USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 3
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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
Sarah W. Hagen
FULL NAME
Place of )
Chelmsford, Males
Death * S
Residence
,
"1
Age.
87
... years.
DATE OF BURIAL
apr. le 190€
M
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
STATISTICAL DETAIL
SEX
COLOR
/ date
SINGLE, MARRIED, WIDOWED OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE İ
Formule Mass.
NAME OF FATHER
Patate Ready
BIRTHPLACE OF FATHER Į
Reland
MAIDEN NAME OF MOTHER
Mary O'steen
BIRTHPLACE OF MOTHER #
Ireland
OCCUPATION
Operatore
INFORMANT S Pater& Recidy
Father
PLACE OF BURIAL OR REMOVAL | DATE OF BURIAL St Patrickos. Kouzel reaAfull 9 ... 190.6.
UNDERTAKER
ADDRESS 324 martin SA
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
Sept 11 190 5 To Ppo 6 19%) 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 :
(DURATION). JAYS
Contributory
. DAYS
(Signed)
parte
M. D.
.190 G (Address) Koniec
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 apr. 9. 1 6 Edward J. Bobbing
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.
I Name of cemetry.
Chelmsford Mass. CITA OF 88 LOWELL
RETURN OF A DEATH
FULL NAME Mary Celia Ready
Place of Death *
Date of Death
Registered No .. 165 Hbutmant St North laclus for Mass grill 8h. 1906 Age 2,
29
years 10 months 20
days
COMMONWEALTH OF MASSACHUSETTS
COMMONWEALTH OF MASSACHUSETTS
CITY 89 OF LOWELL
Registered No. 30
Age.
years
months
days
STATISTICAL DETAIL
SEX m
COLOR
White
SINGLE, MARRIED, WIDOWED,-OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # West Chenofud
NAME OF FATHER
Joseph Moran
BIRTHPLACE OF FATHER +
Lawrence Mars
MAIDEN NAME OF MOTHER Sarah Boy
BIRTHPLACE OF MOTHER # Forwell Mann ass
OCCUPATION
INFORMANT § Steph Moran
PLACE OF BURIAL ØR REMOVAL II
Leters
DATE OF BURIAL apr 13 ... 190 ..
6
UNDERTAKER ADDRESS horas. I'Mheimat To Jaham
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
.190 .... to.
april 12,006
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 :
infantile: atelectasia
Contributory
(Signed)
JE Varney
. M. D.
april 12
.190 .... (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 ?.
april 12 1906 Edward . Rolfma
Com 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. D Name of cemetry.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FULL NAME
Place of Death * West chersford
Date of Death
apr 12, 19/06
RETURN OF A DEATH Moran
. (DURATION) .. . DAYS
.... (DURATION)
DAYS
How long at
=
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME Stillbox 10 Stalch
Place of Death * North Chelmsford
Date of Death abril 15, 1900 0
Age-
years.
months days
STATISTICAL, DETAIL
SEX
COLOR
Firmale
SINGLE, MARRIED, WIDOWED OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # With Chelmsford.
NAME OF FATHER
Patrick, Walch
BIRTHPLACE OF FATHER İ
Ireland
MAIDEN NAME OF MOTHER
Alice. Me Cabe
BIRTHPLACE OF MOTHER #
Preland
OCCUPATION
l'perative
INFORMANT § Patrick Halch
PLACE OF BURIAL OF REMOVAL II wordt malmeting
DATE OF BURIAL apr. 15, 1906
UNDERTAKER Patrick Salah
ADDRESS No. chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
april 15 6
illness, from. .190. to
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 : still buch ,
. (DURATION). DAYS
Contributory
. DAYS
(Signed)
M. D.
afaf 15 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/ av. 15 190 16 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 Institution, give its NAME instead of street and number.
t 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.
|| Name of cemetry.
ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY 90 OF LOWELL
Registered No .. 31
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Place of Death *
Date of Death april
RETURN OF ,A DEATH Vitill Dory Munt Theline 15th. 1906. ... Age
CITY OF LOWELL
Registered No ..
32
years
months
.days
STATISTICAL DETAIL
SEX
COLOR
SINGLE-MARRIED, WIDOWER OR DIVORCED.
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Inth Chelmsford
NAME OF FATHER
BIRTHPLACE OF FATHER ±
England
MAIDEN NAME OF MOTHER Jelia Flatles
BIRTHPLACE OF MOTHER +
OCCUPATION
INFORMANT'S The Distant
PLACE OF BURIAL OR REMOVAL Por anil 16 It Palets conder, .6
ADDRESS
UNDERTAKER J.DDowell Jours 324 maist
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
.190.
abril 15 0mb
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 : ..
shell- born
Contributory
(Signed)
DE Varney
H.D.
april 1 6 90 6 (Address) H. Chalusfio
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents. *
Former or
How long at
Usual Residence".
Place of Death ?.
Days
Where was disease contracted, if not at place of death ?.
Filed apr. 16.
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
DATE OF BURIAL
(DURATION). DAYS
.. (DURATION). ... DAYS
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Martin Robbins
(CITY OR TOWN.)
33
.Registered No.
Place of )
Chelmsford, mass
Date of l
april 25
190 6
Residence
Age 53
.. years.
6
.. months.
11
.. days
STATISTICAL DETAILS
SEX
M.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
Swanville, Maine
NAME OF
FATHER
John Robbins
BIRTHPLACE
OF FATHER#
Juanville Me
MAIDEN NAME
OF MOTHER
Salary Dunfre
BIRTHPLACE
OF MOTHER$
Sidney me
OCCUPATION
Real Estate
INFORMANT §
Mrs. Martin Robbins
PLACE OF BURIAL OR REMOVAL II
Forfatter Leens
DATE OF BURIAL
apr. 29 1906
ADDRESS
UNDERTAKER
Waller Pechan Gelmeden
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
a/21. 20 190 6 to Upi, 25 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 :
Double Lobar Pneumonia
.. (DURATION).
6
OAYS
Contributory :
V ... (DURATION).
.. DAYS
(Signed)
Antune G Scobona
M.D.
apr. 27 1900 (Address)
Chefrue, ford, Man.
SPECIAL INFORMATION only for Hospitals, Institutions, Translents,
or Recent Residents.
How long at
Place of Death 7
years.
months.
days
Where was disease contracted,
If not at place of death ?
Filed
May 1
06 Edward & Rotting
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
92
Death * S
Death
2
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
Chelmsford CITY
93
LOWELL
FULL NAME
Charles E. Soderberg
Place of Death *
Chemsford leentre
Date of Death
May 8th 1906
Age ..
29
years
3
months
29
days
STATISTICAL DETAIL
SEX
74.
COLOR
Ir.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
· HUSBAND'S NAME +
BIRTHPLACE # Lowell
NAME OF FATHER Charles & Loderburg
BIRTHPLACE OF FATHER + Sweden
MAIDEN NAME OF MOTHER Elizabeth arnott
BIRTHPLACE OF MOTHER Auknown
OCCUPATION
Draughtsman
INFORMANT §
Irike
PLACE OF BURIAL OR REMOVAL II Edson Cometery
DATE OF BURIAL
May 8th
6
.... 190.
UNDERTAKER ABbarrier
ADDRESS
68 Present Sp
PHYSICIAN'S CERTIFICATE
I HEREBY/ CERTIFY that I attended deceased during last
illness, from ..
May 3, 190 6 to May 8, 1906
that to the best of muy knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows : Cerebro-spmal ning its Primary : . .
. (DURATION). DAYS
Contributory
(Signed)
Riche Y Acoloria, N. D.
Thay 8, 1906 (Address) Thebestand M.
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 may 8 1906 Edward J. Rafting 0
Var 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.
11 Name of cemetry.
5
..... (DURATION). .. DAYS
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
RETURN OF A DEATH
Registered No .. 34
COMMONWEALTH OF MASSACHUSETTS
CITY 94 OF LOWELL
35
Registered No ...
Place of Death *
Date of Death. may 12, 1906
Age ... 750
years
6
months
15 days
STATISTICAL DETAIL
COLOR
SEX Female white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Francied
MAIDEN NAME +
Eliza a
Hildreth
HUSBAND'S NAME 1 Jonathan Wright
BIRTHPLACE #
Chelmsford maso
NAME OF FATHER moses Hildreth
BIRTHPLACE OF FATHER İ barolite mass
MAIDEN NAME OF MOTHER
Eliza murdock
BIRTHPLACE OF MOTHER # Caroline mass
OCCUPATION
at home
INFORMANT §
Husband
PLACE OF BURIAL, OR REMOVAL !! Proufathers DATE OF BURIAL Chelmsford Mass may 10 G.
ADDRESS
UNDERTAKER b. M. Hrung the 23 Precotte Name of cemetry,
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from May 12 190 6.to May 12 190 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 : Paneral Debility
.. (DURATION). DAYS
Contributory
.. (DURATION) ...... ... DAYS
(sigyed)
sg .. M. D. Mayer 0 6 (Address) Come Know
SPECIAL INFORMATION only for Hospitals, Institucions, Transients,
or Recent Residents.
Former or
%
How long at
Usual Residence.
Place of Death ?
Days
Where was disease contracted, if not at place of death ?.
Filed May 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. + 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.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
RETURN OF A DEATH
FULL NAME
Eliza ti.
a.
Wright
South Chelmsford mars
A
15
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Mand Curarti Robinson
Registered No.
36
Place of Death *
Date of Death
May 17 1906
Age ...
49
. years.
.months.
days
STATISTICAL DETAILS
SEX
Final
COLOR
While
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Mundow
MAIDEN NAME +
Mand Dragan
HUSBAND'S NAME t
S. a Bothunion
BIRTHPLACE # Phoneton HYB
NAME OF
FATHER
andrew Drugan
BIRTHPLACE
OF FATHER#
Unknown
MAIDEN NAME
OF MOTHER
Unknown
BIRTHPLACE
OF MOTHER #
Infraun
OCCUPATION
Domestic
INFORMANT §
mrs y MHayward
29 Olives St Malden
PLACE OF BURIAL OR REMOVAL I
malden
Mars
DATE OF BURIAL
May 19
... 190.Co.
UNDERTAKER
ADDRESS
Daniel Bram So Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Thay15 .1906 to may/ 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 :
Pulmonary OInterculos
about 3 km.
....
. (DURATION) ..
DAYS
Contributory :
.. (DURATION) ..
DAYS
(Signed).
Arthur SScolina, M.D.
May 17, 1906 (Address).
Chelmsford, Mais,
SPECIAL INFORMATION only for Hospitais, Institutions, Transionts, dr 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 17
Edward & Rafting
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 details. || Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL 'NAMES TO BE IN FULL
1
COMMONWEALTH OF MASSACHUSETTS
96
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Olive @ Haut
.Registered No.
37
Place of l
Death *
Chelmsford Centro
Date of l
May 18 1906
Death
S
2
months ...
29
... days
STATISTICAL DETAILS
SEX
COLOR
w.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Charlestown
NAME OF
FATHER
Samuel C. Hunt
BIRTHPLACE
OF FATHER #
Carlisle
MAIDEN NAME
OF MOTHER
Elizabeth a Warren
BIRTHPLACE
OF MOTHER #
arlingtoni
OCCUPATION
INFORMANT § Susie Het
PLACE OF BURIAL OR REMOVAL II Forfatter Com Cheusing
DATE OF BURIAL
May 20 1906
UNDERTAKER
Walter Perlow
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
Dec.
190 $ to May 18 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 :
Dropay
. (OURATION).
6 mos.
.... DAY6
Contributory :
... (DURATION)
DAY8
(Signed).
Chnasa Howard M.D.
May 20 1906 (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 May 20 1906 Edward J. Roffing
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. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Residence
Chelinefang
Age.
74
.. years.
-
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
STATISTICAL DETAIL
SEX female
COLOR Wirili,
SINGCE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
2 prachy
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER
BIRTHPLACE OF FATHER Į
Irland markant May
BIRTHPLACE OF MOTHER #
OCCUPATION
at home
INFORMANT § Condraw Neste
PLACE OF BURIAL OR REMOVAL I Jascott ME
DATE OF BURIAL
UNDERTAR 110
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
aug.
195 to May 29 1906.
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 : Primar Chronic Nephritis
Contributory
Cardiac
.(DURATION) .. DAYS
(PURATION) .. . DAYS
(Signed) Amara Howard . D. May 31 1906 (Adres) Chelmsford mar
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 May 31, 19 6 Edward J. Robbing
Jour 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.
Il Name of cemetry.
97
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death
Wildwood SH Chelmsford May 29-1906 At 12 . years.
CITY OF LOWELL
38
Registered No ..
months days
COMMONWEALTH OF MASSACHUSETTS
.
MAIDEN NAME OF MOTHER
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death
Newly, Uralth may 30,
My Cabra 1'Chelius ford 1906
Age 34 . . .
years
montlis
days
STATISTICAL DETAIL
SEX
COLOR
male White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ± Anth Cheles ford
NAME OF FATHER
Henry M. Caly
BIRTHPLACE OF FATHER Į
Duland
MAIDEN NAME OF MOTHER
Margaret. M .: Cry
BIRTHPLACE OF MOTHER #
Ireland
OCCUPATION Moulder
INFORMANT § mather
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last.
illness, from ... Xml20 190 to. 1.90 6., 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 :
Bronchitis
.(DURATION). DAYS
Contributory
.(DURATION) .. .. DAYS
(Signed)
.. M. D.
190(Address) 253 Curralsr
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usnal Residence.
How long at
Place of Death ?. Days
Where was disease contracted, if not at place of death ?.
Filed June 1 16. Edward & Roofing
Join Clerk .
PLACE OF BURIAL OR REMOVAL !! NA Patricks century
DATE OF BURIAL
16
UNDERTAKER
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.
1 In case of married or divorced woman, or widow.
# State or Country ; also city, town or connty, if known.
§ Name and address of person giving statistical details.
| Name of cemetry.
ALL NAMES TO BE IN FULL.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD %
CITY 98 OF LOWELL
39
Registered No ..
COMMONWEALTH OF MASSACHUSETTS
C 99
RETURN OF A DEATH
(CITY OR TOWN.)
Registered No.
40
Place of 2
Death * S
Chelmsford Central
Residence
Chelmsford
Age.
90
0
9
.months.
205
.days
STATISTICAL DETAILS
SEX
firmale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
wid,
MAIDEN NAME +
I.a. Deseance
HUSBAND'S NAME +
Benjamin F. Hodges
BIRTHPLACE #
East Boxboro
NAME OF
FATHER
Dominic DEssance
BIRTHPLACE
OF FATHER
East Boxtoro
MAIDEN NAME
OF MOTHER
annie Fielde
BIRTHPLACE
OF MOTHER #
Jaunton
OCCUPATION
at home
INFORMANT § Mary J. Cummings
PLACE OF BURIAL OR REMOVAL !! Hovefathers Secretary
DATE OF BURIAL
June 4 1906
UNDERTAKER
Halte Perham
ADDRESS
Chelmsford.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last illness, from. 190 ..... to lune/ 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 :
Senile
(DURATION)
.. DAYS
Contributory :
... (DURATION) ..
DAYS
(Signed) ..
.M.D.
June 2 1906 (Address) Chelmsford.
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
June 3
6. Edward). Nothing
down 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
FULL NAME
Julia 9 Hodges
Date of )
190%
Death
5
.years.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
FULL NAME Bela Pr 1
Place of Death *
Date of Death
C
06
Age
years
6
months
days
STATISTICAL DETAIL
SEX Of.
COLOR
White
- SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
.
BIRTHPLACE # North Chelmsford .
NAME OF FATHER
Illegitingle - Child Father Unknown
BIRTHPLACE OF FATHER Į north Chelmsford
MAIDEN NAME OF MOTHER Mario Primeau
BIRTHPLACE OF MOTHER + Canada
OCCUPATION
Child
INFORMANT §
marie Primeau
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
dato stated above, and that the CAUSE OF DEATH was of follows :
Primary :
....
C
Contributory
(Signed) ..
JE Vaney
.. (DURATION). ... DAYS
Eigent Brand & HealerM. D. Ane 3
.1906 (Address) northChiliunder
...
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 Slune 4 19 6 Edvard Robbing
John Clerk.
PLACE OF BURIAL OR REMOVAL II If Joseph's
DATE OF BURIAL
.... 190 ...
UNDERTAKER voveph albert
ADDRESS
sof Cheever
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.
I Name of cemetry.
100
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
neau Worth Celinaford
Registered No ..
41
How long at
. (DURATION). DAYS
-
:
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
01
RETURN OF A DEATH
FULL NAME Place of Death Grainfield It. North Cheer
Date of Death
Lamel 7 1906 Age. Uefa
years
months days
STATISTICAL DETAIL
SEX
COLOR While
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Hagarty
HUSBAND'S NAME + Letar Q.
BIRTHPLACE ±
Phillip
NAME OF FATHER
BIRTHPLACE OF FATHER #
Eiland
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER # Towel, Mass.
OCCUPATION
INFORMANT §
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 : Planning porjustino
.(DURATION). DAYS
Contributory
(DURATION). Ho Sich Med. Cea. D.
Jours
June 7 1906 (Adress) 219 Caballo
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 June 7 1906 Edward ). Nothing
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.
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