USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 11
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ALL NAMES TO BE IN FULL
.Registered No.
Date of l
A05.28,109
190
Death S
TE
/33
COMMONWEALTH OF MASSACHUSETTS
134
Chef
01. 2/a.22
(CITY OR TOWN.)
FULL NAME
...
Garah. E. johnson2.
Piace of 2
Mait Gainward. Grass.
Death *
5
Death 5
Residence
ivEnt Chelinvia1. 5. 2020
Age
63
a
... years.
months.
.days
STATISTICAL DETAILS
SEX Female,
COLOR
InFile
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
Sarah. E Edwards Glas. Johnson.
BIRTHPLACE#
Herford Mars.
NAME OF FATHER Mozes. Edwards
BIRTHPLACE
OF FATHER#
England.
MAIDEN NAME
OF MOTHER
Mary, Jasker.
V
BIRTHPLACE
OF MOTHER #
OCCUPATION Housewife.
INFORMANT §
Sent Gelmind. Mas
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
West Chelipad Camela Geht / 1909
UNDERTAKER David. Le Greig
ADDRESS Weinfurt Mars
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from. aug. 29 1909 to aug 30 1909 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 : Carcinoma of Itnout
Contributory :
.(OURATION)
........... DAYS
(Signed).
7.D Lambert
M.D.
My 31 1909 (Address) Tymabrouk
SPECIAL INFORMATION only for Hospitais, institutions, Transients, or Recent Residents.
How long at Piace of Death ? years ................. months. .days
Where was disease contracted,
if not at place of death ?
Filed ing. 31 ? Edward . Nothing
Cierk
* City or town, street and number, if any. if death occurs away from USUAL RES !- 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
RETURN OF A DEATH
.Registered No.
56
Date of ¿
august : 30 1909
(DURATION) 200 DAYS
COMMONWEALTH OF MASSACHUSETTS
RETURN OF ADEATH
Chelmsford (CITY OR LOW'N.) 57
FULL NAME
Ustill Born
Place of l
Death *
S
Residence
hath Chinrush 001
Age
.years.
.months.
days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE # North leurhustad
NAME OF FATHER Puchal 14
Ward
BIRTHPLACE OF FATHER$ luland
MAIDEN NAME OF MOTHER Lignes Simpson
BIRTHPLACE OF MOTHER $ England
OCCUPATION
INFORMANT § puchal /Waidy.
rather
PLACE OF BURIAL OR REMOVAL !! St. Peters Centina
DATE OF BURIAL
Sept/ 1909
UNDERTAKER
ADDRESS
n
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Self.S Dept. of 1902 .... to 1909 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 : Stilllow
.(DURATION). DAYS
Contributory :
(DURATION). ..... . DAYS
(Signed)
Jangly
M.D.
Soft. 6, 1909 (Address)
No. Collinsford Ma
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
...............
. months. .. day
Where was disease contracted,
If not at place of death ?
Filed
Selt, 7
1909 Edward J. Rohbing
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.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
135
Registered Ng/4
Date of l
Death
Seht 5
190
9
-
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
136
RETURN OF A DEATH
(CITY OR TOWN.) 58
FULL NAME
Place of
Date of l
Death * S
Death
Residence
Ag
82
6
3
months.
days
STATISTICAL DETAILS
SEX Male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Bergen Norway
NAME OF FATHER Bereut Fröken Paasche
BIRTHPLACE OF FATHER+
Bergen Norway
MAIDEN NAME OF MOTHER Parenting Olsen
BIRTHPLACE OF MOTHER #
Bergen, Norway
OCCUPATION Retired
INFORMANT § araminta Paasche
PLACE OF BURIAL OR REMOVAL II Edenler Lowell
DATE OF BURIAL
Hd+9
1909
UNDERTAKER Natur Perham
ADDRESS Chelapul
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from Unq: 20 1909 to Sept. 6, 1909 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 : Malignant Disease of Liver
(DURATION). DAY8
Contributory : Senility
.. (DURATION) ........... DAYS
(Signed)
Autour , Scormia
.M.D. ,
Bekt. 8, 2.190 .. .. (Address)
Chelmsford Mars.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? .years
months. ........... ..... days
Where was disease contracted, If not at place of death ?.
Filed
Seft. 9.
.190
9. Edward Kobling
C
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. Il Name of cemetery.
1
Bereut alexander Paasche
.Registered No.
Sepr 6 1909
.. years.
L
5
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended degeased during last illness, from 190 Sp-7 .. to 1909 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 hours
(DURATION). .. BAYS
Contributory :
atrophy (Jeho frecifu)
(Signed)
JEVarney
.M.D.
Sift. 8
1909 (Address)
21. Chilihundred
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 ?..
Ejled Sept. 9.
9. Eduard . Rabbim
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.
1
FULL NAME
Place of l
Death *
Granth Chelmsford
Date of l
Death S
de21-8 1909
Residence
(North Chelmsford Age
.. years.
months. ........... .days
STATISTICAL DETAILS
SEX mole
COLOR
2/
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE # Lawell Mass
NAME OF FATHER Defrenie Robert
BIRTHPLACE
OF FATHER#
Caso de
MAIDEN NAME OF MOTHER Dilia Valle'
BIRTHPLACE OF MOTHER #
OCCUPATION
Ganada
INFORMANT §
PLACE OF BURIAL OR REMOVALA?
DATE OF BURIAL
IlIneth - Lefoto
190.
UNDERTAKER
ADDRESS 738 Alichambault Queum
137
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Ix. Sene deland Roberts
(CITY OR TOWN.)
. Registered No. 159
(DURATION).
.. DAYS
Name of cemetery.
7
i
1
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Place of 1
1.0
City Hasht
Date of l
Death
1
Sept 4 1909
Residence
Chelmsford mars
Age
40
.. years
months.
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME +
BIRTHPLACE # Erland
NAME OF
FATHER
Unknown
BIRTHPLACE
OF FATHER+
Ireland,
MAIDEN NAME
OF MOTHER
Unknown
BIRTHPLACE
OF MOTHER #
Ireland.
OCCUPATION at Home
INFORMANT § My Thos Sheehan,
PLACE OF BURIAL OR REMOVAL II
Calvary Com. Boston
DATE OF BURIAL
190.6
UNDERTAKER
I. L. M L enough
ADDRESS
108 Jarhar
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 1 illness, from 1016. 3 Jep. 4 .... 190. 190G.to 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 : poplexy
.(DURATION)
DAYS
Contributory :
(DURATION).
. DAYS
(Signed)
Forster 76. Smith
M.D.
Sup. 4.
190 1 (Address)
Lowell mail.
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
........ years.
2
months.
days
Where was disease contracted, If not at place of death ?.
Filed Sep. 2/ 1009 Gerard ? Hadewar
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. Al Name of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
Hannah L'aile
1.264
.Registered, No.
Death * S
-
138
٠٠٠
:
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Chemsford Murs
NAME OF FATHER Joseph L'Heureux
BIRTHPLACE OF FATHER$ CCanada
MAIDEN NAME OF MOTHER Emelie Grene
BIRTHPLACE OF MOTHER # Canada
OCCUPATION
INFORMANT § Father
PLACE OF BURIAL OB REMOVAL !!
DATE OF BURIAL It Josyhe Left 12. C
UNDERTAKER ADDRESS 738 A.Archambaud Meric Name of cemetery.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .... August 10 1909 to. Jet- 11 1909. 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 : Congenital Debelly
мысль (DURATION). DAYS
Contributory :
(DURATION). .... DAYS
(Signed)
La Rochetto
M. D.
Tel-11 .190 ..... (Address)
732 charm
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 Sept. 11 1909 Odward, Robbie
Com
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.
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.
139
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
marie G. X.Herren Regi
.. Registered No. 61
Place of l
Chelmsford
Death
Sept 11 19 d
Death *
S
Residence
Old Turn Base
Age
-
.years.
1 months 5days
COMMONWEALTH OF MASSACHUSETTS
140% Thelawford
RETURN OF A DEATH
(CITY OR TOWN.) 6.2
.Registered No.
Place of
Chelmsford
Death *
Residence
Brookeine
Age
43
.years.
11
months.
9
.days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
nursed
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE +
Bath me.
NAME OF
FATHER
Thank Luce
BIRTHPLACE
OF FATHER#
five Islands The.
MAIDEN NAME
OF MOTHER
Frances a. Showman
BIRTHPLACE
OF MOTHER #
OCCUPATION
Electrical Engineer
INFORMANT §
E.C. Beasley
PLACE OF BURIAL OR REMOVAL Il Bach me. Com.
DATE OF BURIAL
Sepr24
190 .. 9.
UNDERTAKER
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from the 30 190
8/2/ 1905 ... to .. 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 :
Nephritis
......
........ .(DURATION) DAYS
Contributory :
(Signed)
amParado
.(DURATION). . DAYS
andall
M.D.
Sef 2× 1905 (Address)
Lowell
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at Piace of Death ? years .. .............. . days .. months.
Where was disease contracted,
if not at place of death ?.
Filed
Sept. 24 1909 Edward . Boffinns
Clerk
Join
* 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 i also city, town or county, if known.
§ Name and address of person giving statistical details. ll Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
FULL NAME
Mark Showman Luce.
Date of l
Sept 21
.190
Death S
سرطان
-
COMMONWEALTH OF MASSACHUSETTS
Chehustand. 141
...
(CITY OR TOWN.) 63
FULL NAME
Place of )
Death *
Residence
South Checkusted
Age.
96
.years
.months.
26 .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, -MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Ilannak M. adams
HUSBAND'S NAME
+ Soloman Edvin Byam
BIRTHPLACE #
Chebestand.
NAME OF
FATHER
Isaac adame.
BIRTHPLACE
OF FATHER#
Chebefund.
MAIDEN NAME
OF MOTHER
Hannah adams.
BIRTHPLACE
OF MOTHER #
Chehusferd. Mac.
OCCUPATION It Home
INFORMANT S
Zur . Frank Byan .
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL
Souche- Chelwefind Sept. 24
1909
UNDERTAKER
ADDRESS
Waller Fecham Chelmsford.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Seit 12 1909 to Sept 21 1909 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 : Obstruction A bowel
(DURATION).
.. DAYS
Contributory :
Old age Exhaustion
(DURATION) ......... DAYS
(Signed)
B.16.By am
.M.D.
Sept 24 1909 (Address): 1248381 Forell
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at
Place of Death ?
......
.. years.
months .. ..... ..... . days
Where was disease contracted, If not at place of death ?
Filed
Seht. 24.
009. 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, 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
RETURN OF A DEATH
Hannah Maria Byam
Registered No.
Date of Sett. 21.
190%.
Death
2
COMMONWEALTH OF MASSACHUSETTS
142 Chelmsford
(CITY OR TOWN.)
FULL NAME
Stillborn) Pickard
.Registered No.
611
Place of
Chelmsford
Death *
Residence
Chelmsford
Age
years.
months.
days
STATISTICAL DETAILS
SEX
Female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACEİ
Chelmsford
NAME OF
FATHER
Seo. W. Pickard
BIRTHPLACE
OF FATHER
Little ton
MAIDEN NAME
OF MOTHER
Bertha F. Nelson
BIRTHPLACE
OF MOTHER#
Boston
OCCUPATION
INFORMANT S Mrs Bertha Wilson
PLACE OF BURIAL OR REMOVAL !!
Hortation Ceus.
DATE OF BURIAL
Oct 14
1909
UNDERTAKER M.Perhan
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 190 Oct. 14 909 .to 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 : Hilltown
(DURATION). DAY8
Contributory :
.( DURATION).
.. DAYS
(Signed) ..
Antun . Scofma -
M.D.
Oct. 15, 190
1 .. 190.
4 (Address)
Chelmsford, Mais.
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
Oct. 14
1909 Edward , Poffin
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 | aiso city, town or county, If known.
§ Name and address of person giving statistical detalls. ll 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
Date of l
Och 14
1909
Death
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
marke
FULL NAME
Place of l north Chelmsford
Date of ¿
Death let 21 1909
Residence
north Chelmsford
Age
.. years.
.. months. 2 days
STATISTICAL DETAILS
SEX female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE # North chelmsford.
NAME OF
FATHER
Charles Henry marko
BIRTHPLACE
OF FATHER+
Providence R. I.
MAIDEN NAME
OF MOTHER
Sophia a. E. Trainer
BIRTHPLACE
OF MOTHER +
Lynn, masa
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II Riverside cemetery
DATE OF BURIAL
Oct. 22 1909.
UNDERTAKER
ADDRESS
James 9. Walting to. Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last. illness, from Oct. 20 .. 1909 to Det. 21 1908. 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 : Fremative Built
..... (DURATION).
Contributory :
(Signed).
H. L. Jagi,
.M.D.
det. 22 190 ..... (Address).
No telelinford, Mas.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,, or Recent Residents.
How long at
Place of Death ?
years
...........
months.
Where was disease contracted, If not at place of death ?.
Filed
Oct. 22
20.2. Edward Joplin
----
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 er Institution, glve 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
Death * 5
14.3 north chelmsford. (CITY OR TOWN.) 65 .Registered No.
.. (DURATION). ..... DAYS
1
-
144
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Margaret & Bjorge
.Registered No ....
1524
Place of }
Death*
y Leerfuld It Double "mars.
Date of ¿
Cat. 22
Death
S
8
.months
4
days
STATISTICAL DETAILS
SEX
COLOR
M.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE # Lowell.
NAME OF
FATHER
Levering Byjorge
BIRTHPLACE
OF FATHER#
norway
MAIDEN NAME OF MOTHER 1 Deverine Larsen
BIRTHPLACE
OF MOTHER
norway
OCCUPATION
INFORMANT § Father
PLACE OF BURIAL OR REMOVAL !!
Edson Cam Lowell,
DATE OF BURIAL
Oct 24. 100.
UNDERTAKER
Haller Perham.
ADDRESS
trelawford
PHYSICIAN'S CERTIFICATE
-
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 :
aubercular hipjoint disease
(DURATION).
34hr
DAYS
Contributory :
1
(DURATION)
. DAY8
-
(Signed)
M.D.
det 22
190 (Address)
Thelansford "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 Cet 23 1909.
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 detalls. Il Name of cemetery.
190 9
Residence
Age
12
.. years
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
145 Chelmsford
RETURN OF A DEATH
FULL NAME
William Rufus Howle
(CITY OR TOWN.) 67
.Registered No.
Place of l
Chelmsford
Death *
Residence
Chelmsford
Age
64
.. years-
3
.months.
.days
STATISTICAL DETAILS
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE # Dracut
NAME OF
FATHER
Edward Howle
BIRTHPLACE
OF FATHER$
Noburn
MAIDEN NAME
OF MOTHER
Hannah Damon
BIRTHPLACE
OF MOTHER #
Reading
OCCUPATION
Merchant
INFORMANT § Mrs. N.R. Howle
PLACE OF BURIAL OR REMOVAL II
Horefathers Com.
DATE OF BURIAL
Oct 25 1909
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Oct 8, 190 9 to Oct. 22 1909 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 harmonhaga -
.(DURATION) .. 14
Contributory :
(Signed)>
Antun G. Scon
(.ADURATION).
... DAYS
colma, M.D.
Oct. 231909 (Adress).
Chelen ford, hans
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
Oct. 23
190 2 Edward Raffin
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
Date of l
Oct 22
.1909
Death
S
COMMONWEALTH OF MASSACHUSETTS
146
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Alice
Freel
Registered No ..
68
Place of
Death *
Residence
Age
.. years.
9
months ..
.. days
STATISTICAL DETAILS
SEX
F.
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVOROLD
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACE #
Clinton mass
NAME OF FATHER Edward Freel
BIRTHPLACE OF FATHER $ England
MAIDEN NAME OF MOTHER Emma babanna
BIRTHPLACE
OF MOTHER $
Canada
OCCUPATION
INFORMANT § Factur
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from Oct. 23 190.9 .... to
Oct. 24 1909 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 : Der Caleba
(DURATION). ......... DAY8
Contributory :
per (Signed) IL Lage
(DURATION). ........... DAYS
M.D.
Oct. 25,900 (Address) to Chebus ford.
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at Piace of Death ? .. years .. ................ .. months .................... days
Where was disease contracted, if not at place of death ?
Filed
Osx. 25
1909 Edward & Koffie
Clerk
PLACE OF BURIAL OR REMOVAL II
Clinton masse
DATE OF BURIAL
Oct. 25
190.9
* 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; aiso city, town or county, if known.
§ Name and address of person giving statisticai detalis.
UNDERTAKER ADDRESS John f. Olenwell 1010 lean sixgame of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
Date of l
Och, 24
Death S
.1909
......
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
STATISTICAL DETAILS
SEX
Mace
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
married
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Firefield maine.
NAME OF
FATHER
Jas. H. Willis
BIRTHPLACE
OF FATHER#
Pittsfield me.
MAIDEN NAME
OF MOTHER
Helen M. Leavitt
BIRTHPLACE
OF MOTHER#
augusta
OCCUPATION
Loom fixer
INFORMANT §
Thro R. L. Millie
PLAGE OF BURIAL OR REMOVAL!
Pine Grove Leen.
Manchester n.t.
DATE OF BURIAL
Oct. 31
190 ..
9
ADDRESS
UNDERTAKER
Walter Perham Chelmsford Mk1g
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last iliness, 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 :
nephritis
Several Years
(DURATION).
Contributory :
Pneumonia
(DURATION).
14
.. DAY8
(Signed)
Amara Otoward
M.D.
art. 30
190.9.(Address)
Chelmsford Mars.
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
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