USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 3
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§ Name and address of person giving statistical details.
I Name of cemetery.
MARGIN RESERVED FOR BINDING
2
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II Concord n. H.
DATE OF BURIAL March 28 190 8 UNDERTAKER J. B. Currier Co Lowell m ADDRESS
Registered No. 25
Death * 5
40
COMMONWEALTH OF MASSACHUSETTS
2.6
Lowell
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME arthur Henry House
Registered No. 30121
Place of )
Death *
S
Harren ave Endowed Center Man Death
Date of Mai. 26 ........ .. 190 &
Residence
11
Age
.. years.
/
months.
21 days
STATISTICAL DETAILS
SEX m
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE#
Greenland Contre Mars.
1
NAME OF
FATHER
Charles 3. House
BIRTHPLACE OF FATHER#
Fort Levensworth Kansas
MAIDEN NAME OF MOTHER Lucy Onley
BIRTHPLACE OF MOTHER# Billerica Mass
OCCUPATION
INFORMANT § Charles Q. House
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Mar. 25 1908, to Mar 27 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 : acute Labar Pneumonia
(DURATION)
6
DAYS
Contributory :
(DURATION) ... DAY8
(Signed)
Arthur & Scobina
.M.D.
Mar. 27, 1908.
.190.0. (Address)
Cluburstores, 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 mar. 27 20 8: Edward. Rolling
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
PLACE OF BURIAL OR REMOVAL II
Edson Cemiteur
DATE OF BURIAL
Mar. 28
190.8
UNDERTAKER
ADDRESS Ed Lembeck 80 Mider SA
COMMONWEALTH OF MASSACHUSETTS
27
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Still Born Child
.Registered No. 27
Place of l
Warren an Chersfard mars
Death 1
Date of l March 27 1908
Death *
Residence
Warren and Chansfar & Lang Age
-
.years.
-
. -
.months .. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
male
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Chemsford Warz
NAME OF
FATHER
John muller
BIRTHPLACE OF FATHERA Ireland
MAIDEN NAME OF MOTHER Mary V. Burke
BIRTHPLACE OF MOTHER# Ireland
OCCUPATION
-
INFORMANT § Father .
PLACE OF BURIAL OR REMOVAL # St. Patricke Lowell Mass
DATE OF BURIAL
Brav 217 190 8
UNDERTAKER By Ami Danauch
ADDRESS 108 G orhan
PHYSICIAN'S CERTIFICATE
.to 1 HEREBY CERTIFY that I attended deceased during last iliness, from 19 0. March 27908, 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 :
Contributory :
(Signed)
Antina G. Scobona
.. M.D.
Kan, 27, 1908 (Address
chelmsford more.
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. 28
1908
Edward . Robbing
Clerk
* City or town, street and numbor, 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.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.. (DURATION) . DAYS
(DURATION)
.DAY8
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
John Thorne.
Registered No. 28
Place
Washington Of North Chelmsford, Mase
Date of ¿
March 30, 1908.
Death 1
Residence
Washington St. Nr. Chelmsfords
Age
75
.years.
months.
.days
STATISTICAL DETAILS
SEX
M.
COLOR
Vr.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed.
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Wellington, England.
NAME OF
FATHER
Unknown.
BIRTHPLACE
OF FATHER#
England.
MAIDEN NAME
OF MOTHER
Unknown.
BIRTHPLACE
OF MOTHER #
England.
OCCUPATION
Retired.
INFORMANT §
Ger. H. Ripley.
PLACE OF BURIAL OR REMOVAL II Edson Cemetery.
DATE OF BURIAL
April 2. 190.8.
UNDERTAKER
Geo. HeHealey.
ADDRESS
79 Branch Px.
PHYSICIAN'S CERTIFICATE
to I HEREBY CERTIFY that I attended deceased during last iliness, from 190. Mch 30 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 : Unamia
6 hours
(DURATION).
Contributory :
Organic decare of heart
suvenir eight years DURATION) ............. DAY9
(Signed)
LE Barney
M.D.
(Address)
n. Chilistand
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 1
198 Edward . Rolling
Clerk
Com
* 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.
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.
28
COMMONWEALTH OF MASSACHUSETTS
Death *
4
F
COMMONWEALTH OF MASSACHUSETTS
29
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
may V, Mullin
.Registered No.
534-29
Place of l
At Johns Noskl.
Date of l
nwar 30
1908
Death
1
Residence
Warren are Chelmsford mass.
Age
33
.. years
.months ..
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Burke
HUSBAND'S NAME +
John Mullin
BIRTHPLACE # Ireland
NAME OF
FATHER
michael Buske
Anske
BIRTHPLACE
OF FATHER
Ireland
MAIDEN NAME
OF MOTHER
T. ucherie Bruke
BIRTHPLACE
OF MOTHER +
Ireland
OCCUPATION at Home
INFORMANT § Husband.
PLACE OF BURIAL OR REMOVAL IL
" Patrick Jane Lowill!
DATE OF BURIAL
8
190 ..
UNDERTAKER
ADDRESS
108 Jarham
24
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last
illness, from.
mar 28
1908 to
mar. 30 190 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 :
Unenmania
(DURATION)
6
... DAYS
Contributory :
(Signed)
James & Hel
.M.D.
mar 31
190 8 (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months
1
days
If not at place of death ?
Where was disease contracted,
Chelmsford mais
Filed Mar 3/1908
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. HI Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
Death *
S
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
(DURATION)
DAYS
COMMONWEALTH OF MASSACHUSETTS
30
Chelmsford
RETURN OF A DEATH
(GIFF OR TOWN.) 30
FULL NAME
amos Byamy adams
Registered No.
Place of l
Death *
Chelmsford Centre
Residence
Chelmsford
Age.
54
.. years.
months ...
days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Chehusford
NAME OF
FATHER
Otic adams
BIRTHPLACE OF FATHER# Chelmsford
MAIDEN NAME
OF MOTHER
Caroline S. Slover
BIRTHPLACE
OF MOTHER #
Westford
OCCUPATION
Harmer
INFORMANT § Edward E. adama
PLACE OF BURIAL OR REMOVAL !! Horefathers Com.
DATE OF BURIAL
april 11, 1908
UNDERTAKER Walter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from alm 1et 190.3 .. to a/n. 8th . 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 : Pneumonia -
(DURATION).
7
. DAYS
Contributory :
×
.(DURATION). .... DAY8
(Signed) ..
Amaza Howard
M.D.
aln. 9
190 .. S. (Address)
Chelmsford.
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Piace of Death ? . years.
. months .............. ........ days
Where was disease contracted, If not at place of death ?.
Filed
Cris 10
8
.190
durand. Nothing
Clerk
1
* 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
Date of l
april 8
190៛
Death 1
8 21
COMMONWEALTH OF MASSACHUSETTS
3/
RETURN OF A DEATH
FULL NAME
Joseph & Schmand & Heures Registered No.
(CITY OR TOWN.)
31
Place of }
Chelmsford Center
Date of l af 14 190 Death
8
Death *
.
5
Residence
Chelmsford Freute
Age
.. years ..
months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
mole
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
NAME OF FATHER Rough SHerrero
BIRTHPLACE OF FATHER# Ganache
r
MAIDEN NAME OF MOTHER Enulla grener
BIRTHPLACE OF MOTHER # Canada
OCCUPATION
- Where was disease contracted, If not at place of death ?.
INFORMANT §
PLACE OF BURIAL OR REMOVAL !! If Yough
DATE OF BURIAL / 15 /908 190 ... 8
UNDERTAKER
ADDRESS
438
Auchanbauch Men de Name of
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from April 4 1908 to april 14/ 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 : Este Perctantes
(DURATION).
10
DAY8
Contributory :
.(DURATION). . DAYS
(Signed)
LURochetto
M.D.
Anul 14 1908 (Address).
732 Merrimack
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? years.
months. .................... days
Filed alv 14. 1908 Edward Y. Nothing Jorin 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.
f In case of married or divorced woman, or widow. # State or country ; also city, town or county, if known.
§ Name and address of person giving statistical detalls, JI Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
32
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
aseneth.
Sauver
Registered No. 32
Place of l
East Chelmsford mass
Death *
S
Residence
Basf Chelmsford
Age
78
.. years.
-
.months.
21
.days
STATISTICAL DETAILS
SEX Female
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME +
aveneth St. Wilson
HUSBAND'S NAME t
Jacob a. Hariver
BIRTHPLACE #
Canada
NAME OF
FATHER
Thomas Hitem
BIRTHPLACE
OF FATHER #
Canada
MAIDEN NAME
OF MOTHER
unknown
BIRTHPLACE
OF MOTHER #
Unknown
OCCUPATION at home
INFORMANT §
Queband
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL Edson Cemetery april 23 1908
UNDERTAKER
ADDRESS
I'm. Young 23 trecut a Name of cemetery,
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, fro
mar 6th 190 %, to Apr, 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 : Valvular Diseases of Heart.
Contributory :
» .(DURATION).
. DAYS
(Signed)
Solon Bartlett.
M.D.
Apr24T, 1908. (Address)
Lowell, Mass.
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 af. 23
1908 (0),and) 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. # 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
Date of ¿
april 21 1908
Death
(DURATION). .......... . DAYS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
STATISTICAL DETAILS
SEX
In.
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME $
HUSBAND'S NAME t
BIRTHPLACE+ Lettland
NAME OF
FATHER
BIRTHPLACE OF FATHER+ Ireland
MAIDEN NAME OF MOTHER Mary Gillisplay
BIRTHPLACE
OF MOTHER +
Ireland
OCCUPATION Jahren
INFORMANT §
PLACE OF BURIAL OB REMOVAL ! St. Patrick Centery
Lowall man
DATE OF BURIAL
May 2.
8
190.
UNDERTAKER C. H. Molloy
ADDRESS
Paule Mars
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
190 ℃ .. to
april 30 908 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 : Organic desene 1 heart-
over two years (DURATION). .... DAYS
Contributory :
.. (DURATION). ........... DAY8
(Signed).
I & Varney
.M.D.
190.8. (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 2
1908
Edward Rotting
Com 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 Institutlon, 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.
ALL NAMES TO BE IN FULL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mc. Jeaque
Registered No.
33
Place of l
Highland and
Date of ¿
april 30
.1908
Death * S
Death
S
Residence
nº Chelmsford
Age
60
... months ....
-
.days
... years.
33
COMMONWEALTH OF MASSACHUSETTS
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME Joseph &. Harrow.
(CITY OR TOWN.)
34
.Registered No.
Place of l
Groton Road, No. Chelmsford.
Death * S
Residence
Groton Road, No. Chelmsford.
. Age
35
.years.
1
4
months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single.
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACE#
St. Johna New Brunswick.
NAME OF
FATHER
hoe. B. Farrow.
BIRTHPLACE
OF FATHER$
New Brunswick.
MAIDEN NAME
OF MOTHER
Mary A. Snow.
BIRTHPLACE
OF MOTHER #
New Brunswick.
OCCUPATION
Derrick Rigger.
INFORMANT §
Carrie B. Orgalle.
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from af. 25 190 & ... to apr. 30, 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 : Pneumonia
(DURATION)
6
.. DAYS
Contributory :
(Signed)
H & Varney
M.D.
af. 30 190.
0.8 (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
1908
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
PLACE OF BURIAL OR REMOVAL !!
Riverside Cemetery
North Chelmsford.
DATE OF BURIAL
May 2
190.
8.
UNDERTAKER
Gro. Nr. Healey.
ADDRESS
79 Branch It.
34
Date of ¿
April 30.
.. 190 8.
...
Death )
(DURATION). .... DAY8
-
1
COMMONWEALTH OF MASSACHUSETTS.
35
CITY OF BOSTON. 4179
FULL NAME
Arthur Wright
Registered No.
Place of Death l
Boston
Ambulance of Div.3, Boston Police Dent
and Residence S
Date of Death
Mar 21
1908.
Age
20
years
.. months.
12
.days.
STATISTICAL DETAILS.
PHYSICIAN'S CERTIFICATE.
SEX
COLOR
SINGLE, MARRIED, WID., DIV.
M
S
I HEREBY CERTIFY that I attended deceased during last illness,
from ... 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 :
Maiden Name
ST
T PATRIBUN. SITD
Primary (Duration)
Pistol shot wound of head
Husband's Name ........
SI
IFICE:
(Suicidal)
BOSTONIA CONDITA AD.
Name of
Olin L Wright
Father
Birthplace of Father
Westford
Contributory : ( (Duration)
Maiden Name Mary J Ross
of Mother.
Birthplace of Mother
Rockland N B
(Signed) Geo. B. Magrath, Med . Ex M.D.
Mar 21
908.
....
SPECIAL INFORMATION from Hospitals, Institutions, Transients, or Recent Residents.
Informant
.....
Place of Burial
Concord"Sleepy Hollow
Usual Residence.
No. Chelmsford (3 Shaw Ave )
or removal.
E W Blossom
May 6
Undertaker Blossom Undertaking
1908.
Filed A true copy. Attest : ErMSlenen
Registrar.
MARGIN RESERVED FOR BINDING.
RAR'S
Birthplace Acton
CITY
CTYTTAT
A A, 1822; TISREGIMINE DONATA A. . MAS.S.
BOSTO
Coachman
Occupation
RETURN OF A DEATH-1908.
-PP-H7530 4 39 WHO
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Registered No.
36
Place of l
Date of ¿
Death * 5
Death 1
190
Residence
Age
1
.years.
1
months .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER
BIRTHPLACE OF FATHER #
MAIDEN NAME OF MOTHER
.
BIRTHPLACE OF MOTHER $
OCCUPATION
)
INFORMANT §
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from april 26. 1908 to april 30 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 : Brocha- Fneumonia
0
(DURATION)
6
DAY8
Contributory :
(DURATION). ...... DAYS
(Signed)
1. H. May
M.D.
May 1 1908 (Address)
141 Parhunddet 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 may 1 1908. Edward J. Rolling
Clerk
PLACE OF BURIAL OR REMOVALH
DATE OF BURIAL
Chelmsford
1
190.
UNDERTAKER
ADDRESS
* 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. li Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
36
30
COMMONWEALTH OF MASSACHUSETTS
3%
RETURN OF A DEATH
(CITY OR TOWN.)
37
Place of l Checkfrellentre
Death * 5
Residence:
Chelmsford
Age
61
.. years ..
6
.months. 14 .days
STATISTICAL DETAILS
SEX Manuale
COLOR White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME }
Lucy & Hagen
HUSBAND'S NAME t Eben B Marshall
BIRTHPLACE # Mat Lebanon H.H.
NAME OF FATHER Sanford Hagen
BIRTHPLACE OF FATHER# Hartford Of.
MAIDEN NAME OF MOTHER Sarah Word
BIRTHPLACE OF MOTHER # Mot Salomon NH.
OCCUPATION
Housewife
INFORMANT §
PLACE OF BURIAL OR REMOVAL II Forefathers Com. Chellisting
DATE OF BURIAL
May 7
190.& ...
UNDERTAKER Walter Perhan
ADDRESS
Chelustro
PHYSICIAN'S CERTIFICATE
[ HEREBY CERTIFY that I attended deceased during last illness, from. apr. 29 1908 to may 6 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 : Genebro - Spinal Primary :
meningitis
. (DURATION).
8
DAYS
Contributory :
4. ( DURATION) .DAYS
(Signed) ...
Amara Howard
M.D.
May 7 1908 (Address)
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 May 7 1908 Edward Nothing
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, givo 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
FULL NAME ..
Lucy Elizabeth Marshall
Registered No.
Date of May 6 1908
Death )
1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
STATISTICAL DETAILS
SEX tiencale
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE +
Chelmsford.
NAME OF
FATHER
Samuel L. Felch
BIRTHPLACE OF FATHER+ Westford
MAIDEN NAME OF MOTHER Estelle & Hutchinson
BIRTHPLACE
OF MOTHER#
Chelmsford
OCCUPATION
INFORMANT § Saml & Helch
PLACE OF BURIAL OR REMOVAL II Fairview Com. Westford.
DATE OF BURIAL
May 16
1908
UNDERTAKER Walter Perla.
ADDRESS
Chelungul
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from alix. 2/ 1908 to May 14 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
Contributory :
Bronchitis
.(DURATION)
23
DAYS
(Signed).
M.D.
120 mg 14 90 3 (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 many 15 1908. Edward Polline
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, Il Name of cemetery.
ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
=
38
Chelmsford
RETURN OF A DEATH
(CITY OR TOWN.) 38
FULL NAME
Place of l
Chelmsford
Death *
5
Residence
Chelenford
Age
.. years
3
.months.
.days
Gertrude Estelle Helch
Registered No ..
Date of
May 14
1908
Death
S
(DURATION)
.DAYS
COMMONWEALTH OF MASSACHUSETTS
39
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
mary
Wood
Registered No ...
431
Place of 2
Chelmsford Centre
Death *
S
Residence
Chelmsford mass
Age
6 3
.. years.
.months. .................. days
STATISTICAL DETAILS
SEX
COLOR
Female white
SINGLE, MARRIED,
WIDOWED, ORL
'DIVORCED
married
MAIDEN NAME Ť mary adamson
HUSBAND'S NAME +
James W vo
BIRTHPLACE # England
NAME OF FATHER Thomas adamen
BIRTHPLACE OF FATHER+ England
MAIDEN NAME
OF MOTHER
martha Hadfuld
BIRTHPLACE
OF MOTHER#
England
OCCUPATION
at- home
INFORMANT §
Husband
PLACE OF BURIAL OR REMOVAL I!
DATE OF BURIAL Edson Cemetery May. . 190.8
UNDERTAKER bin. young
ADDRESS
33 Prescott)
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from choler
190 ..... to May 24h- 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 : Cancer
(DURATION).
Contributory :
.(DURATION).
. DAY8
(Signed).
T. Laws
M.D.
may 2504
546 Mudd levere ST
190.0 .(Address)
SPÉCIAL 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 ?.
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