USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 2
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MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
74
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME
William
m. Lee
Place of Death * Chelmsford
Date of Death march 7, 1966
.Age ..
66
...
years
4
months
23
.days
STATISTICAL DETAIL
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Canada
NAME OF FATHER
Daniel
BIRTHPLACE OF FATHER # unknown
MAIDEN NAME OF MOTHER unknown.
BIRTHPLACE OF MOTHER #
untennon
OCCUPATION
Retired
INFORMANT § Frank Vie
PLACE OF BURIAL OR REMOVAL !! DATE OF BURIAL Edson Cemeting march 110 6
ADDRESS
UNDERTAKER b. M. Showing Her 33 Prescott of
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. Oct. . 190 5 to Mah. 7 1906. 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 : ...
Paralysis
-
several months .... (DURATION) ..
Contributory
Umara Howard
.. (NURATION). .. DAYS
(Signed)
Mich. 8 1906 (Address).
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Cow Usual Residence
How long at
Place of Death ?. . Days
Where was disease contracted, if not at place of death ?.
Filed mar. 10 ..... EdwardJ. Rofmy
Tom Clerk.
.City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
-H Name of cemetry.
15
.. Registered No ..
mass
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
... M. D.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
NAME OF FATHER MAIDEN NAME OF MOTHER OCCUPATION -- FILL OUT WITH INK .- THIS IS A PERMANENT RECORD --
STATISTICAL DETAIL
SEK Female White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Annize Petelle
HUSBAND'S NAME + Joseph Frechette
BIRTHPLACE # Canada
Regio Petelle
BIRTHPLACE OF FATHER İ Canada
Aurelie Gervais
BIRTHPLACE OF MOTHER # Canada
House - Keeper
INFORMANT § Joseph Frechette
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL March 10 g 6
UNDERTAKER foxjelu albert
ADDRESS 5M Cheever
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from.
3 March 1906 to Clark 1906
that to the best of my knowledge and belief death occurred on the
dato stated above, and that the CAUSE OF DEATH was of follows :
Primary :
a
(DURATION). DAYS
Contributory
.(DURATION) ...
.. DAYS
(Signed)
M. D.
1/8 1906 (Address) 104 cl21.
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 mas. 9, nos Eduard J. Robbing Tom Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details. Il Name of cemetry.
75
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME
Umuza Frechette.
16
.. Registored No ...
Place of Death * # Lepor St Mouth Chelmsford mass.
Date of Death March 9 th- 06
Age
50
years.
3
months 8 days
₹
90 Procent.
mignantt-
COMMONWEALTH OF MASSACHUSETTS
76
CITY OF LOWELL 17
FULL NAME Eliza Linecião viva 2
Registered No ..
Place of Death * Chelmsford, was
Date of Death. March 9, 1906
.Age ...
82
years.
4
months
3
days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, 1WIDOWED, OR DIVORCED
MAIDEN NAME + Eliza Liuscott
HUSBAND'S NAME t Beij. B. Mayberry
BIRTHPLACE # Chapleigh ME
NAME OF FATHER
James Loinscott 6
BIRTHPLACE OF FATHER I hayleigh ME
MAIDEN NAME OF MOTHER Mary Huntress
BIRTHPLACE OF MOTHER # Chapleigh hur
OCCUPATION
INFORMANT § Fred CN The
PLACE OF BURIAL OR REMOVAL | DATE OF BURIAL So. Windham Me. Imav 15 .... 190.6.
UNDERTAKER dr. Webech
ADDRESS decwill amare
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ..
Mar. 4.
... 1906.to
Mar, 9 1906.
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 : Right hemiplegia !. . .
(DURATION). DAYS
Contributory .. Ducation-Ham, 11 months ~
.. DAYS
(Signed) ..... Anhuny, Seofina, ...... M. D. Mu 10, 1906 (Address) ....
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. 14 1906 Edward J. Robbing Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details. Tame 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
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
77 Chelousford. (CITY OR TOWN.)
FULL NAME
......
Place of
Death *
Residence
Chelmsford
Age 11
.. years ..
... months.
30 days
STATISTICAL DETAILS
SEX
male
COLOR
chile
SINGLE, MARRIED, , WIDOWED, OR Cordones DIVORCED
MAIDEN NAME 1
HUSBAND'S NAME
BIRTHPLACE # New thomas N.M
NAME OF FATHER
BIRTHPLACE
OF FATHER#
bouillong, mate
+
MAIDEN NAME
OF MOTHER
Vanesa
Rece
BIRTHPLACE OF MOTHER # Goddard N. N
OCCUPATION
INFORMANT §
PLACE OF BURIAL OFF REMOVAL II
Westford
DATE OF BURIAL
meta. 17.
... 190 .. 5
UNDERTAKER
1. B leurvier
ADDRESS
58 Presente St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
iliness, from
Oct-1
. 1905 to Llee
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 :
abriler y
i
Found dead in bed .
. (DURATION).
DAYS
Contributory :
(Signed)
I E Jamey
M.D.
Mich. 14 906 (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
mar. 15 1906. Edward &, Robbins
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." if In a Hospital or institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country ; also city, town or county, if known.
§ Name and address of person giving statistical details. Il Name of cemetery.
18
Registered No ..
Date of ¿
Death
March 14 1906
.. (DURATION) .. .DAYS
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death ..
March 16 th 1 gul
Age
44
years
months
days
STATISTICAL DETAIL
SEX
COLOR
SINGDE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + Gathering un alom
HUSBAND'S NAME +
BIRTHPLACE #
Nuland
NAME OF FATHER Bernard mcaloon.
BIRTHPLACE OF FATHER Į Ireland
MAIDEN NAME OF MOTHER Mary Mi Manomin
BIRTHPLACE
OF MOTHER +
Ireland
OCCUPATION
Housewife
INFORMANT §
PLAGE OF BURIAL OR REMOVAL II It Jabude Country
DATE OF BURIAL March, 19 1 ... 1904.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from Micha 10 6 0 Mdr 06 190 %. ., 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 :
Conca ne veuilo
.(DURATION) ..
DAYS
Contributory
(DURATION) 7
. . DAYS
(Signed)
M. D.
Mar 17 1906 Adres ) Chelager found ries.
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 196 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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
78
CITY OF LOWELL
19
Registered No ..
fathering مسلسلبد
Puesel ith chilis ford
K
COMMONWEALTH OF MASSACHUSETTS
RETURN
OF A DEATH Elizabeth & Mcgrath. Chehusford /1906 Age ...
CITY OF LOWELL
Registered No. 20
. years
months
days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, On DIVORCED"
MAIDEN NAME + Elisabeth R Kerr
HUSBAND'S NAME + This. All Erath
BIRTHPLACE # South Hampton NS.
NAME OF FATHER John terr
BIRTHPLACE OF FATHER + Scotland
MAIDEN NAME OF MOTHER Sarah Doherty
BIRTHPLACE OF MOTHER # Scotland
OCCUPATION at Home
INFORMANT § Daughter
PLACE OF BURIAL OR REMOVAL TOOL
DATE OF BURIAL Parrabara, N. J. Mar 19, 96
ADDRESS
UNDERTAKER Chas, A Halloy Lowell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Mch. 7 190 6 to Mich. 17 1900 6 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 : ....
Grenmonia
(DURATION) 10 DAYS
Contributory
(Signed) AmacaForward .... M. D. Mehr 17 1906 (Address).
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence. Place of Death ?. Days ) Where was disease contracted, if not at place of death ?.
Filed
Mar. 19, 106 Edward & Rabbins.
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.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
FULL NAME
Place of Death *
Date of Death Mar 17.
79
J ... (DURATION) .. .. DAYS
How long at
20
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
CITY 80 OF LOWELL
RETURN OF A DEATH
FULL NAME
Cecil H. Noble
Place of Death * * Chelmsford Centre
Date of Death
Mar 18 th
1206
.Age .....
4
years.
months
days
STATISTICAL DETAIL
SEX Male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME 1
-HUSBAND'S NAME 1
BIRTHPLACE # Chelmsford Centre
NAME OF FATHER Henry Wi Noble
BIRTHPLACE OF FATHER + ( Douglastown N. B.
MAIDEN NAME OF MOTHER Anna H. Mic Erath
BIRTHPLACE OF MOTHER + South Hampton N.S.
OCCUPATION
at Home
INFORMANT § rather
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL St. Patricks Mar, 20. 6
1. 1990 ..
UNDERTAKER
ADDRESS C. A. Hollow Lawell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Mch, 6 1906 to Mehr 18 2906.
that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows : Primary : ..
Pneumonia
.(DURATION) .... / .. Z. DAYS
Contributory
.. (DURATION) .. .. DAYS
(Signed) ...
Mich. 19 1906 (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
Mar. 19 1906 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.
1 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. 11 Name of cemetry.
award 0
21
Registered No ..
Baston Road
are Brather Layal
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Jullie
a.
Brown
.Registered No ..
22
Piace of )
worth Chelmsford mass
Death * S
Residence
north Chelmsford mas Age.
62
... years.
1
.months.
15
.days
STATISTICAL DETAILS
SEX
tem nale
COLOR
white
SINGLE, MARRIED,
DIVORCED married
MAIDEN NAME +
nellie a Staples
HUSBAND'S NAME }
Charles W. Brown
BIRTHPLACE ± Elliott maine
NAME OF
FATHER
Samuel Stables
BIRTHPLACE
OF FATHER#
Elliott maine
MAIDEN NAME
OF MOTHER
mary Dixon
BIRTHPLACE OF MOTHER Elliott maine
OCCUPATION
af home
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from november 1905 to Mich 20 1906, 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 :
Organic disease I heard.
Contributory :
.. (DURATION). DAYS
(Signed)
JE Vamed
M.D.
Mch. 21 1906 (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
mar, 23
1906 Edward J. Rabbino
Com
Clerk
PLACE OF BURIAL OR REMOVAL II Riverside Cemetery
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.
b.M. Young ter 33 Rescate Name of cemetery.
Lowell
Husband
DATE OF BURIAL March 25 190 6
8
COMMONWEALTH OF MASSACHUSETTS
Date of )
march 20 190 G
Death
.. (DURATION).
DAYS
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME Antoinette F Sampson. Place of Death * No Chelmsford Mass Mar 1906.
Date of Death
'53
Age.
years
4
months .3
days
STATISTICAL DETAIL
SEX Female
COLOR White
SINGLE, MARRIED, WIDOWED, OR Married DIVORCED'
MAIDEN NAME +
Antoinette F Small dames A Sampson
HUSBAND'S NAME +
BIRTHPLACE # Machiasport Me
NAME OF FATHER
Nathaniel Small
BIRTHPLACE OF FATHER ±
MAIDEN NAME OF MOTHER
Margaret Barter
BIRTHPLACE OF MOTHER #
Machiasport Me
OCCUPATION
House Wife
INFORMANT §
James A Sampson
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Oct
198 to Mch. 24 1906
that to the best of my knowledge and bellef death occurred on the dato stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Dance- of de Uterus
1 visar 6 mos (DURATION)
Contributory
.(DURATION) .. .. DAYS
(Signed) Dinara Howard ..... M. D. Mich. 2.5 1906 (Address) Chelmsford
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 Mar. 26, 190 b Edward J. Robbins 0
Clerk.
PLACE OF BURIAL OR REMOVAL |!
DATE OF BURIAL
No Chelmsford
.Mar . 27th I906
UNDERTAKER John A Weinbeck
ADDRESS
.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 Couutry ; also city, town or county, if known.
§ Name and address of person giving statistical details.
No 80 Middlesex Sti Lowentry Mass
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
82
Registered No .. 23
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
Machiasport Me
.
:
COMMONWEALTH OF
RETURN OF A DEATH
FULL NAME
Esther Flanell
Registered No ...
24
Place of Death *
Chalifund Dias
Date of Death.
inan-
28
Age 2
years ..
months
.days
STATISTICAL DETAIL
SEX
COLOR
W.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
* Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Chelmsford Mass
NAME OF FATHER John Flanell
BIRTHPLACE OF FATHER Į
England
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during, last
illness, from.
Mch. 21 1906 to Mich. 28 1906
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 : Congestion of tion of lungs Primary :
...... (DURATION) .... ... . DAYS
Contributory
Whooping Cough
(DURATION) 0/ 4/ .. DAYS
(Signed)
Almasas
ward ..... M. D.
7/0 28 190 6 dress) Chelmsford.
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 Mar, 28 190 6 Canard J. Somg
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 inarried or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
INFORMANT §
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL It Patricles Lawng mar, 29 6
ADDRESS
UNDERTAKER/
45yorkcom +Name of cemetry.
CITY OF LOWELL
MASSACHUSETTS
83
10
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OF TOWN.)
FULL NAME
Enter R Lewis
Registered No.
Place of Thelegend Town Har
Date of ¿
Death
march 26. 1906
Residence
....
Age
80
.. years
months
days
STATISTICAL DETAILS
SEX Handle
COLOR
White
MINGLE, MARRIED.
WIDOWED, OR
DIVOHOED
MAIDEN NAME !
Ryan
1.7
HUSBAND'S NAME 1
BIRTHPLACE *
Araldo, maine
NAME OF FATHER
BIRTHPLACE OF FATHER:
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER!
OCCUPATION
Inmate Town Fram
INFORMANT § a.P. Brown, Supt.
PLACE OF BURIAL OR REMOVAL ! Pine Ridge lem
DATE OF BURIAL
March 28 1906
UNDERTAKER Nation Penha
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last Illness, from Mch. 24 190 G to Imch 26. 190 G. 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 :
Paralysis
. .. (DURATION )
3
.. DAYS
Contributory :
( PORATION ) DAYS
(Signed
Amara Howard
M. D.
Mich., 28 1906 (Address)
Chelmsford
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years
months days
Where was d'sease contracted,
If' mot at place of death ?
Filed Mar. 27. 1906 Edward . el220 Clerk
1
· City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for uader "Special information." If In 2 Hospita or lastitut om, give its NAME instead of street and number.
1 In case of married or divorced woman, or widow.
: State of country; also city, town or county, If known.
§ Name and address of person givlag statist cal details. V hamo of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Death ·
Chelmsford
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX Male
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE#
Scortland
NAME OF FATHER Stewart Mac RKay.
BIRTHPLACE OF FATHER# Scotland
MAIDEN NAME OF MOTHER
Helen Not Known
BIRTHPLACE OF MOTHER# Scotland
OCCUPATION Patten Maker
.
INFORMANT §
Mrs Stewart Mac Kay
PLACE OF BURIAL OR REMOVAL II .
DATE OF BURIAL
No Chelmsford Mass Apr ... 4th 1906
UNDERTAKER
ADDRESS
John A Weinbeck Lowell Mass
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 :
desense of Heart.
Need suddenly
.. (DURATION).
DAYS
Contributory :
(DURATION) DAYS
JE Varney
.M.D.
(Signed).
agent- Board
april 2 1906 (Address) MontChalcontent
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
afr. 3
Edward J. Rating
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.
85
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Stewart Mac Kay
Registered No ..
26
Place of 2
North chelmsford Mass
Date of l
Death .Mar .... 3Ist.
1906
Death * S
North Chelmsford Mass
43
Residence
.
Age
.years.
.months.
.. days
1
-
501
r
86
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Waren Chandler
.Registered No ......
27
Place of l
Chelmsford Mass
Date of kr. 3rd
Death
.190 Q
Residence
Chelmsford, Mas Age.
69
.years ..
7
... months.
.. days
STATISTICAL DETAILS
SEX
M
COLOR
w.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t HUSBAND'S NAME +
BIRTHPLACE Westford, Wass .
NAME OF
FATHER
William Chandler
BIRTHPLACE OF FATHER# Westford, mass
MAIDEN NAME OF MOTHER Shoda Drveta
BIRTHPLACE OF MOTHER # Dunstable, Masc.
OCCUPATION Farmer.
INFORMANT §
Fred, W. Chandler.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Mar. 2, 1906 to 1906 to april 3 1906 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 -
(DURATION) .. DAYS
Contributory :
(DURATION). DAYS
1
Arthur . cobana.M.D.
1906 (Address) Chulmatin Dans.
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents. How long at Place of Death ? months. days years ..
Where was disease contracted,
If not at place of death ?
Filed als, 5- 1906 Edward J. Rabbin
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
PLACE OF BURIAL OR REMOVAL Riverside leen.
DATE OF BURIAL
apr. 6 1906
ADDRESS
UNDERTAKER Walter Lehang Cha
Death *
87
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
28
Registered No.
Date of Lekr. 4
Death
1906
21
.days
STATISTICAL DETAILS
SEX
COLOR
W.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
Sarah Words
HUSBAND'S NAME + Sanford Hagen
BIRTHPLACE İ at Lebanon, Y. H.
NAME OF
FATHER
Henry G. Word
BIRTHPLACE
OF FATHER#
West Lebanon, D.H.
MAIDEN NAME
OF MOTHER
Beter Gerrish
BIRTHPLACE
OF MOTHER #
Boccawen N.H.
OCCUPATION
INFORMANT § Feed a. Hagen, low
PLACE OF BURIAL OR REMOVAL II 110 fathers Cer.
UNDERTAKER
ADDRESS
Walter Jechany (telefond)
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Mch. 28 1906 to Calm. 4 1906, 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 :
Bronchitis
(DURATION).
7
DAYS
Contributory :
old age.
.... (DURATION). DAYS
(Signed)
Amara Howard
.M.D.
am. 4 1906 (Address).
Chelmsford.
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
ah. 6.
1906 Ochrande 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.
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