USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 7
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...... (DURATION) . . DAYS
Signed) ..
Arthur D. Scobina
M. D.
278.17, 1906, (Addres
Chilenaford, mas.
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
Dec. 19 190 6 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.
I| Name of cemetry.
84
Registered No ..
Wheeler
maso
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
السعيدة
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Lawrence W. Greenwood
.Registered No ..
Date of Lec. 23
1906
Death *
Death
.years.
3
.months.
23
.days
STATISTICAL DETAILS
SEX
m
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED.
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE#
Concord, Mass .
NAME OF FATHER Thomas Green wood
BIRTHPLACE
OF FATHER#
Gilbertville, mass
MAIDEN NAME OF MOTHER
Josie Pillsbury
BIRTHPLACE OF MOTHER4 Joule, mark
OCCUPATION
INFORMANT §
Thee . Greenwood
PLACE OF BURIAL OR REMOVAL II Rua Tombe. Forefactors Cem.
DATE OF BURIAL
lec. 26 top 6
190.
UNDERTAKER
Walter Puchary
ADDRESS
Chelmsford
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 as follows : Primary :
3
.(DURATION) ..
23
... DAYS
Contributory :
..... (DURATION)
DAYS
(Signed)
Athin & Scobin, M.D.
Dir. 2-61900, (Addres).
Agt. Boschlin ford, Mas
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
Acc. 26
6. Eduard J. 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
144
Cebelinsfind -
(CITY OW TOWN.) 85
Place of l
Chelmsford
Residence
. Age
7
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
-
145
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITTORTOWN.)
FULL NAME
alexander John Park
.Registered No.
86
Date of
Dre 30
1906
Residence
So. Chelmsford
Age
40
... years ..
.. months ..
.. days
STATISTICAL DETAILS
SEX
male
COLORO
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE
Battie Coun.
NAME OF
FATHER
John M. Park
BIRTHPLACE
OF FATHER#
Windham WH
MAIDEN NAME
OF MOTHER
Rebecca+: ) itcomb
BIRTHPLACE
OF MOTHER#
WEbeter n.H.
OCCUPATION
Gardner
INFORMANT § Mrs. J.M. Park
PLACE OF BURIAL OR REMOVAL II Hart Pond Com, So Chelmsford
DATE OF BURIAL
fan 3
.. 190.
UNDERTAKER Walter Pechan
/ADDRESS
chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. REC. 21 1906 to Nic. 30, 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 :
Epidemie Influenza and
Pneumonia
.. (DURATION).
.DAYS
Contributory :
asecco
7 (DURATION)
9
DAYS
(Signed)
Arthur & Scolonia
M.D.
Jan.2. 1907 (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months.
days
Where was disease contracted,
if not at place of death ?
Filed
Jan. 3
1906 Edward I. Puffing
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.
Chelmsford
Place of 1
Death * S
South Chelmsford
Death
٦
146
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Jothan Goodell
Place of )
Death * S
City Works Lowell Mann Death
Residence
no Chelmsford
.....
Age
89
.years ..
.months.
....... days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
NAME OF
FATHER
abraham Goodell
BIRTHPLACE
OF FATHER#
Sturbridge mars
MAIDEN NAME
OF MOTHER
Believe Whiller
BIRTHPLACE
OF MOTHER#
Rehoboth mars
OCCUPATION Retired
INFORMANT §
mes Litchfield
PLACE OF BURIAL OR REMOVAL II
Edson Cem. Laval
DATE OF BURIAL
Jan 3
.... 190 ...
UNDERTAKER
ADDRESS
C. M. Young + 60 33 Prescott Of
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Oct. 6 1906 to Nic 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 :
General Debility of
old age
.. (DURATION) ..
.... DAY 8
Contributory :
A .... (DURATION)
.... DAY8
(Signed)
Forster N. Smich
M.D.
Jan / 1907 (Address).
Lowell mare
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
. years ..
months
1 0 days
Where was disease contracted,
If not at place of death ?
Filed (
Jan 4 190y
a
4.
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Registered No.
1918
Dec. 31 190 6
-
3
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Registered No ..
Place of 1
1. 1.
Corporation Works
Date of l
Leci 28
190 6
Residence
Chelmsford mars
Age
.years.
-
.months.
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # England
NAME OF
FATHER
michael Homes
BIRTHPLACE
OF FATHER+
England,
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
England
OCCUPATION mill operative
INFORMANT § Mas Simeon Naylor
PLACE OF BURIAL OR REMOVAL II
Edson Om, Lowell
DATE OF BURIAL
Des.30, 190 6
... 190 ..
ADDRESS
UNDERTAKER
O'Donnell + Sona Lowell May
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 as follows :
Primary :
birshares of Lower
.. (DURATION) ..
DAYS
....
Contributory :
.(DURATION).
.. DAYS
(Signed).
Dic 30 1906
(Address).
Lowell Though,
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
Die -3/ 1906
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 Institutlon, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow.
# State or country ; also clty, town or county, If known.
§ Name and address of person glving statistical detalls. il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
147
CITY OF LOWELL
1906
Death * S
Death
1
1
M.D.
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
(CITY OR TOWN.)
FULL NAME
Cunico Emiline Smith
.Registered No. /
Place of )
Chehonderd, Mass.
Date of ¿
Jan. 13
190%
5
.. months.
days
STATISTICAL DETAILS
SEX
COLOR
w.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
1
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE#
Stratham. n. 76.
NAME OF
FATHER
Daniel J. Smith
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER 22 ana E. Ellie
BIRTHPLACE OF MOTHER# manchester, UL.
OCCUPATION
INFORMANT §
Daniel S. Smith
PLACE OF BURIAL OR REMOVAL II blauw Cene. 2, n. 4
DATE OF BURIAL
Jan 15 1901
ADDRESS
UNDERTAKER
Waller Veckan Chelmsford.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from .. 1906 to Have. 12 190, that to the best of my knowledge and beef death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary :
Disease Indefinite (DURATION). DAYS
Contributory :
Parair Congestión
offins + Kadry.
(DURATION).
.DAYS
(Signed) Arthur M. Seabona
M.D.
Jan. 14.
4,1907 (Address)
Chilunsford, mass.
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
Jan 15
1906 Edward Golfing
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.
148
Chilmas
€
Death * S
Death
9
Residence
11
Age
8
.. years ..
COMMONWEALTH OF MASSACHUSETTS
plass, OF Chelmsford LOWELL
CITY CHY 149
RETURN OF A DEATH
FULL NAME
Coleen Want.
Registered No ... 2
Place of Death *
Church It ruth bulmsford heurs
Date of Death Jamy 17, 1907
.Age ...
years
months days
STATISTICAL DETAIL
SEX
COLOR White
SINGEE, MARRIED; WIDOWED, OP DIVADLED' Tharried
MAIDEN NAME +
Ellen Formally.
HUSBAND'S NAME +
Stephen March
BIRTHPLACE #
Ireland
NAME OF FATHER
Pelin Donnelly. Leur
-
BIRTHPLACE OF FATHER Į Sulard
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER
OCCUPATION
at Home
INFORMANT § Steffen Ward Husband
DATE OF BURIAL
V
..
ADDRESS Fortell class.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last From Jamy 7 10 7 ofmay 17 1907. that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows : 4
Primary :
.(DURATION). Organic disease f Kuchay 2 years
.. (DURATION). ... DAYS
(Signed)
.M. D.
they 18 1907 (Address).
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 Jan. 19, 1907 Quard S. Robbing 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.
f 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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
PLACE OF BURIAL OR REMOVAL 112
UNDERTAKER fr. Thomastions
10
DAYS
Contributory
..
COMMONWEALTH OF MASSACHUSETTS
CITY 150 OF LOWELL
RETURN OF A DEATH
FULL NAME
Place of Death *
norte chelankford
Date of Death.
lan 20 1906
Age
40
years
2 months 20 days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
manuel
MAIDEN NAME + mary & Sitchfield
HUSBAND'S NAME + Edward At Ruje
BIRTHPLACE ± Carlisle
NAME OF FATHER
7
BIRTHPLACE OF FATHER İ Carlisle
MAIDEN NAME OF MOTHER Sarah & Carter.
BIRTHPLACE OF MOTHER # Barrul 7/-
OCCUPATION at home
INFORMANT § EN. Keye2
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
1
UNDERTAKER
ADDRESS
Horace Cela 12 Hund 84
Lowell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness
You May 19 1907 0 day 20
..
1907.
that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
diabetic Coma
12 hours
... (DURATION) .. . DAYS Deemailis 223 gives
Contributory
FE Varney
.. (DURATION). .. DAYS
(Signed)
M. D.
Jauz 21 1907 (Address) Chaleur den
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
Jan. 23 190
7 Edward J. Robbin
..
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.
ALL NAMES TO BE IN FULL.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD --
Inary
Registered No. 3
r
COMMONWEALTH OF MASSACHUSETTS
CITY 15/
bulmaAnd Mass OF LOWELL
RETURN OF A DEATH
FULL NAME
Place of Death * 1 Inth Chilis ford
Date of Death January 23/199 Age 45
-
years
months
days
STATISTICAL DETAIL
SEX mal
COLOR
SINGLE, MARRIED WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # "Forth Chilies ford
NAME OF FATHER
BIRTHPLACE OF FATHER #
MAIDEN NAME OF MOTHER Margaret m. Toy
BIRTHPLACE OF MOTHER #
Wieland
OCCUPATION alevi
INFORMANT § Mater Apethere . Cabe.
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL tan 205 ...... 190.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
.I HEREBY CERTIFY that I attended deceased during last -
illness, f 1) Jauz 19 190/10/Day 23 190.2., that to the best of my knowledge and belief death occurred on the
date stated above, and that the CAUSE OF DEATH was of follows :
Primary :
.
.. (DURATION). DAYS
Contributory
.(DURATION) .. . DAYS
(Signed)
JEJJamey
.M. D.
Fany 23 1907 (Address). H. Exelente
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 Jan. 24, 190%. Edward) YJobbing
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.
Tut. (4mill Io 324 mm( ex Name of cemetry.
C .
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
Chelunsford Mass
Registered No ... 4
How long at
COMMONWEALTH OF MASSACHUSETTS
CITY
LOWELL 5
FULL NAME
Place of Death *
Cast Shelowford
Date of Death Mano 26 1967
Age .. {
years ..
/
... months
14
- days
STATISTICAL DETAIL
SEX
Male
COLOR
If tete
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE 16 Skelmsford.
NAME OF FATHER Harry Cf. Buyton
BIRTHPLACE OF FATHER İ Fitchburg. Mass.
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT § Harry Q. Buyto Gather
PLACE OF BURIAL OR REMOVAL !! EdsonSem. 1 mb.
DATE OF BURIAL Jan 29 .... 190 ... ]
UNDERTAKER
AD ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. VreIZ- 1906 to Nr.30 . 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 : Premature butt- Primary ;
Granitión
.(DURATION). DAYS
Contributory
(Signed)
Arthur & Verbena
1
.... M. D.
1-28
..... .... 190. .. (Address) ..
Chilune ford, more
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 Jan. 29 1907 Edward 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.
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.
RETURN OF A DEATH
Registered No.
........ (DURATION).
.. DAYS
How long at
1 . 5
A
COMMONWEALTH OF MASSACHUSETTS
CITY / 53 OF LOWELL
RETURN OF A DEATH
Julia Growley
(
Registered No ..
Place of Death * ast chemsford
Date of Death fan 30, 1907
Age
70
years
months
days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Julia L. Reardon
HUSBAND'S NAME + Cromeline Growly
BIRTHPLACE #
Ireland
NAME OF FATHER Unknown
BIRTHPLACE OF FATHER Ireland
MAIDEN NAME OF MOTHER Unknown
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION at Home
INFORMANT Daniel Reardon Ecast Chelmsford
PLACE OF BURIAL OR REMOVAL II St Patrick
DATE OF BURIAL Feb 2, 1907.
ADDRESS
5/ homan J, Mc Dermit 70 lahan"
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
Jau. 30
190. .. to
Jau 20
. . . . .
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 :
Pneumonia
.(DURATION) .... 3
DAYS
Contributory
Senility
(DURATION). DAYS
(Signed)
Grange J. G.Donnelly
...... M. D.
Pau 3, 02
.. .... 1907 (Address) to. Billarie à Mars
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 Jan 31 130 Edward J. Rafting
Clerk. Town
*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.
FULL NAME
6
COMMONWEALTH OF MASSACHUSETTS
CITY /54 OF LOWELL
Registered No ..
Place of Death * Chelmsford Centre mass
Date of Death
lan
31.1907
Age 83
years
/
months
9
days
STATISTICAL DETAIL
SEX
COLOR
Female white
- SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widow
MAIDEN NAME +
Rhoda J. Hilton
HUSBAND'S NAME + Williamft Hoyt
BIRTHPLACE # Parsonsfield mane
NAME OF FATHER
George It. Hilton
BIRTHPLACE Parsonsfile maine
MAIDEN NAME OF MOTHER abigail Ricker
BIRTHPLACE OF MOTHERIt Parsonsfield maine
OCCUPATION at home
INFORMANT §
Lon
PLACE OF BURIAL OR REMOVAL II
Chelmsford Centre Feb 3 00 7
UNDERTAKER Com. young Hos
ADDRESS 33 /rescott
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 DEATHI was of follows :
Primary :
. (DURATION). DAYS
Contributory
.(DURATION) .. DAYS
(Signed)
20bf 1907 (Address) 218 Cambra( St.
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 tel. 2
190
0 7. Eduard. Robbin
Som 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
RETURN OF A DEATH
FULL NAME Rhoda Hout
DATE OF BURIAL
How long at
JEDENI DE V REVIK
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY /55 OF LOWELL
8
Place of Death *
Wright St.& North Chelmsford, maso
Date of Death February 3, 1907
Age.
23 years.
2 months
28 days
STATISTICAL DETAIL
SEX
Make
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Nottingham, England
NAME OF FATHER Unknown
BIRTHPLACE OF FATHER İ Unknown.
MAIDEN NAME OF MOTHER Unknown
BIRTHPLACE OF MOTHER #
Unknown
OCCUPATION
0 Unventar
INFORMANT § Tra jan Buadleri
PLACE OF BURIAL OR REMOVAL II Edson Competenties
DATE OF BURIAL
feb 6,. .... 190.7.
UNDERTAKER
ADDRESS
q. a. Weinbeck so Middy St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, froyr ....
company 3
to Hay 3
Lany 30 1907 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 : Influcuja.
·(DURATION) 5 . DAYS
Contributory
.(DURATION) .. DAYS
(Signed)
JE Vany
.M. D.
fly 4 190) (Address).
I Chelwater
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 Febr 6
190/
7 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.
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.
E
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
John B
radley
(Registered No ..
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
156
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Jahn a Knowles
Registered No.
9
Place of Death *
west- Chelansford
Date of Death ...
Feel in the
1907
Age
84
.years.
9
months
days
STATISTICAL DETAILS
SEX
m
COLOR
W
SINGLE, MARRIED,
WIDOWED,
OR
DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # Orford n. H.
NAME OF
FATHER
Samuel Knowles
BIRTHPLACE
OF FATHER#
unknown
MAIDEN NAME
OF MOTHER
Betsy Call
BIRTHPLACE
OF MOTHER #
unknown
OCCUPATION
retired
INFORMANT §
Daughter
Filed
190
07 Edward J. Rafting
Clerk
PLACE OF BURIAL OR REMOVAL II
West Chelmsford
DATE OF BURIAL
Feb 11th
7
UNDERTAKER
JBburrier & Go
ADDRESS
58 Prescott St
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
iliness, from ..
Feb 4
1907 to Feb 7
.. 190 .. 7 .. ,
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 :
Influenza
.(DURATION) ..... Z.
DAYS
Contributory :
Heart failure
.(OURATION).
DAYS
(Signed).
le Ce Harbour
M.D.
Feb 10 1907 (Address) Tyngaber,
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 ?
* 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
Leddie E. Emerson
Place of Death *
Chelmsford Centre
Date of Death
Feb 11/24 1907
Age.
64
years
months.
days
STATISTICAL DETAIL
SEX
COLOR
-
OINCLE, MARRIED, WIDOWED, OR DIVOROLD
MAIDEN NAME + Mittedge
HUSBAND'S NAME Ť Samle P. Emerson
BIRTHPLACE Lowell
NAME OF FATHER George Keithedge
BIRTHPLACE OF FATHER Į Vermont.
MAIDEN NAME OF MOTHER
Eliza Heald
BIRTHPLACE OF MOTHER Carlale
OCCUPATION his Home
INFORMANT § Husband
PLACE OF BURIAL Of REMOVAL Cerchinoford teentre
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