USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1906-1907 > Part 9
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COLOR
white
SINGLE, MARRIED, -+- WIDOWED, OR DIVORCED
MAIDEN NAME +
Olive J. Brown
HUSBAND'S NAME t
George H. Philrick
BIRTHPLACE#
amesbury mass.
-
NAME OF
FATHER
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
-
BIRTHPLACE
OF MOTHER #
OCCUPATION at Home
INFORMANT §
George H. Philbrick
PLACE OF BURIAL OR REMOVAL !! amesbury mass april 8 .190 ... 7.
DATE OF BURIAL
UNDERTAKER 1 B. Currier & Co.
ADDRESS
Lowell mass
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
March 15
190) to apal 4 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 :
Unaenie
(DURATION) 14
DAYS
Contributory :
(Signed)
JEVarney
M.D.
april 190) (Address) M. Cheleuchtend.
SPECIAL INFORMATION only for Hospitais, 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 ?
april 7 1907 Edward J. Roffing
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." If in a Hospital or institution, give its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, if known.
§ Name and address of person giving statistical detalis. | Name of cemetery.
... (OURATION). OAYS
FILL OUT WITH INK. THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
STATISTICAL DETAIL
SEX male
COLOR,
SINGLE, MARRIED, WIDOWED, OR DIVORCED
vingle
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE No. Chewie food
NAME OF FATHER
Edward Inches
BIRTHPLACE OF FATHER İ
Main
0
MAIDEN NAME OF MOTHER Gatherros Common
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT § Edward Tucke.
PLACE OF BURIAL OR REMOVAL !! Is Patrick
DATE OF BURIAL
Wanie 10
.190 ..
UNDERTAKER b. H. Molloy
ADDRESS
Marker for
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
af. 7 1907 to apr.,0 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 :
vertentes
(DURATION) ......... DAYS
Contributory
(Signed)
(+1 6. Jamen.
.M. D.
2/1.10, 190 % (Address) No. Chebet
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence . Place of Deatlı ?.. . Days
Where was disease contracted, if not at place of death ?.
Filed als-10.
.. 190 7 Edward J. Roftime
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 / 72 OF LOWELL
RETURN OF A DEATH
FULL NAME Samuel Raymond
Ingles
Registered No ... 25
Place of Death * Mr. Cheline ford. Mars.
Date of Death apr. 10, 07 1
-
1
COMMONWEALTH OF MASSACHUSETTS
(Seoulette St. Age 4 woke års.
months
days
.. (DURATION) .. .. DAYS
How long at
173
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Daund J. M. falls
(CITY OR TOWN.)
FULL NAME
Place of Church What If Chelmsford
Death * S
Date of l Death
Residence
Age.
... years.
.months.
.days
.
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, ØR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # post, Chelesford
NAME OF FATHER
Pating MS Falls
BIRTHPLACE OF FATHER# Wieland
MAIDEN NAME OF MOTHER Margaret Banitt
BIRTHPLACE OF MOTHER #
OCCUPATION
INFORMANT § Brother Nur V.
PLACE OF BURIAL OR REMOVAL null ( Palmego cuentra UNDERTAKER FORwell In 324 may et xx ADDRESS
DATE OF BURIAL New/13 1907
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last iliness, from. April 1 1907 to Unit 10 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 : ... Mhranic Bronchitis
.. (DURATION). DAYS
Contributory :
.. (DURATION). DAY8
(Signed).
M. D.
af. 13
190. .... (Address).
203 central Sh
SPECIAL INFORMATION only for Hospitals, 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 ?.
Filed
apr. 13
1907 Edward. Jobbing
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
CITY OF LOWELL
.Registered No ... 26
34
خروج
سعر
COMMONWEALTH OF MASSACHUSETTS
174 Chelucford
RETURN OF A DEATH
FULL NAME
Beatrice Collier
(CITY OR TOWN.) 27
.Registered No ..
-
Death * S
Residence
Chelmsford
Age 91
.. years.
.. months.
9
.. days
STATISTICAL DETAILS
SEX Hemale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widow.
MAIDEN NAME +
Beatrice nelson
HUSBAND'S NAME t
John 9 Collier
BIRTHPLACE #
Bergen, Norway
NAME OF
FATHER
This nelson
BIRTHPLACE
OF FATHER#
Bergen Norway
MAIDEN NAME
OF MOTHER
Anna M. Ramslov
BIRTHPLACE
OF MOTHER #
Bergen Norway
OCCUPATION
-
at Home
INFORMANT §
Mrs thrones Tay
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
Riverside lem No. Chel april 14
07
ADDRESS
UNDERTAKER Walter Parham 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 :
Senility
.. (DURATION). . DAYS
Contributory :
(DURATION)
DAYS
(Signed) ....
Anthus & Scobonu- M.D.
apr-13 190 (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 Of. 14 1907 Edward J. Bobbing
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 detalls. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Place of )
Chelmsford Centre
Date of l
april 11
.1907
Death
5
COMMONWEALTH OF MASSACHUSETTS
175 Chelmsford
RETURN OF A DEATH
(CITY OR TOWN.) 28
FULL NAME
Effie Margaret Jucker
Place of )
Chechueford
Death * S
Residence
Chelmsford
Age
0
... years.
6
.months.
7
.days
STATISTICAL DETAILS
SEX temale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
7
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE#
Prince Edward Island
NAME OF
FATHER
Millian C Jucker
BIRTHPLACE
OF FATHER
Hartland ME.
MAIDEN NAME
OF MOTHER
Katie Mckinnon
BIRTHPLACE
OF MOTHER #
Prince Edward Island.
OCCUPATION
INFORMANT § William C. Jucker
PLACE OF BURIAL OR REMOVAL !!
Mat Cemetery
Weet Chelandford
DATE OF BURIAL
april 16
190.7
UNDERTAKER
Walter Perkan
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
april 7
1907 to Shr 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 as follows : Primary : Brancho -pneumonia
-
.
.. (DURATION) ..
7
.DAYS
Contributory :
.
.(DURATION) . DAYS
(Signed).
F. E Varney
M.D.
Cfr 15 1907 (Address)
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
april 15, 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 "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 FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Registered No.
Date of l
april 14 1907
Death
S
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
FULL NAME
Faustina.p.
standley
Place of Death * . South Chelmoforat mais
Date of Death
april 15.1999 Age 56 years.
months
days
STATISTICAL DETAIL =
SEX Female
COLOR white
SINGLE, MARRIED, WIDOWED, OR
Widow
MAIDEN NAME +
Faustina
Wright-
BIRTHPLACE ±
Chelmsford Mass
NAME OF FATHER Jonathan Wright
BIRTHPLACE OF FATHER İ nashua n ft.
MAIDEN NAME OF MOTHER Elena Hildreth
BIRTHPLACE OF MOTHER # Chelmsford mass
OCCUPATION at home
INFORMANT § Brother
PLACE OF BURIAL/OR REMOVAL II msford Centre april 18
DATE OF BURIAL
.190.
ADDRESS
UNDERTAKER l. M. Young to 33 Prescott
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 1 illness, from .. apr. 9- 1907 to afm.15 1907,
that to the best of my knowledge and belief death occurred on the
HUSBAND'S NAME + Levage Handler, late stated above, and that the CAUSE OF DEATH was of follows :
Primary : ..
Pneumonia!
.(DURATION) .. DAYS
Contributory
... (1)URATION) .. .. DAYS
(Signed) .
Camara Howard M.D.
apr. 16 1907 (Address) Chelmsford
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 W/02.18 100 Eduard Jolting
own Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
# In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
Il Name of cemetry.
-
-
-COMMONWEALTH OF MASSACHUSETTS
-
RETURN OF A DEATH
~
-4
CITY /76 OF LOWELL
Registered No ... 29
rovarr ATIDE
CU
COMMONWEALTH OF MASSACHUSETTS
177
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Cocan Everett Present
Place of ì
Death * S
Residence
Chelautard
Age ..
......
0
.years.
4
.. months.
2
.days
STATISTICAL DETAILS
SEX
Male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Lowell
NAME OF
FATHER
thank R Prescott
BIRTHPLACE
OF FATHER#
Thetford
MAIDEN NAME
OF MOTHER
amine 2. Erling
BIRTHPLACE
OF MOTHER#
Sheffield, n. B.
OCCUPATION
INFORMANT § H. R. Prescott
PLACE OF BURIAL OR REMOVAL I Fairview Cem, Westford mars
DATE OF BURIAL
april 25 1907
UNDERTAKER
Walter Partam
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190 / ... to apr 23 ,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 : Indigestion-Consulado
.. (DURATION). .DAYS
Contributory :
DURATION)
... DAYS
Antun G. Sobena M.D.
und 0
apr -25 907 (Address) @
SPECIAL INFORMATION only for Hospitals, Institutlons, Transients, or Recent Residents.
How long at Place of Death ? years.
months days
Where was disease contracted,
If not at place of death ?.
Filed
als 25
.190
7 Edward Bobbing
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 marrled 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
Registered No.
30
Date of l
april 23
Death
1
........ 1907
COMMONWEALTH OF MASSACHUSETTS
178
Chelmsford
(CITY OR TOWN.)
FULL NAME
Charles B Cole
Place of )
Chelmsford
Death *
5
Residence
Chelmsford
Age 15g
7 years.
6
.months.
.3
.days
STATISTICAL DETAILS
SEX
Tale
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # Sackville n. B.
NAME OF
FATHER
Benjamin Cole
BIRTHPLACE
OF FATHER#
Newyork State.
MAIDEN NAME
OF MOTHER
Jane Lockhart
BIRTHPLACE
OF MOTHER#
Sackville U.B.
OCCUPATION
Blacksmith
INFORMANT §
Benjamin Cola
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Edern Cem. Lowell april 28, 1907
UNDERTAKER
Walter terhow
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
190.
.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 :
... (DURATION).
DAYS
Contributory :
..... (DURATION).
DAYS
(Signed) AG. Auch Med- Euro
Can- 26 1907 (Address) 219 Control SC-
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 aln. 28 1907 drand ) Robbing
Clerk
* City or town, streot 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
RETURN OF A DEATH
Registered No ..
Date of l
Death
1
abril 25
.190 7
=
COMMONWEALTH OF MASSACHUSETTS
119
RETURN OF A DEATH
FULL NAME Henry H. Buzgell
Registered No ..
Place of Death * Mast Chebuford
Date of Death abril 26 1907
.Age ..
78
years
0
months
17
.days
STATISTICAL, DETAIL
SEX Male .
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widowed
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ± Middleton 71. 7.
NAME OF FATHER Henry H. Buzzell
BIRTHPLACE OF FATHER Madbury n. H.
MAIDEN NAME OF MOTHER Hodgedon
BIRTHPLACE
OF MOTHER #
n.H.
OCCUPATION Retired
INFORMANT §
Chas. E. Buzzell
PLACE OF BURIAL OR REMOVAL || Hillside Lakeport 4. 74
DATE OF BURIAL
april28.
- 1907
UNDERTAKER Walter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ...
af.23, 1907 to apr. 26, 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 : Diabetes Senility
.. (DURATION)
. DAYS
Contributory
Diabetes
(Signed),
(+ S Vanily
.M. D.
ale. 26, 1907 (Address).
Tto chees ford
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 ?.
a/r. 27 1907. Edward J. Robbing
Clerk.
*City or Town, street and number, if any. If deatlı 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
CITY OF LOWELL
.(DURATION) .. ... DAYS
How long at
٠٠ 1
COMMONWEALTH OF MASSACHUSETTS
CITY/ 80 OF LOWELL
RETURN OF A DEATH
FULL NAME 1
Place of Death * East Chelmsford Date of Death april 27:
Age.
70
years
months
days
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # derland
NAME OF FATHER / Danni Coughlin
BIRTHPLACE OF FATHER İ Ireland
MAIDEN NAME OF MOTHER 1 Margaret Kommedy
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION Retired
INFORMANT § michael loughlin
PLACE OF BURIAL OR REMOVAL II St-Patricks 62mm
DATE OF BURIAL april 29" . 90%
UNDERTAKER
John F Rogers 445 Gorham be Lowered Hanges cemetry.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from April 22nd/1907 to April 29 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 : partially strangolated hiring
(DURATION) one .. DAYS Contributory venta confection of Jung with Samlity (DURATION) ... ... DAYS
(Signed)
DonneM. D.
ifpril 21 1907 (Address) to Killweg Man
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 ?.
apr. 27 1907 Edward Jr Rafting 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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
1
=
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
ADDRESS
Registered No .... 33
İ
COMMONWEALTH OF MASSACHUSETTS
18
Chelmsford
RETURN OF A DEATH
(CITY OR TOWN.) 34
FULL NAME
andrewK Brothereton
Registered No.
Date of ¿
april 29
· Death
197
Residence
Dowall mass
Age .......
# 49 years.
-11
.months.
29
.. days
STATISTICAL DETAILS
SEX
Male
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
it idowed
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE± Yalashiels Scotland
NAME OF
FATHER
Unknown
BIRTHPLACE
OF FATHER#
Unknown
MAIDEN NAME
OF MOTHER
ann Brotherston
BIRTHPLACE
OF MOTHER#
Sitoswelle, Scotland
OCCUPATION
laborer
INFORMANT § Una Hay & Mrs William Cunningham
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL Pine Ridge Ceau, Chelmsford May1 190 ..
UNDERTAKER Malte Peshaca
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 :
. (DURATION).
DAYS
Contributory :
.. (DURATION). DAYS
(Signed).
: M.D. 6. 4 90 (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 may 1
.190
7 Edward & Ratting
- 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 detalls. Il 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
Chelineford mars
Death * S
COMMONWEALTH OF MASSACHUSETTS
182
RETURN OF A DEATH
FULL NAME
Place of Death *
Date of Death ..
Assil 29
Age ..
. years.
months .days
STATISTICAL DETAILS
SEX 1 male
COLOR Mit
SINGLE, MARRIED, WIDOWED, OR DIVORCED Single
MAIDEN NAME HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER Mercifulus Jones
BIRTHPLACE OF FATHER#
auflisten Quatre- 1
7
MAIDEN NAME OF MOTHER Emily Igurett
BIRTHPLACE OF MOTHER # Hor Pochise Engana
OCCUPATION
INFORMANT §
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from april 24 1907 to Gray 29 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 : Entero colitis
(DURATION).
8
DAYe
Contributory :
.(DURATION). DAYS
(Signed) JE Varney M.D. april 30 1907 (Address). Checkusfind
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 may 1
.190 7 Edward ). Retbin 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
PLACE OF BURIAL OR REMOVAL II DATE OF BURIAL 1 Para dice moment May ST. 190
UNDERTAKER
-
ADDRESS 1
Registered No.
33
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
183 Chelmsford
(OFTT OR TOWN.) 36
FULL NAME Nancy Evans Holt
Registered No ..
Date of l
Death
5
May 10
1907
Residence
Chelmsford
Age ....
82
.. years.
10
... months ..
19
.days
STATISTICAL DETAILS
SEX Herale
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widow
MAIDEN NAME +
nancy E. Mayfield
HUSBAND'S NAME t
Horace Holt
BIRTHPLACE #
Exeter Maine
NAME OF
FATHER
nathan Maxfield
BIRTHPLACE
OF FATHER#
Louden n.H.
MAIDEN NAME
OF MOTHER
Hannah Hill
BIRTHPLACE
OF MOTHER #
Lowder n.H.
OCCUPATION
Lot hours
INFORMANT § Emma Holt
PLACE OF BURIAL OR REMOVAL !!
Union Con
Jaconia n.H.
DATE OF BURIAL
May 14
1907
UNDERTAKER Walter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY, that I attended deceased during last illness, from March 1907 to May 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 as follows :
Primary : Senile degeneration
.. (DURATION).
.. DAYS
Contributory :
A .. (DURATION).
... DAYS
(Signed) ...
Chmura Howard
M.D.
May 12 1907 (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 Mar 12 1909 Edward , Rolling
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
Death * S
Chelmsford
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
184
FULL NAME
RETURN OF A DEATH Daniel James Pickard
Registered No.
37
Place of Death *
South Chelansford Mars
Date of Death.
Mary 12 - 17.45 a. ml (190%) Age 83
years ..
.months
.days
STATISTICAL DETAILS
SEX male
COLOR
white,
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Canterbury. n. H.
NAME OF FATHER Daniel Pickard
BIRTHPLACE OF FATHER# Rowley, Mais
MAIDEN NAME OF MOTHER Auchan Starwars.
BIRTHPLACE OF MOTHER # Loudew. W. H.
OCCUPATION
Farmer
INFORMANT §
(1) usual home) Daughter
PLACE OF BURIAL OR REMOVAL II Hart Ford Cemetery So. Chelmsford
DATE OF BURIAL
Thay 14,
.. 1907.
UNDERTAKER
Hanie T. Bram
ADDRESS
So. Chelmsford
mass.
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. May 2. 1907 to May 11th .. 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 : Cerebral Hemorrhage
. (DURATION) ..
9
DAY 8
Contributory :
.(DURATION). .. DAYS
(Signed).
O.V. Wells
M.D.
May 12 1907 (Address).
Wishford, Mass
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 Thay 13
190
07 Edward & Coffing
Clerk
Down
* 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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