USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 4
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UNDERTAKER
ADDRESS
16gGlundName and address of person giving statistical details. ZI Name of cemetry.
PLACE OF BURIAL OR REMOVAL !
DATE OF BURIAL
Thay
Registered No ..
42
(Signed)
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
CITY 102 OF LOWELL
RETURN OF A DEATH
FULL NAME
Place
Death *
L
Date of Death
4 1905
Age 28 years
months
days
STATISTICAL DETAIL
SEX female that COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + lane 5. umi vitale
HUSBAND'S NAME + Vily J. Constantine
BIRTHPLACE # Rhode Island
NAME OF FATHER
BIRTHPLACE OF FATHER ₫
Queland
MAIDEN NAME OF MOTHER
Ellen Folie
BIRTHPLACE OF MOTHER #
England
OCCUPATION
at Home
INFORMANT § Irres band
PLACE OF BURIAL OR REMOVAL II Tour PATH OF BURIAL , Faturas Cenuelen
June 1. .... 190.
6
UNDERTAKER
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
4 une 9 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 : Unaemia.
.(DURATION) .. ... DAYS
Contributory
organic desease / /cedros
4000 you (DURATION).
.. . DAYS
(Signed) ..
JE Vaney
June 9 1906 (Address) M. Chelfantas.
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 June 11 1906 Edward & Gallina ..
Varm 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.
M Name of cemetry.
How long at
ADDRESS
43
-
COMMONWEALTH OF MASSACHUSETTS
103
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
mary Gam Mr Cake
Registered No ....
940
Place of 1
Death *
Residence
South Chelmsford.
Age
80
.years.
months
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
S.
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE # Boston mars,
NAME OF
FATHER
Hugh m' babe
BIRTHPLACE
OF FATHER#
Ireland
MAIDEN NAME
OF MOTHER
Char Pile
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION More
INFORMANT § Frederick Barley
PLACE OF BURIAL OR REMOVAL !!
Edson Com. Lowell.
DATE OF BURIAL
June 24,90 6
UNDERTAKER
J. B. Curia
ADDRESS
58 Prescott Rt
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. may 190 6 to June 21 190 6 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
apoplex y
. (DURATION).
1
DAY6
Contributory :
(Signed)
Forster 16 Smith
M.D.
June 22 190 6 (Address).
Lowell 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 Frame 25 ,90 6
Citi
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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
Ility Hospital
Date of l
June 22 190 6
Death
..... (DURATION)
. ...... DAY 8
-
COMMONWEALTH OF
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death.
June 2nd 1906 Age 16
years.
months
-
days
STATISTICAL DETAIL
SEX
What
SINGLE, MARRIED, WIDOWED, OR DIVORCED.
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # worth Thelaws fond
NAME OF FATHER
tiffen Hard
BIRTHPLACE OF FATHER ± Duland
MAIDEN NAME OF MOTHER Ollen Nouvelles
BIRTHPLACE OF MOTHER # Wieland
OCCUPATION
School Boy
INFORMANT § father
PLACE OF BURIAL OR REMOVAL !! DATE OF BURIAL Afaturas center pure fun 2006
UNDERTAKER ·
ADDRESS 324 mayet
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from. Dec. 5 .1900
to time 22 190 6,
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 :
Hodg Kin's Deseres
Contributory
.(DURATION). ... DAYS
(Signed)
JE Varney
fum 23 1906 (Adress) H. Chilien ford Mais
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence. . Place of Death ?. . Days
How long at
Where was disease contracted, if not at place of death ?.
Filed June 25 1906 Oderand ). Jobbar 2 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.
1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL.
104
MASSACHUSETTS
CITY OF LOWELL
45,
Registered No ...
havel
Sichaudys hand of the Theluce food
.. (DURATION). DAYS
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(
Cumon W. Sweet
.. Registered No. 46
Place of 1
Death * S
Chelmsford,
Date of June 25
190€
Residence
11
Age.
63
.0
3
.months.
15
.days
STATISTICAL DETAILS
SEX
m
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
lottedans n. 4
NAME OF FATHER/ 0 those Sweet
BIRTHPLACE
OF FATHERT
Sweetsbrug Canada
MAIDEN NAMEY OF MOTHER ( Maria Winslow
BIRTHPLACE
OF MOTHER #
4. 4. Stale-
OCCUPATION Muchauk
INFORMANT §
Me. a. I. W. Sweet
PLACE OF BURIAL OR REMOVAL !
DATE OF BURIAL Fine Didge Chelmsford June 28 100 le
UNDERTAKER (/
ADDRESS
Waiter Tenham Shelves en,
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. noo, 1903 to June 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 : Pulmonary tuberculosis ,
· (DURATION) 6 mas.
Contributory :
(Signed)
Amara toward
6
.M.D.
Anna 26 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 June 27 1906 durand 4. Rubbing
Clerk
6
* 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.
Il Name of cemetery. 20
105
COMMONWEALTH OF MASSACHUSETTS
Death
.. years.
.. (DURATION)
. DAYS
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
106
RETURN OF A DEATH
FULL NAME
Frank Devigan
Place of Death *
North chelmsford Iwas
Date of Death
July 4 1906
Age.
57
years.
months
days
STATISTICAL DETAIL
SEX
COLOR
-SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Ireland
NAME OF
FATHER
Peter Derungen
BIRTHPLACE
OF FATHER #
Ireland
MAIDEN NAME OF MOTHER Unknown
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION Maulder
INFORMANT § Jannes Duringarc
PLACE OF BURIAL OR REMOVAL Il St Patrick
DATE OF BURIAL
July 5
.... 190.4.
ADDRESS
UNDERTAKER Helle Dermott To Gorham St
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ..
July 3 1906 to.
July 3m 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 :
Heart disease.
. (DURATION) .. DAYS
Contributory
. (DURATION). . . DAYS
(Signed) ..
M. D.
July 5 1906 (Address) 253 Central St
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 July 5 .... 6. Comand J Ketting
Con 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.
CITY OF LOWELL
47 0
Registered No ...
COMMONWEALTH OF MASSACHUSETTS
107
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Still Born
Lambert
.Registered No.
48
Death * S
Place of l
Mer Chelmsford Mess
Date of l Death S July 6
.1906
Residence
Werk Chelmsford Man Age
.years ..
... months ...................... days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
'BIRTHPLACEİ Werk Shelves Korel
NAME OF
FATHER
Elinand Lantern
BIRTHPLACE OF FATHER#
Granada
MAIDEN NAME
OF MOTHER
Jose Deuna Peores
BIRTHPLACE OF MOTHER# 1 Novwicket falls
OCCUPATION
INFORMANT § Ed Lambert
PLACE OF BURIAL OR REMOVAL Ji
DATE OF BURIAL
July 8th
190 ..
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 ... 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 : ...
Conhuxia neonatoricón
Teur enmili
(DURATION).
DAYS
Contributory :
.
.(DURATION). .DAYS
(Signed).
JE Vaney
M.D.
July 7 1904 (Address) 7. Cheluckfund.
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
July 7 1906. Edward J. Robbins
Form 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,
57 ( hever 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
CITY 108 OF LOWELL
49
Registered No ... ...
Place of Death *
North Chelmsford
Date of Death.
July 7, 1906
1
Age.
82.
.. years.
5
months
17
days
STATISTICAL DETAIL
SEX Male
COLOR
W
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE # South Hanson, Mais
NAME OF FATHER
Joseph Bearce
BIRTHPLACE OF FATHER Į .
Pembroke Mass L'emburo
MAIDEN NAME OF MOTHER
Betsy Dammon
BIRTHPLACE OF MOTHER #
Pembrokes Mars.
OCCUPATION
Fron Foundry Percent
INFORMANT § Bessie a To
1 PLACE OF BURIAL OR REMOVAL 11 DATE OF BURIAL North Chehusford July 10, 06
UNDERTAKER & h. Wembeck
VADDRESS 88 Middlese HAN
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ...
Jan / 1906 to July/ 1904
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 :
Uramuna
5
.(DURATION).
DAYS
Contributory
Chronic Pericarditis
(Signed) .
& a Harla
...... (DURATION).
Years
.. M. D.
July 9/ 1906 (Adress) Iyugaberg
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence ..
How long at Place of Death ?.. Days
Where war disease contracted,
if not at placo 2th ?..
Filed
1906
Vann 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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
RETURN OF A DEATH
FULL NAME
Elijah hammon
Telearee
Mars
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
CITY /09 OF LOWELL 50
RETURN OF A DEATH
FULL NAME
2
edoncer
Place of Death *
Date of Death.
1906
.Age.
years ..
Registered No .. cheliunfind Mais 56 days 6 months
STATISTICAL DETAIL
SEX
Female
COLOR
w
SINGLE, MARRIED, WIDOWED, OR- DIVORCED
MAIDEN NAME +
HUSBAND'S NAME 1
BIRTHPLACE # Lowell Mass.
NAME OF
FATHER
Vernis Varea
BIRTHPLACE
OF FATHER
Woonsocket R.l
MAIDEN NAME
OF MOTHER)
Leticia Sedoncer
BIRTHPLACE
OF MOTHER #
Saber Mars
OCCUPATION
INFORMANT §
Letitia Ledouces
PLACE OF BURIAL OR REMOVAL !! Edson Cem
DATE OF BURIAL
July 9
6
.... 190 ..
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. July 9 190 to July 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 :
.(DURATION) .... One DAY
Contributory
(DURATION). . DAYS
(Signed)
....
M. D.
190 .... (Address) ...
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
July 10.
196 Edward J. Rokbing
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.
COMMONWEALTH OF MASSACHUSETTS
CITY /10 OF LOWELL
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death.
July
11.1906
Age
65
2
years.
months
days
STATISTICAL DETAIL
SEX COLOR Female white
SINGLE, MARRIED, WIDOWED, OR, DIVORCED
married
MAIDEN NAME +
HUSBAND'S NAME +
Mary W Linney Charles a Half
BIRTHPLACE # Vowell mass
NAME OF FATHER
alden Princy
BIRTHPLACE OF FATHER Į Vermont-
MAIDEN NAME OF MOTHER
Robbins
BIRTHPLACE OF MOTHER # Chelmsford mass
OCCUPATION
at
INFORMANT § Queband
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL Riverside GemetonJuly 20 0 6
ADDRESS
UNDERTAKER b.m. trung Her 33 Tres cotter
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. Im Only 5 1906 to mely 11 . 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 :
Refused Food & drink to 16 days
.... (DURATION) .... ... DAYS
Contributory
.. (DURATION). ... DAYS
(Signed) .
JE Janney ...
July 11 1905 (Address) 81, Chelsea .
.......
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence.
How long at
Place of Death ?. .Days
Where was disease contracted, if not at place of death ?..
Filed July 13 1906 Edward J Robbins .. 190
0
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. ame o
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
1
mary youth
north Chelmsford
Registered No ...
51
maso
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY OF LOWELL
52
Place of Death *
north Chelmsford
maso
Date of Death .....
July
14.1906
Age.
8/
years ..
months
16
days
STATISTICAL DETAIL
,
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Hancock n. H
NAME OF FATHER
Christy Duncan
BIRTHPLACE OF FATHER # Hancock n. f.
MAIDEN NAME OF MOTHER Vois Dow
BIRTHPLACE OF MOTHER # Hancock n. f.
OCCUPATION Retired
INFORMANT § Fred T Duncan
, PLACE OF BURIAL OR REMOVAL II Riverside Cemetery
DATE OF BURIAL July 16 .190
ADDRESS
UNDERTAKER b. M. Young the 33 Prescott of"
PHYSICIAN'S CERTIFICATE
I HEREBY , CERTIFY that I attended deceased during last
illness, from.
fame 3
.1906 to July /4 1906,
1
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 :
Organic licenceliveat
fast sechinees about six wirk
.. DAYS
Contributory
(Signed)
FE Janney
. . M. D.
.. DAYS
July 14 1
.1906 (Address) . Collision
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 July 16 1906 Edward ) Rotting
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
nathaniel, J. Duncan
Registered No ..
How long at
COMMONWEALTH OF MASSACHUSETTS
CITY 1/2 OF LOWELL
RETURN OF A DEATH
FULL NAME
Porphy Cobert
Place of Death *
Date of Death
July 18- 06
Age
years
months
days
STATISTICAL DETAIL
SEX
COLOR
male while-
SINGLE, MARRIED, WIDOWED, OR
DIVORCED
MAIDEN NAME
HUSBAND'S NAME +
BIRTHPLACE # Borth Chelmsford
NAME OF FATHER Delvini Robert
BIRTHPLACE OF FATHER # Canada
MAIDEN NAME OF MOTHER Delia Vallé
BIRTHPLACE OF MOTHER # Canada
OCCUPATION
Ull Home
INFORMANT §
Selvini
Robert
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. .to July 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 of follows : Primary : Still barn
Contributory
. (DURATION). . .. DAYS
(Signed)
JE Vaney
.. M. D.
July 18- 1906 (Address) H. Chelasford
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 July 19 1906 Edward . Robbins Tom lerk.
PLACE OF BURIAL OR REMOVAL !! Itouch. 2
DATE OF BURIAL July 19 .... 190 ...
UNDERTAKER, Joseph albert
ADDRESS 5/ 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.
1| Name of cemetry.
>
53
/Registered No ..
Princeton St, North Chelunsford.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
.(DURATION) .. DAYS
ـكة
COMMONWEALTH OF MASSACHUSETTS
CITY /13 OF LOWELL
RETURN OF A DEATH
FULL NAME
Sarah M. Cornell
Registered No .....
54
Date of Death
Place of Death * north Chelmsford July 18, 06
Age ......
51
years 5
months
10
days
STATISTICAL DETAIL
SEX Female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t Sarah maria Gibson
HUSBAND'S NAME + Charles m. Cornell
BIRTHPLACE #
Itesford, Masa
NAME OF FATHER
Georgo Gibson
BIRTHPLACE OF FATHER ± Not known
MAIDEN NAME OF MOTHER
Joanna Cherry
BIRTHPLACE OF MOTHER #
Ticonderoga, N.Y.
OCCUPATION
QA Home.
INFORMANT § Charles Cornell
PLACE OF BURIAL OR REMOVAL JI
DATE OF BURIAL
North Chel July 201006.
ADDRESS
UNDERTAKER J. a. Weinbeek 80 Middlesex SA C
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 0 illness, from Any 3 1906 to July 18 1906 0 that to the best of my knowledge and belief death oceurred on the date stated above, and that the CAUSE OF DEATHI was of follows :
Primary :
Janquene
15
. (DURATION) ... . DAYS
Contributory .....
Organer deserved tad
(Signed)
7.6 Janey
July 18 196 (Addres) H. Checosfund
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 July 19 190 6 (Around ). Pofiner 5
0
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. Ju Name of cemetry.
FILL OUT WITH INK .- THIS IS A. PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
.. (DURATION). . .. DAYS
How long at
COMMONWEALTH OF MASSACHUSETTS
114
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Evelyn
Clinica
Registered No ..
50
Date of l
July 25
1906
Death
Residence
Age
Stillborn months.
.days
STATISTICAL DETAILS
SEX
COLOR
W
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
lehrlingfund, Mass .
NAME OF
FATHER
James letingan
BIRTHPLACE
OF FATHER#
Scotland
MAIDEN NAME
OF MOTHER
annie Locke
BIRTHPLACE
OF MOTHER #.
Baring low, n. H.
OCCUPATION
INFORMANT §
Mrs. Geo. Locke
PLACE OF BURIAL OR REMOVAL II
Hart Pond, Cemetery
DATE OF BURIAL
July 26
190 ..
6
UNDERTAKER
ADDRESS
Walter Pecham Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
iliness, from.
July 25 906 to.
90 ..
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 :
... (OURATION)
. OAYS
(Signed) ...
mara toward'
M.D.
.190.6 (Address).
Chulmetod.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months.
days
Where was disease contracted,
If not at place of death ?
Filed
July 26 1906 Edward - Robbing
2.
Cierk
* 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. Il Name of cemetery.
1
Death * S
Place of 1
letchisford, mass
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
-
115
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Elijah andrews
Registered No ....
06
Place of )
Checkuford Town Harm
Death *
S
Residence
Chelmsford
Age 76
.years.
.5/
.. months.
12 days
STATISTICAL DETAILS
SEX
Male
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE# Huden U.Ht.
NAME OF
FATHER
Sinvieno andrews
BIRTHPLACE
OF FATHER#
Unkann
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT § a. P. Brown
Filed
July 28
6. Eduard ). Robbins
Clerk
Form
PLACE OF BURIAL OR REMOVAL !!
hel
PineRidge Ceans
DATE OF BURIAL
July 28 1906.
UNDERTAKER
ADDRESS
Nale Pestana Chelisted
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 1905 to Ouly 27 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 : anaemia
. (DURATION).
DAYS
Contributory : Senile
(OURATION)
DAYS
(Signed) ...
Amaraltoward M.D.
July 25 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 ?
* 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.
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