USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 8
Note: The text from this book was generated using artificial intelligence so there may be some errors. The full pages can be found on Archive.org (link on the Part 1 page).
Part 1 | Part 2 | Part 3 | Part 4 | Part 5 | Part 6 | Part 7 | Part 8 | Part 9 | Part 10 | Part 11 | Part 12
DATE OF BURIAL Feb 13th .... 190. 7
UNDERTAKER ADDRESS Bleurien + les .- 54 Prescott St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
Tab. 10, 1907 to Tek, 10, 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 :
Cerebral harmonhogy-
14 hours
7 ..... (DURATION). DAYS
Contributory
(Signed)
Anlar & Scobina, M. D.
Tab 11, 1907 (Address).
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
Feb. 11 1907 Edward . Nothing
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.
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.
157
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
Registered No .. 10
DURATION) ...
... DAYS
How long at
....
به
FOMENT
COMMONWEALTH OF MASSACHUSETTS
158
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
seph arthur Bourget
.Registered No ..
11
Place of 1
Death * S
North Chelmsford Mass
Date of &
Feb. 11th
Death
Residence
North Chelmsford
.Age
......
.years.
-
.months.
.....
... days
STATISTICAL DETAILS
SEX
Male White
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # North Chelmsford
NAME OF FATHER Telephone Bourget Contributory:
BIRTHPLACE OF FATHER# Canada
MAIDEN NAME OF MOTHER Celina Martel
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
INFORMANT § Bourget -
PLACE OF BURIAL OR REMOVAL I St Joseph Com
DATE OF BURIAL Feb 15 1907
UNDERTAKER Joseph albert
ADDRESS 57 Cheever heave Name of cemetery,
1.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. no allowed me 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 : unknown
. (DURATION) .. DAYS
(OURATION) .. . OAYS
(Signed)
JE Vaney
agent Bland ASLeace M.D.
July 12 1907 (Address) Mintchelentes
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
Feb. 15
0. 7 Edward Robbins
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or Institution, give its NAME instead of street and number,
t In case of married or divorced woman, or widow.
1 State or country ; also city, town or county, if known.
§ Name and address of person giving statistical detalis,
1907
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
مشابه
-
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY /59 OF LOWELL 12
FULL NAME Emily M. Tauber
.. Registered No.
Place of Death *
Mit Chelmsford, Trass
Date of Death.
February 3, 1907
Age ...
3.5 years
months
10 days
STATISTICAL DETAIL
SEX Female
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE
No. Chelmsford, Maso.
NAME OF FATHER John inbey
BIRTHPLACE OF FATHER + England
MAIDEN NAME OF MOTHER Emilie Spour
BIRTHPLACE OF MOTHER # England
OCCUPATION
at home
INFORMANT §
Emanuel Tribes
PLACE OF BURIAL OR REMOVAL !!
no. Chelmsford, Mas Feb. 17
.... 190,2
ADDRESS
UNDERTAKER C. a. Neinbeck so Tiddr. St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
Feb 3
.. 1907 to Feb 19 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 :
Influenza
DURATION) 60
.. DAYS
Contributory
arthritis Deformens
(Signed)
le au Harlow
.. M. D.
Feb 14 1907 (Address) Tyngsboro
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 .10 Edward ) Ketting
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.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
DATE OF BURIAL
DURATION). ... DAYS
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
COMMONWEALTH OF MASSACHUSETTS
CITY / 60 -OF LOWELL Forth theliusford ruas
RETURN OF, A DEATH
FULL NAME
J atués et. Mi Gnano
Place of Death *
youth Thelunsford Mais.
Date of Death.
J'aiby 14, 1907
Age
64 years
months
days
STATISTICAL, DETAIL
SEX
blake
COLOR
Inhete
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME ៛
HUSBAND'S NAME +
BIRTHPLACE freland
NAME OF FATHER Otthon Mcenany
:
BIRTHPLACE OF FATHER Į
1
MAIDEN NAME OF MOTHER Have i Granny
BIRTHPLACE
OF MOTHER #
OCCUPATION Iron Moreden
INFORMANT § Rate WE Enany
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL St. Falk's homel star, why /6 100
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ....
... 409 .... to.
taby 14 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 :
Organic disease of heart
(DURATION). DAYS
Contributory few minutes
.(DURATION). .. DAYS
(Signed)
JE Varney
tiky ( 190 (Address).
91. Chefer
.M. D.
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 Feb 15 1907 Edward & Robbing Orion 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.
Registered No .. 13
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
How long at
TOMGET
COMMONWEALTH OF MASSACHUSETTS
161
Chelineford
(GITY OR TOWN.)
FULL NAME
Horace Butters
Registered No. 14
Place of Chelmsford Vown Darm
Death *
Residence
Dracut
Age ..
605
years.
.. months ..
.. days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE# Dracut
NAME OF
FATHER
Senas Butters
BIRTHPLACE
OF FATHER#
audover
MAIDEN NAME
OF MOTHER
Martha Spiller
BIRTHPLACE
OF MOTHER #
Ipswich
OCCUPATION
farmer
INFORMANT § Hvid Butters
PLACE OF BURIAL OR REMOVALI
DATE OF BURIAL
Forfatter Que. Chilenep Hel 19 - 1907
UNDERTAKER
Walter Pestana
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
| HEREBY, CERTIFY that I attended deceased during last illness, from. No attendance ... 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 :
Hemiplegia
(DURATION). .DAYS
Contributory :
(DURATION).
.. DAY8
(Signed)
Arthur & Scobonn,.
M.D.
Feb. 18, 1907,(Address).
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at
Piace of Death ?
. years ..
5
months ..
- days
Where was disease contracted,
if not at place of death ?.
Filed
DEb. 19
1907 Edward Rolling
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 detalls. || Name of cemetery.
.1907
Date of )
HEG 17
Death
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
-
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
library 18, 1907 Age 27
years.
months
days
STATISTICAL DETAIL
SEX
COLOR
male that
SINGLE, MARRIED, WIDOWED OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ± Prince Edward Island
NAME OF FATHER
BIRTHPLACE OF FATHER Į
MAIDEN NAME OF MOTHER mary mcphe
BIRTHPLACE OF MOTHER # una Edward bland
OCCUPATION Farm Hand
INFORMANT §
Vister
Mr. Vrang Stiller
PLACE OF BURIAL OR REMOVAL #T
DATE OF BURIAL
. . . . 190 .. 61
UNDERTAKER,
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. Ihm / 100 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 :
.. (DURATION) .. DAYS
Contributory
.. (DURATION). ... DAYS
(Signed)
M. D.
.190 .... (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
Febr 19, 1907 Edward f. 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.
" Name of cemetry.
162
COMMONWEALTH OF MASSACHUSETTS
CITY ~OF LOWELL
RETURN OF A/DEATH houpon
Registered No ......
15
٦
٨٠٠ BRANDY OF VERVAT
L
COMMONWEALTH OF MASSACHUSETTS
CITY/ 63 OF LOWELL
16
Registered No ...
Place of Death * Chelmsford maso
Date of Death Feb 19, 1967
Age 38
years ..
months
days
STATISTICAL DETAIL
SEX Male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Boston mass
NAME OF FATHER
Richard Watts
BIRTHPLACE OF FATHER Į England
MAIDEN NAME OF MOTHER Catherine Nella
BIRTHPLACE OF MOTHER # England
OCCUPATION Collector
INFORMANT S Widow
PLACE OF BURIAL OR REMOVAL || DATE OF BURIAL Edson Cemetery Hele 21 7
UNDERTAKER
lem spring too 33 rescin Nam fortemetry.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
Tab 14, 2007 to find 19, 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 : ...
·
(DURATION) 5
. DAYS
Contributory
.... (DURATION) . . DAYS
(Signed)
M. D.
Ful. 20, 1907 (Address)
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 ?.
File Feb. 21 1907 Edward Robbing
Tom Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
& Name and address of person giving statistical details.
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
Watto
ADDRESS
How long at
1
Please Return
POMEre
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Mary Ann Smith
Registered No ...
17
Place of Death *
South Chelmsford
Date of Death.
Feb 19 jao~
Age
8.8
.years ..
1
.months
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED WIDOWED, OR DIVORCED
MAIDEN NAME + mary Ann griffin
HUSBAND'S NAME Ť
Jacob B. Smith
BIRTHPLACE #
Westford, mars.
NAME OF
FATHER
matthew Griffin
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER #
2221/22202022
OCCUPATION
At home.
INFORMANT §
Geo. f. Smith
PLACE OF BURIAL OR REMOVAL II
westford mass.
DATE OF BURIAL
Feb, 2%.
My
190.
--
4
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from.,
Jan 28th 1907 to Feb19 1907, 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 : asthenia
. (DURATION)
. DAYS
Contributory :
(Signed)
W.J. Sleeper por Dr. Well
M. D.
teb19
1907 (Address).
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
Fit. 20
1907 Canard V. Porfin
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.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
1
1
164
.(DURATION).
DAYS
一
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
STATISTICAL DETAIL
SEX
A
male
COLOR
white
SINGLE, MARRIED, WIDOWED, ORL DIVORCED
Married
MAIDEN NAME t
HUSBAND'S NAME +
BIRTHPLACE #
England
NAME OF FATHER Henry Hall
BIRTHPLACE OF FATHER İ England
MAIDEN NAME OF MOTHER Sarah E. Sugden
BIRTHPLACE OF MOTHER #
England
OCCUPATION
Retired
INFORMANT § Widow
PLACE OF BURIAL OR REMOVAL 11 DATE OF BURIAL Riverside Cemetery Feb 23 90 7
UNDERTAKER ADDRESS I'M. Enning flo 33 Trescott
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. 190 .... to. by 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
a few nemale,
.(DURATION). DAYS
Contributory
(Signed) .
Ye Jamey
M. D.
July 20
...
.... 190 .... (Address).
n. Che
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
Deb. 21
Do Edward J. Robbing
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.
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.
Al Name of cemetry.
TV
COMMONWEALTH OF MASSACHUSETTS
CITY /65 OF LOWELL
RETURN OF A DEATH
FULL NAME
Place of Death *
north Chelmsford
mass
years
11
months
/3
.days
Date of Death
20.1907 Age 70
Hall
18
Registered No ..
.. (DURATION). .. DAYS
How long at
COMEI
COMMONWEALTH OF MASSACHUSETTS
166
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
arnold Dustin White
Registered No.
19
Date of l
Death * S
Residence
Mort! Encimento
meford Mar Age
.. years.
.months.
6 days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVOROED
MAIDEN NAME 1
HUSBAND'S NAME 1
BIRTHPLACE# North Chelmsford Pran.
NAME OF
FATHER
George F. White
BIRTHPLACE
OF FATHER#
Hudson nr. 2
MAIDEN NAME
OF MOTHER
Lena C. Quativi
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT § George J. White
PLACE OF BURIAL OR REMOVAL Il nashua n. 2.
DATE OF BURIAL
mar. 13, 1907
ADDRESS
UNDERTAKER 4. a. Weinbed so Much St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. July 201 1907 to Mek 12 1907 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 : Premature birth
(DURATION) 16
DAY8
Contributory :
.. (DURATION). . DAYS
(Signed).
FE Janney
.M.D.
mah 13
.. 190.7 .... (Address).
n. Cheleifert
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
.years
months days
Where was disease contracted,
if not at place of death ?.
Filed
Mar. 13,
.....
.1907 Edward. alting
Clerk
* City or town, street and number, if any, If death occurs away from USUAL RESI- DENCE, glve 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
Place of 1
North Chelmsford, , cass
Death
Tranch 12 190°
1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
COLOR
SHOLE MARRIED,
WIDOWED OR
DIVORAED
MAIDEN NAME +
ann Dolan
HUSBAND'S NAME Patrick Mabluster
BIRTHPLACE#
Pelque
NAME OF
FATHER
Frank Orlan
BIRTHPLACE
OF FATHER
Pieland
MAIDEN NAME
OF MOTHER
Ann Maxwell
BIRTHPLACE
OF MOTHER #
TEiland
OCCUPATION
at- Home
INFORMANT §
Som
Frank conla Cluster
PLACE OF BURIAL OR REMOVAL !! St Patricks Century
DATE OFBURIAL
190.
UNDERTAKER
ADDRESS
Lunch Mass
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Jeby 20 15 1907 to Mek 11 190%, 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 :
Fallalories
Contributory :
(Signed)
LEVarney
M.D.
nech 11 190 (Address).
H. Chebestand.
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
.. years.
months days
Where was disease contracted,
If not at place of death ?
Filed
Mar. 14 1907 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 details. Il Name of cemetery.
167
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.) Chelivoford
FULL NAME
Registered No ...
Date of l
March 12
.190 Z
Residence
Age .....
45
.years.
.. months ..
.days
20
Death * S
Place of 1
Columbia Road NorthChelmann
Death
5
4
.. (DURATION).
DAYS
.. (OURATION).
.. DAYS
COMMONWEALTH OF MASSACHUSETTS
CITY /68 OF LOWELL
RETURN OF A DEATH
FULL NAME
Vidia
Whitten
Registered No .. 21
Place of Death * Chelmsford mais
Date of Death
march 13.1907
91
.Age .....
years
0
months
12
days
STATISTICAL DETAIL
SEX COLOR Female white
SINGLE, MARRIED, WIDOWED, OR, DIVORCED
MAIDEN NAME 1
Lydia G. Gove
HUSBAND'S NAME 1 Charles P. Whitten
BIRTHPLACE Į Henniker n.7%.
NAME OF FATHER abraham Love
BIRTHPLACE OF FATHER İ Deering 2. 2.
MAIDEN NAME OF MOTHER nancy Jones
BIRTHPLACE OF MOTHER #
Ware To. fr.
OCCUPATION
at home
INFORMANT § Emily Whitten
6
PLACE OF BURIAL OR REMOVAL !! Virvell Cemetery
DATE OF BURIAL march 15
ADDRESS
UNDERTAKER b.m. Youngthe 33 Prescott exame of cemetry.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
Tub. 21 1907 to Mar. 13, 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 : Semilita
.(DURATION) .. . DAYS
Contributory
(DURATION) ...... ... ... DAYS
(Signed)
Jectoa . M.D.
Mails, 1907. (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence .. Place of Death ? Days
How long at
Where was disease contracted, if not at place of death ?.
Filed Mar 14 1907 Edward So Jab in
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 FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
UST MRI
roMECr
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
CITY / 69 OF LOWELL
Registered No ...
22
Place of Death *
To Checkmalard . 200
Date of Death.
March 64,009
Age ..
80 years 2.
months
days
STATISTICAL DETAIL
SEX
Mare
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Dur Table, Thass.
NAME OF FATHER Peter iston
BIRTHPLACE OF FATHER I Dunstable Class
MAIDEN NAME OF MOTHER Esther Perry
BIRTHPLACE OF MOTHER # Wilmington or Reading, Tix. 0
OCCUPATION Farmer
INFORMANT § Mr. Etta M. Quater
PLACE OF BURIAL OR REMOVAL !!
Tyngsboro, Masa.
DATE OF BURIAL mar, 50, 100".
ADDRESS
UNDERTAKER 4. a. Wanbeck so Huddr. ST.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
Meh 14 1907 to Much 16
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 :
Enebral Embolism
... (DURATION) 2
.... DAYS
Organice desears I head.
Contributory
..
.(DURATION) ..
... DAYS
(Signed)
JE Vonney
.M. D.
.1907 (Address) . Chelengfind
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
Mar. 19 1907 Edward J. Robbing
Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL If in a RESIDENCE, give facts called for under " Special Information.' 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.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
Heter Kimball (EtÀ2)
How long at
POMEM
08YTH
1
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Reardon
Registered No.
23
Date of l
- Mar. 20.
Death
1907
.months.
3
days
STATISTICAL DETAILS
SEX
m.
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME }
BIRTHPLACE # Rowell
NAME OF FATHER Charles Deardor
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER Natie Smith
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT § Mat Boey Me Pulty - 95 John St.t
PLACE OF BURIAL OR REMOVAL I Edson Cemeter
DATE OF BURIAL
Inar. 21.
190 7 190.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from March 1 1907 to Mand 2090Y 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 : Punchitis
.(DURATION). DAY8
Contributory :
(Signed) mioldua
Eduarddia (PURATION). .. DAYS
.M.D.
March 2190 (Address) Laurel 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 Mar, 21 1907 Edward Rafting 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, giva Its NAME instead of street and number.
t in case of married or divorced woman, or widow.
1 State or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
ThinkSaunders 522 messonach IL Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
Place of )
Chelmsford Center, Dass
Death * S
Residence
Chelles ford
Age. .. years ..
170
=
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
17)
RETURN OF A DEATH
FULL NAME
Olive @ Philbrick
Registered No.
24
Place of Death *
north Chelmsford mass
Date of Death.
april 4, 1907
Age.
56
years.
2.
.... months
14 days
STATISTICAL DETAILS
SEX
female
Need help finding more records? Try our genealogical records directory which has more than 1 million sources to help you more easily locate the available records.