USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 2
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(CITY OR TOWN.)
FULL NAME
Rautieine Mª mation
.Registered No.
Date of
Jeb. 8
/
190 8
Death
Residence
nº Chelmsford
Age
6
.years.
... months ...
.. days
STATISTICAL DETAILS
SEX
15
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED-
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
nº Chelmsford
NAME OF
FATHER
Patrick M: Mahon
BIRTHPLACE
OF FATHER$
nº Chelmsford
MAIDEN NAME
OF MOTHER
Margaret M: Goy
BIRTHPLACE
OF MOTHER #
Nº Chelmsford
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
S. Patrick Cemetery
DATE OF BURIAL
Feb 8
190
UNDERTAKER
bt. molloy.
ADDRESS Lowell
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last iliness, from tel. 2 190 to
tel. 8 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 : Germania
Primary :
Tiplitheria
Scarlet Fever
(OURATION).
...
DAYS
Contributory :
(Signed)
H. L. Sage
... (DURATION)
.......... DAYS
M.D.
Heli. 8.
Do. Cabeluifora
1900 (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
pub. 8
190
8 Edward Staffing
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 statisticai detalis. || Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Place of }
Death *
Printen Ir.
13 .
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Charles Finnick
.Registered No.
209
Place of )
Death
St John's Hospital Lowell, Mass.
Date of Į
Feb. 7.
190
8.
Residence
East Chelmsford.
Age
72
... years.
.months ...
......... days
STATISTICAL DETAILS
SEX
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # Iveland.
NAME OF
FATHER
Richard Finnick
BIRTHPLACE
OF FATHER+
Ireland.
MAIDEN NAME
OF MOTHER
Ellen not known
BIRTHPLACE
OF MOTHER+
Ireland.
OCCUPATION Farmer.
INFORMANT S
Daughter.
Miss Mary Pinnick
PLACE OF BURIAL OR REMOVAL II St. Patrick's Cemetery
DATE OF BURIAL
Feb. 10.
1908
190
UNDERTAKER ADDRESS J. F. O' Donnell & Sons, 324 Market
PHYSICIAN'S CERTIFICATE
190
I HEREBY CERTIFY that I attended deceased during last
illness, from
190
.. 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 :
Pnuemonia
(DURATION).
. DAYS
Contributory :
Epithelioma of lip,
(DURATION) ... DAYS
(Signed)
Toe vincent Meigs,
M.D.
Feb. 7, 190 8 (Address).
160 Merrimack St.
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. 10, 190 8 .
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. ! Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Death
COMMONWEALTH OF MASSACHUSETTS
14 Chelinford
(CITY OR TOWN.)
8 Ovelin
Yogan
.. Registered No. 14
Place of l Rumeton VI ha Chelwand Date of
Death 1
years.
2
.months .. - days
STATISTICAL DETAILS
$EX female that COLOR
SINGLE, MARRIED, WIDOWEDPOR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE# Worth Cheles ford
NAME OF FATHER
BIRTHPLACE OF FATHER$
MAIDEN NAME OF MOTHER Mar . Bodudream
BIRTHPLACE OF MOTHER# North Chelmsford
OCCUPATION
INFORMANT § Father
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from ... Jan. 26 190 8 to feb 13 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 : Pulmonary Congestion.
(DURATION) ....
18
DAY8
Granger Hogan worth Chelesford Contributory : .. (DURATION) . DAYS elevatore (Signed) .. Amara toward M.D.
Feb. 14 908 (Address)
Chilmetre.
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
1908
Edward J. Robbins
Clerk
Gain
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
UNDERTAKER AJO Annel No.
ADDRESS 13 24 mayvi
* 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
RETURN, OF A DEATH
FULL NAME
Death * 5
Fibro
190
8
Residence
Age.
₣
15
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
frank Elmer Smith
.....
.....
Registered No
15
Place of South Chelmsford
Death *
5
Residence
South Chelmsford
Age.
22
.. years.
1.1
months.
17
.. days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť -
HUSBAND'S NAME t
BIRTHPLACE#
South Chelmsford
NAME OF
FATHER
George H. Smith
BIRTHPLACE
OF FATHER#
Westford
MAIDEN NAME
OF MOTHER
Cora E. Dow.
BIRTHPLACE
OF MOTHER #
wilton, maine.
OCCUPATION
Brakeman
INFORMANT §
Carrie Re: Dow
Filed
Feb. 18.
1908 Edward J. Robbing
Clerk
Joan
PLACE OF BURIAL OR REMOVAL !!
Removed to
Action, mais.
DATE OF BURIAL
Job- 19
190 ...
UNDERTAKER
q. B. Currier & Co.
ADDRESS
Prescott SL.,
Lowell mass.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Feb-14 1908 to Feb-17 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 :
Double Lobar
Pneumonia
(DURATION,
3
DAYS
Contributory :
(DURATION)
DAYS
(Signed).
O.G. wells
M.D.
Jeb 17 190 8 (Address)
Westford 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 ?
* 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 detalis. Il Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Death
1
Date of l
February 17,190%.
7
COMMONWEALTH OF MASSACHUSETTS
16
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Edward. Doherty
Registered No.
16
Place of )
West: Chelmsford
....
Death
5
Residence
Age
61
.. years
.months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED,OR
DIVORCED -
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
NAME OF
FATHER
Janice Doherty
BIRTHPLACE
OF FATHER$
Ireland
MAIDEN NAME
OF MOTHER
Van. Morris
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION
Laberor
INFORMANT § Daughter
PLACE OF BURIAL OR REMOVAL !! St. Patrick Center
DATE OF BURIAL
Feb. 22.
190.0
8
UNDERTAKER
C. H. Molloy.
ADDRESS Market In.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
1908 to July 19
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 :
Pleurisy
may.
Contributory :
(DURATION). .. . . .. .. . . .. DAY8
(Signed)
.M.D.
Jelly 20
190 ...... (Address).
2. Chefue Low
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
Fsb. 21
1908 Edward ). Rolling
Tom
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 glving statistical detalls. || Name of cemetery.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
1
1908
Death
5
Date of l
Jef. 19
(DURATION)
69
.. DAY8
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Lowell 17
(CITY OR TOWN.)
FULL NAME
Lucy W. Buttery
Registered No. (301
Place of l
North Chelmsford, Mans
Date of l
Mar. 1.
190
Death
1
3
.months. 0 days
STATISTICAL DETAILS
SEX
COLOR
20
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Lucy an Ferrand
HUSBAND'S NAME + Joseph Buttery
BIRTHPLACE# England
NAME OF
FATHER
William Ferrand
BIRTHPLACE
OF FATHER$
England
MAIDEN NAME
OF MOTHER
Sarah Bottom
BIRTHPLACE
OF MOTHER+
OCCUPATION
England
atytome
INFORMANT § Jouph Thos . Buttery
PLACE OF BURIAL OR REMOVAL II
Tivei Vide Cemetery
DATE OF BURIAL
Mar. 3
8
ADDRESS
UNDERTAKER LA. Webech. so Muddy. It
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from July 22 -190Ft 190.9 ., 8 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).
5
DAY8
Contributory :
Chile buch
(DURATION)
8,
. DAY8
(Signed).
make
1908 (Address)
n. Childrenferal
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
. years.
.... ......
months. ....... days
Where was dlsease contracted, If not at place of death ?.
Filed mar. 3
190
Edward . Robbins
Town 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
Death * S
Residence
Age
(3 2 years.
M.D.
J
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Harriette ann Clarke
.. Registered No.
Place of l
Chelmsford Mass
Date of
Man. 6
.190€
Death
Residence
Age
80 years.
......... months.
23 days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVOROED
MAIDEN NAME +
Harnette ann Fillebrown
HUSBAND'S NAME + William H. Clarke
BIRTHPLACE # Lexington Mans.
NAME OF FATHER
abriel H Ines Fillebro
BIRTHPLACE OF FATHER+ Lexington , Mas.
MAIDEN NAME OF MOTHER Hannah Locke
BIRTHPLACE OF MOTHER +
OCCUPATION
Lexington, Mass it home
INFORMANT § Mrs. Edmund a. Carle
PLACE OF BURIAL OR REMOVAL !! Edson Cemetery
UNDERTAKER
ADDRESS
f. A. Weinbach 80 Middrik
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during, last illness, from . 1900, 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 : -ilactive of Rt femme (DURATION). 6 at the week, DAY8
Contributory :
Serulity -
(Signed)
Arthur J. Scolonia.
M.D.
marc6, 1908 (Address)
1
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. ?
1908 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. Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
18
Lowell
60-18
Death 1068 Chelmsford St.
DATE OF BURIAL
Mar. 8
190.8
.. (DURATION) .. DAYS
COMMONWEALTH OF MASSACHUSETTS
19
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME 1 John. Mulligan
Registered No. 19
Place of )
Date of l
march. 10
190 8
Death *
5
Death
Residence
Age
5.8.
.. years
.months .days
........
STATISTICAL DETAILS
SEX
mal
COLOR
While
SINGLE, MARRIED, WIDOWED, OR DIVORCED"
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
NAME OF
FATHER
BIRTHPLACE
OF FATHER#
Suland
MAIDEN NAME OF MOTHER mary J. finally
BIRTHPLACE
OF MOTHER #
dulande.
OCCUPATION 0 laberam
INFORMANT §
ster
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190.x.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 : old a grat detility
(DURATION). .........
. DAY8
Contributory :
(Signed)
Owner Pourles
M. D.
DURATION). . DAY8
mari 11
1908 (Address)
233 Curta
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
nlar. 11
198 Edward , Robbing
Vomi Cierk
* Clty or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, glvo 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
PLACE OF BURIAL OR REMOVAL !! Dr. Patrick Camely
DATE OF BURIAL
March. 12,908
ADDRESS
UNDERTAKER CH. Malloy
20
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
So. Chelmsford.
(CITY OR TOWN.)
FULL NAME
Elizabeth
1 Dinning
2
Date of l
Death
S
march 10, 190%
Residence
So, Chef
Age
$1
.. years.
6
.. months ...
2.5
.days
STATISTICAL DETAILS
SEX
COLOR
72
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowad
MAIDEN NAME +
Elizabeth Johnson
HUSBAND'S NAME }
بكيو صوصقد
BIRTHPLACE# granville, C. F.
NAME OF
FATHER
David Johnson
BIRTHPLACE
OF FATHER+
-Nu. jd.
MAIDEN NAME
OF MOTHER
Hive
BIRTHPLACE
OF MOTHER #
-
OCCUPATION
At home.
INFORMANT § 1. Reci mining
PLACE OF BURIAL OR REMOVAL II So. Chelmsford
DATE OF BURIAL
March 12
UNDERTAKER Daniel. P. Bijam ..
ADDRESS
So. Chelmsford,
mass
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Mar- 3 1908 .. to 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 : Inanition .
. (DURATION)
6
DAYS
Contributory :
Cerebral Hemorrhage
2
(DURATION)
.. DAYS
(Signed)
D.V. Week
M.D.
Mar. 10 908 (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
Mar. 11.
90 8 Edward . Rafting
Town 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
.Registered No.
20
Place of
Death * S
So Chelmsford
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
FULL NAME
Place of Death * West-Chelmsford
Date of Death
March 110- 1408
Age
Stillborn
months days
STATISTICAL DETAIL
SEX Female
COLOR
white
-
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE # Went Chelmsford
NAME OF FATHER Nicola Palmiotti
BIRTHPLACE OF FATHER #
Italia
MAIDEN NAME OF MOTHER
grazia Arnora
BIRTHPLACE OF MOTHER # Italia
OCCUPATION
Nicola Halmiotto
INFORMANT West-Chelwofford
PLACE OF BURIAL OR REMOVAL !I
DATE OF BURIAL Auch 12 Tonal ...
UNDERTAKER a.f. Istrid for
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceases during last Mek 11 8
illness, from
190_1 .***
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 : tillbone
Contributory
. (DURATION ). ... DAYS
(Signed)
Mich 11
190 8 (Address) .. Ichellaunfond .... M. D.
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
2har, 11
.190
Edward J. Rolifting
Clerk.
Len Cercity 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.
21
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
Registered No.
21
. (DURATION) . . DAYS
طهحسين لدى
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME Mildred & Thompson
Registered No. 22
Place of Death *
Chelmsford
Date of Death
March 15th
Age
6
years
4
months
7
days
STATISTICAL DETAIL
SEX female
COLOR while
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Andon Mars
NAME OF FATHER Milions & Thenfema
BIRTHPLACE OF FATHER
Shirley may
MAIDEN NAME OF MOTHER Edech & Hace
BIRTHPLACE OF MOTHER #
OCCUPATION
. mecan (places)
INFORMANT S
PLACE OF BURIAL OR REMOVAL !! Sheila
DATE OF BURIAL
mek ??
8
190.
UNDERTAKER Luvi inette
ADDRESS
Leger
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ..
196 .... to.
Mich 15 8 .,
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 :
22 hours
(DURATION) . . DAYS
Contributory
.. (DURATION) ... DAYS
(Signed) .
I. E. Varney
M. D.
Mich 16
190 .... (Address).
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence. Place of Death ?. .... Days
How long at
Where was disease contracted, if not at place of death ?
Filed Mar. 16 no # Edward . 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.
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.
22
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
Place of Death *
What Celelins ford. Mas.
Date of Death
Mar. 16-08
Age
years
months
days
STATISTICAL DETAIL
SEX Male
COLORO White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE + Test Cheluns ford, Mas.
NAME OF FATHER Carl Nelson
BIRTHPLACE OF FATHER I Sweden
MAIDEN NAME OF MOTHER Mans Peterson
BIRTHPLACE OF MOTHER # wneden
OCCUPATION
-
INFORMANT §
Halter
PLACE OF BURIAL OR REMOVAL II West Cemetery DEat Chelmsford
DATE OF BURIAL mar. 17 . 1908
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last.
illness, from. Mar. 16. 1908. to. Mar. 16 190 2 ....
that to the best of my knowledge and belief death occurred ou the (late stated above, and that the CAUSE OF DEATH was of follows : Primary : wall bour ,
. (DURATION) .DAYS
Contributory
.. (DURATION). ... DAYS
(Signed)
.M. D.
Mar, 16 1908 (Address).
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, or Recent Residents.
Former or Usual Residence
How long at
Place of Death ? ....... .. Days
Where was disease contracted, if not at place of death ?.
Filed
mar. 17
.190
8 Edward & 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.
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 ALL NAMES TO BE IN FULL.
23
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH Nelson
Registered No ..
23
COMMONWEALTH OF MASSACHUSETTS
24
CITY OF LOWELL
RETURN OF A DEATH
FULL NAME
Bernice
6. Thompson
Registered No. 24
Place of Death *
No Chelmsford.
Date of Death March 21
Age
4
years
8
months
6
days
STATISTICAL DETAIL
SEX Female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME T Bernice Evelyn Thompson. HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER Willians &. Thomkerw.
BIRTHPLACE OF FATHER +
3
MAIDEN NAME OF MOTHER Edith & Hall.
BIRTHPLACE OF MOTHER # Mr. Chelmsford. Pres
OCCUPATION
INFORMANT § Wochen.
PLACE OF BURIAL OR REMOVAL I! Shirley Centre
DATE OF BURIAL
War 24
.... 190.8 ..
UNDERTAKER Levi Julile
ADDRESS
ayer Wars,
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
to. illness, from. Mar. 15 1908 Mar 21 8
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 : Inhumana
(DURATION) DAYS
Contributory
... (DURATION). .. . DAYS
(Signed)
Varner,
.... M. D.
Mar 22100 (Address)
SPECIAL INFORMATION only for Hospitals, Institucions, Transients, e
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
mar. 23
8 Edward 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.
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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
COMMONWEALTH OF MASSACHUSETTS
25
RETURN OF A DEATH Edith m Gray
(CITY OR TOWN.)
FULL NAME
Place of )
Chelmsford Mass
Date of l March 25 908
Death S
Residence
.Age
.years.
.. months.
.days
STATISTICAL DETAILS
SEX
Female White
COLOR,
POTHOLE MARRIED,
WIDOWED, OR
Edith French
MAIDEN NAME +
HUSBAND'S NAME t Charles W. Gray
BIRTHPLACE # Unknown
NAME OF
FATHER
andrew French
BIRTHPLACE
OF FATHER+
Unknown
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER +
OCCUPATION at Home
INFORMANT §
Husband.
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 : Renal Cola.
. (DURATION). ... DAYS
Contributory :
(Signed)
Ankun J. Scolina
.(DURATION) ... DAYS
M.D.
Mar. 27 1906 (Address) Chelmsford, mass.
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 mar. 27
.1908.
Edward. Robbing
Form
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.
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