Chelmsford
.Age.
75
... years.
... months ...
6
... days
STATISTICAL DETAILS
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widowed
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Patterns 21.2.
NAME OF
FATHER
John Clark
BIRTHPLACE OF FATHER# Paisley Scotland
MAIDEN NAME
OF MOTHER
Susan Beach
BIRTHPLACE
OF MOTHER #
n.Y. State.
OCCUPATION
Retired
INFORMANT § thouses Clark
PLACE OF BURIAL OR REMOVAL !!
Horstathens Cem. C, C 22022 . 190.
UNDERTAKER Walter Perfume
ADDRESS
Chelaufend
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last
illness, from.
Dic 18
190 .. ( ... to. DEc. 19, 1907. 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 : Uncumoura
2
. (DURATION).
DAYS
Contributory :
marcardet
.(DURATION). .. DAYS
(Signed).
Auteur S/ dcolonia M.D.
..;. 190 ..... (Address).
SPECIAL INFORMATION only for Hospitais, 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
DEc.22
1907 Eduard ), Rather
Clerk
Com
* 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.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
DATE OF BURIAL
Death
Date of l
Dre 19
.1907
COMMONWEALTH OF MASSACHUSETTS
Chelmsford 226
(CITY OR TOWN.)
79
.. Registered No.
Date of l
Death
months. 14 .days
STATISTICAL DETAILS
SEX COLOR male that
SINGLE, MARRIED WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE# Generville maso
NAME OF FATHER Han et Lille
BIRTHPLACE OF FATHER#
Everett mass
MAIDEN NAME - OF MOTHER man, F. Tayfun
BIRTHPLACE OF MOTHER # Worth Whilewe ford
OCCUPATION
INFORMANT § father
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from ... gres 1907 to DEe 25 1907. 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)
M.D.
DEC. 27 1907 (Address).
253 Central Sr
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 Arc. 27 1907 Edward Jabbing
Clerk
PLACE OF BURIAL OR REMOVAL Yhay
DATE OF BURIAL
190.
UNDERTAKER
ADDRESS
* 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
RETURN OF A DEATH Thomas Lampen, Lillio
FULL NAME
Place of l Death * S
Highland war forth Cheles for
Residence
Age.
3
.years ..
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
William martin
.. Registered No.
Place of 1
Death * S
West Chelmsford
Death
Residence
Age.
7/
years.
.. months ..
.days
STATISTICAL DETAILS
SEX male
COLOR OR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # CMland
NAME OF
FATHER (
Patrick martin
BIRTHPLACE OF FATHER$ Inland
MAIDEN NAME
OF MOTHER
Por Cahill
BIRTHPLACE · OF MOTHER # : Leland
OCCUPATION Farmer
INFORMANT § Son Frank martin
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
. 190 7
UNDERTAKER
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Dec 15 1907 to Dee 26 1907 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) ...
11
DAY8
Contributory :
.. (DURATION) .. DAYS
(Signed)
M.D.
Dee 26 1907 (Address). Chaletfel
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? years ..
months. days
Where was dlsease contracted, If not at place of death ?
Filed Dec. 27 1907 Edward , Rafting
Clerk
* City or town, streot 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. AState or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalis. |[ Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.
Chelmsford
227
(CITY OR TOWN.) 80
Date of }
Dec 26
1907
COMMONWEALTH OF MASSACHUSETTS
228
Chelmsford
(CITY OR TOWN.)
Malvina Hodgeman
FULL NAME
Place of 2
Chelmsford, Mass.
Death * S
Residence
"
Age .....
70
.years.
11
.months .. 19 .days
STATISTICAL DETAILS
SEX
1.
COLOR
W.
SINGLE, MARRIEDY
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Chelmsford. Muss .
NAME OF
FATHER
asa Hodgman.
BIRTHPLACE
OF FATHER#
Chelmsford
MAIDEN NAME
OF MOTHER
Sallie Spaulding
BIRTHPLACE
OF MOTHER#
Chelmsford , Mars.
Mars.
OCCUPATION
athome
INFORMANT §
W. a. Parklarch
PLACE OF BURIAL OR REMOVAL II
touhathus cern.
Chehusford, mass.
DATE OF BURIAL
Jan. 21
8
190 ..
UNDERTAKER
Waller Perham
ADDRESS
Chelinefull
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. .190 .. .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 : Arterio sclerosei
. (DURATION) .. ... DAY8
Contributory :
....... (DURATION) ...
.. DAY8
(Signed) ..
Arthur y cabina
.. M.D.
A/an. 2, 1908 (Address) Chelmsford Man,
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
Jan 1,
: Edward Rofen
Down
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. Il Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
Registered No ....
81
Date of l
Dec. 30
Death
.190 8
COMMONWEALTH OF MASSACHUSETTS
229
RETURN OF A DEATH
(CITY OR TOWN.)
.. Registered No.
82
Place of 1
Chelmsford
Death * S
Residence
Chelmsford mass Age 39
.years ...
.. months.
days
STATISTICAL DETAILS
SEX male
COLOR
white
SINGLE, MARRIED,
WWOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ± Carlile mars
NAME OF
FATHER
Stephen & nickler
BIRTHPLACE
OF FATHER#
Carlile mass
MAIDEN NAME
OF MOTHER
martha & Carry
BIRTHPLACE OF MOTHER # Strong maine
OCCUPATION Teamoter
INFORMANT § Martha E. Hulslander
PLACE OF BURIAL OR REMOVAL !! Green Cemetery Carlile
DATE OF BURIAL
Jan 3 1908
UNDERTAKER / ADDRESS Thomas It-Green Cardlite mil
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from .... Sept. 190 ...... to 530.31 1907 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 : Insanity, Quanition.
.(DURATION).
. DAYS
Contributory :
.. (DURATION).
.. DAYS
(Signed)
Antun & Safona
M.D.
Jan 7 1900 (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 Jan. 3 1908 Edward Lo 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 details.
][ Name of cemetery. 00
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME Elenah Q. Fickles
maso
Date of l
Dec
31
....
1907
Death S ..
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