USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 5
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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 detalls. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Date of ¿
July 27
1906
Death
S
COMMONWEALTH OF MASSACHUSETTS
CITY /1 6 OF LOWELL
FULL NAME
Place of Death *
Date of Death
July 30
Age
years ..
6
months
30
days
STATISTICAL DETAIL
SEX
While
SINGLE, MARRIED, WIDOWES OR DIVORCED'
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Lowell Mass
NAME OF FATHER
Albert Robert
BIRTHPLACE OF FATHER ± Canada
MAIDEN NAME OF MOTHER
Florida Doiron
BIRTHPLACE OF MOTHER # Canada
OCCUPATION
INFORMANT § Albert Nobert
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from ...
to Anly 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 of follows :
Primary :
Mal nutrition
2or3 mauch
DAYS
Contributory
.(DURATION). ... DAYS
(Signed)
JE Varney
.. M. D.
Anly 30 190G (Address) Heraf Chilis fort
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 1906. Comand Rithing
Town Clerk.
PLACE OF BURIAL OR REMOVAL, II IN Joseph &
DATE OF BURIAL
.. . 190. ..
ADDRESS
UNDERTAKER Joseph Albert 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.
+ 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.
RETURN OF A DEATH
Registered No ..
57
Youth Chelmsford Mass
-
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
amuel Q. S.anderson
Place of Death *
lehelms Ind. leentre . Mars.
Date of Death ..
Age
63
years
-
months
-
days
STATISTICAL DETAIL
SEX
Zu.
COLOR
W.
SINGLE, MARRIED, WIDOWED, OR DIVOROED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Milford n.H.
NAME OF FATHER Oliver Sanderson
BIRTHPLACE OF FATHER # Harvard, Mass
MAIDEN NAME OF MOTHER Lucinda Miller
BIRTHPLACE OF MOTHER # Peterborough N.H.
OCCUPATION Carpenter.
INFORMANT § trife
PLACE OF BURIAL OR REMOVAL II Edson Cemetery.
DATE OF BURIAL
aug. 89
. . . . 190 cp
UNDERTAKER
IBleurrer
ADDRESS 58 Pres ott Sx.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased durlug last
illness, from. Try, 3, 196 to aug. 6, ...
. 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 :
Cholua Morbus-
. (DURATION). DAYS
Contributory
(Signed)
Antun y Len COURT
... DAYS
..... I. D.
Cup,lo, 190 6 (Adress) Chelmsford, Man,
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or
Usual Residence ..
Place of Death ?.
Days
How long at
Where was disease contracted, if not at place of death ?
Filed
ang. 7
196 Eduard J. Robbing
Joun
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.
11 Name of cemetry.
CITY OF LOWELL
Registered No ..
5-8
FILL OUT WITH INK. THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
59
Registered No ..
1
years
months
days
STATISTICAL DETAIL
SEX Inale
CALOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Chelmsford har
NAME OF FATHER
andro Sqwhy
BIRTHPLACE OF FATHER Į OAustria
-
MAIDEN NAME OF MOTHER
Sothys Kady
BIRTHPLACE OF MOTHER #
Austria
OCCUPATION
INFORMANT § Father
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
Aug 11 .. 1906. illness, from. 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 : Primary asphy xia
heard-lead- fax hay hour. (DURATION) DAYS
Contributory
.. (DURATION). .. DAYS
(Signed)
JE Vaney
..... M.D.
.1906 (Address) ..
2. Chelone part.
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
aug 10 It 6 Edward . 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.
Il Name of cemetry.
PLACE OF BURIAL OR REMOVAL II Sr Joseph
DATE OF BURIAL
Ling 12 1906.
UNDERTAKER le Belo decual
ADDRESS
Lm.
RETURN OF A DEATH 3. CSAndro, Sowhy Chelmsford o
FULL NAME
Place of Death *
Date of Death.
Ang
.Age.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
How long at
119
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Spaulding, Solomon
Registered No.
60
Death * S.
Place of theloca Soldiers' to
Date of }
..
Death
July 21- 1906
Residence
Chelmsford mass
. Age.
82
.. years.
... months ..
1 day#
STATISTICAL DETAILS
SEX
m
COLOR
w
WIDOWED, of
DIVORCED'
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Westford mass
NAME OF
FATHER
George Spaulding
BIRTHPLACE
OF FATHER#
Watford, masal
MAIDEN NAME
OF MOTHER
Rhoda Frederick
BIRTHPLACE
OF MOTHER #
Tyngsboro masal
OCCUPATION
Blacksmith
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Lowell mass
-
190
UNDERTAKER
ADDRESS
J. a. Weinbach Lowell
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from. Jan 5- 1905 to July 21-1906. 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 :
apoplexy
. (DURATION) 10
.. DAY8
Contributory :
Iheart Disease
years
(DURATION)
DAYS
(Signed)
M.D.
July 21 -1906 (Address)
Chelsea
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
-
. year}
6
months.
16
days
Where was disease contracted,
If not at place of death ?
Filed July 23-1906 Charmant Heard 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. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
theloca
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Terzie In Hadley
A
.Registered No ..
61
Place of )
Chelmsford, mare
Death * S
Residence
Chelmsford, Mass, Age 70
.years ...
.. months. .days
STATISTICAL DETAILS
SEX 7.
COLOR
SINGLE MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t
Persis Ferguson
HUSBAND'S NAME +
BB. F: Hadley
BIRTHPLACE#
Franklin Ut,
NAME OF
FATHER
Edward Ferguson
BIRTHPLACE
OF FATHER#
Unknown
MAIDEN NAME
OF MOTHER
Keziah Ivillie
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
Housekeeper
INFORMANT
Mis. L. 7: Holman
PLACE OF BURIAL OR REMOVAL !!
Edson Gern. Lowell, Man Clug 17.
DATE OF BURIAL
190 €
UNDERTAKER
Walter Perham
ADDRESS
Chehofert.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from July 19 1906 to Cuy 14 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 :
Cardiac Paralyser
-
.. (DURATION)/ ... DAYS
Contributory:
Phthisis
(DURATION) / year.
(Signed).
Chinasa toward M.D.
ang. 16 190 (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
ana 17
1906 Edward J. Robimy
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 detalls. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
120
Date of
aug. 14
1906
Death
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FULL NAME Cœurchie
Couillard
Registered No ..
62
Place of Death *
North Chelmsford Mass
Date of Death. q. lith -016
Age 00-
years.
months days
0
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVOROED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER 4 Mercure Couillard .
BIRTHPLACE OF FATHER #
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT §
PLACE, OF BURIAL OR REMOVAL II
DATE OF BURIAL 11.0/20 100. 6.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
ness, from June 3 190 6 to Aug 2the 1 90 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 : Mitral Insufficiques
DAYS
Contributory
WUR ATIONT ... .. DAYS
(Signed) ..
1 .M. D. Que/7 1906 (Address) 710 Merrimack
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 ana. 20
a. Edward . Robbing Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
| Name of cemetry.
121
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
..
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Sarah Ella Blanchard
(CITY OR TOWN.)
FULL NAME,
Place of )
Chelmsford, Masé
Date of l
aug. 23
Death
.years.
· Age 58
90
26
... months ..
.days
STATISTICAL DETAILS
SEX
7!
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
Sarah Whitemore
HUSBAND'S NAME t
Eldridge a. Blanchon date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Isolation 1
BIRTHPLACE ± Rowell Mass.
NAME OR FATHER ) sac Whitemore
BIRTHPLACE OF FATHER# Tewksbury. Mas.
MAIDEN NAME
OF MOTHER
Emknown
BIRTHPLACE
OF MOTHER #
Unknown
OCCUPATION
INFORMANT §
Leonard Blanchard (now)
Filed
aug. 24 1906 Edward, Rafting
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Green Cem, Carlisle aug 24,0 6
ADDRESS
UNDERTAKER
Walter Perhan Chulmegint.
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. Cup. 20, 1906 to Quy, 23, 1906 that to the best of my knowledge and belief death occurred on the
. (DURATION).
DAYS
Contributory :
(DURATION).
.. DAYS
A
(Signed)
Arthur , Scobana, M.D.
Muy 23 906 (Address).
Chelmsford Mar
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents. How long at Place of Death 7 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, 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
122
istered No ...
63
Death * S
1906,
Residence
"
COMMONWEALTH OF MASSACHUSETTS
123
RETURN OF A DEATH
FULL NAME
Mary Mariah Blaisdell
(CITY OR TOWN.)
Registered No.
64
Place of }
Etishusford Mare.
Death * S
Residence
Chelmsford,
Age
66
.. years.
2
.months.
2
.. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED OR DIVORCED
MAIDEN NAME Ť Mary M. Meade.
HUSBAND'S NAME t
andrew M. Blaisdell
BIRTHPLACE #
Weston, Vermont
NAME OF FATHER Leonard Meade
BIRTHPLACE
OF FATHER#
Vermont.
MAIDEN NAME
OF MOTHER
Olive Baldwin
BIRTHPLACE
OF MOTHER #
Vermont
OCCUPATION
INFORMANT §
Trong Blais dell, (Low)
PLACE OF BURIAL OR, REMOVAL II
Hart- Poudre
South Chelmsford.
DATE OF BURIAL
aug. 29 1906
ADDRESS
UNDERTAKER
Walter Derhan Chelmsford.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. april 29 1906 to Ong/ 26 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 :
Hemiplegia
4 minthe
(DURATION) ..
.DAYS
Contributory :
(Signed)
JE Vannel
.. (DURATION) ..
. DAY8
M.D.
aring 27 1906 (Address).
n. Chelius ford.
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 aug. 28, 1906. 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 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
Death
Date of aug. 26
1906
COMMONWEALTH OF MASSACHUSETTS
TY 124 OF LOWELL 65
RETURN OF A DEATH
FULL NAME
Place of Death * ...
Date of Death Lept 5 th
-0%
Age
. . years
months
days
1 hr
STATISTICAL DETAIL
SEX male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # north Chelmsford
NAME OF FATHER Pierre Coté
BIRTHPLACE
OF FATHER Į
Canada
MAIDEN NAME OF MOTHER Delia Ferville
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
INFORMANT §
Pierre Coté
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last
illness, from ..
190.
Sept 5et
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 :
premature birth
one hour
(DURATION).
DAYS
Contributory
.(DURATION). DAVS
(Signed}
Syft-5 1906 (Address).
...
M. Chillaufend.
M. D.
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
Sept. 5 1946
Edward Kotlin
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
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
PLACE OF BURIAL OR REMOVAL !!
Ir Joseph's
DATE OF BURIAL
6
.... 190. .
UNDERTAKER josephalbert
ADDRESS
57 Cheever
Coté north Chelmsford.
Joseph
Registered No ..
.. . .
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of )
Death * S
City Hospital
Date of l
0
.190
Death
28
.. months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
m.
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE# England
NAME OF
FATHER
Hillian Gillan
BIRTHPLACE
OF FATHER#
England
MAIDEN NAME
OF MOTHER
mary Curtis
BIRTHPLACE
OF MOTHER #
England
OCCUPATION
INFORMANT S Harry Gillar
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
L.b. C.
· 190 5
UNDERTAKER
ADDRESS
I'm forma + Co 33 Prescott LA
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. May 24 1905 to rip 6 190 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 : Heart cliccare
(DURATION).
... DAYS
Contributory :
6
(Signed)
J'outer H. Smith
M.D.
7 190 (Address).
Lowell Mais
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
/
How long at
Place of Death ?
... years.
4
months.
days
Where was disease contracted, If not at place of death ?.
Filed Auf. 101906
City
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
125
Charles Gillar
Registered No
1386
Residence
Chehannoford mars
. Age.
46
.. years ..
.(DURATION)
......... DAYS
COMMONWEALTH OF MASSACHUSETTS
126
CITY OF LOWELL
Registered No.
67
months dave
STATISTICAL, DETAIL
SEX. Inal that.
SINGLE, MARRIED, WIDOWED, on DIVORCED.
MAIDEN NAME t
HUSBAND'S NAME 1
BIRTHPLACE 1 Userland .
NAME OF FATHER matthewm. Fully theland BIRTHPLACE OF FATHER !
MAIDEN NAME OF MOTHER
not finan-Golf
BIRTHPLACE OF MOTHER $ Queland
OCCUPATION Warming
INFORMANT $ Im Michael
PLACE OF BURIAL OR REMOVAL $ Soccer DATE OF BURIAL
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended dermed during
Illness, from alegro 6.0 Acl.8 6
that to the best of my knowledge and beffet death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
Cerebral Hacmortage
( UL KATION). .
Contributory ....
- Welche
(+UNATION) . DAY
(signed)
^^1.1.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients. or Recent Residents
Former or Usual Keside nue
How long it Place of Death '
Where was discase Contracted, if not at place of death .
Sept. 10 Edward Rolfing
"City or Town, street and number, if any It death occurs away from USUAL. RESIDENCE, give facts called for under " Special Information ' it in a Hospital or Institution, give its NASIF. instead of street and number.
f In case of warned r divorced woman, r widow
Į State ur Country ; a so city, wwn or county, if kn wu
§ Name and address of person giving statistical detalla Name of cemetry.
MARGIN RESERVED FOR BINDING ALL NAMES TO BEIN FULL.
FILL OUT WITH INK. - THIS IS. A PERMANENT RECORD
RETURN OF A DEATH
FULL NAME - Auchall M. Cast Chellis ford Place of Death . September 8 1 gul AB Date of Death
hults
years
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.
October 25, 1906 Age 47
years
months
days
STATISTICAL DETAIL
SEX Mal Sthat
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME 1
HUSBAND'S NAME 1
BIRTHPLACE #
NAME OF FATHER
Laws MS Laury
BIRTHPLACE OF FATHER $
Inland
MAIDEN NAME OF MOTHER Pos Gallagher
BIRTHPLACE OF MOTHER #
Ouland
OCCUPATION Cron Boulder
INFORMANT § Varahtm Saver
PLACE OF BURIAL OR REMOVAL !!
DA Patinas center
DATE OF BURIAL Jours Oct 27 ,0 6
ADDRESS
UNDERTAKER A.J. Amwell Jones 3 2 4 mayget It
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
190 .... to
Oct- 25 ,00 €
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 :
Unaencie Convulcan
Two hours
(DURATION) .. DAYS
Contributory
... (DURATION). . DAYS
(Signed)
JE Jamey
.. M. D.
Oct-26 1906 (Address).
H. Chihunter tres
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. 27
.. 190
0 6 Eduard ). Rotting
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. I Name of cemetry.
RAAM
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH UC Javery
68
Registered No.
helena ford
CITY 127 OF LOWELL
5
1
ПОВЕСТ
N
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mary Jane Wing
Registered No.
69
Place of )
Cohelmedard Centre
Date of ¿
Cet. 27
1906
Death * S
Residence
Chelmsford
Age
81
... years ..
3
months.
13
.days
STATISTICAL DETAILS
SEX
Hernale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Salem
NAME OF
FATHER
John Niven
BIRTHPLACE OF FATHER# Salen
MAIDEN NAME OF MOTHER Sally Flint
BIRTHPLACE
OF MOTHER #
Salem
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II Harmony Grove Com. Salem
DATE OF BURIAL
Oct29
1906
UNDERTAKER Walter Pashan
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Oct. 23 1906 to Oct. 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 :
Paralysis
.. (DURATION).
5º
DAYS
Contributory :
Senile
f. (DURATION).
.. DAYS
(Signed)
Amare Howard
M.D.
Cet 25 190 (Address
Chelmsford Mass
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 October 28 1906 Cdwant Y. Jobbing
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclai 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 ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
128
Death
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
1
RETURN OF A DEATH
Michael Driscoll
FULL NAME
Place of Death *
Chemsford Centre
Date of Death
Oct 29
1906
Age. 76 years.
months
days
STATISTICAL DETAIL
SEX male
COLOR
SINGLE, MARRIED, -WIDOWED OR -DIVORCED
MAIDEN NAME 1
HUSBAND'S NAME Ť
BIRTHPLACE #
Ireland
NAME OF FATHER
William Driscoll
BIRTHPLACE OF FATHER Į
Ireland
MAIDEN NAME OF MOTHER Unknown
BIRTHPLACE OF MOTHER #
Ireland
OCCUPATION
at Home
INFORMANT § Mary Driscoll
PLACE OF BURIAL OR REMOVAL II
Haluck
DATE OF BURIAL 0316
IT hos. g. H. Dermitt
ADDRESS 70 gaham
PHYSICIAN'S CERTIFICATE
I HEREBY
CERTIFY that I attended deceased during last
illness, from .. aug. . 1906 to Get. 29 .. 190.la. 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 : . ascites
Contributory
Senile
.. (DURATION) .. .. DAYS
(Signed)
Amara Howard
Oct 2.9. 1906 (Address).
Che
nelmatinal
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. 30 Do + Eduard). Detdans
1
Jony 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 couuty, if knowu.
§ Name and address of person giving statistical details.
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