USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 4
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Filed may 25 1908 Edward S. f.
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 detalls.
Il Name of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
Date of ¿
May 24 190 8
Death ..
S
........
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of l
Death * S
1
Residence
Chulang ford mare!
Age
23
.. years.
months
.. days
STATISTICAL DETAILS
SEX J.
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
mi
MAIDEN NAME Ť
HUSBAND'S NAME +
Brooks
Walter Jose
BIRTHPLACE #
NAME OF
FATHER
William Brooks
BIRTHPLACE
OF FATHER$
MAIDEN NAME OF MOTHER Elisabeth & howare
BIRTHPLACE
OF MOTHER #
OCCUPATION
INFORMANT § Husband.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from May 13 908. may 2/ 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 :
Cerebro Spinal Meningite
(DURATION).
r
. DAYS
Contributory :
(Signed)
la E Simpson
M.D.
may 27 1908 (Address)
Lowell Works.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
.. years.
.. months.
14
days
Where was disease contracted, if not at place of death ?.
Filed May21908 Gurand 10.Vadman
bite
Clerk
PLACE OF BURIAL OR REMOVAL !!
it ellererne quebeck
DATE OF BURIAL
May 27,90 8
190 ..
UNDERTAKER
a. Heinich
ADDRESS
* 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 detalls.
80 middleswy A Name of cemetery,
May 29,1 955
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
$28
Registered No.
Date of l
mais.
27 190 8
Death S
4
40
.(DURATION)
.... DAYS
1
٠
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
Elève
FULL NAME
Place of Death * that thatverbond, Mans
Date of Death June 3rd 1908
Age
55
years
13
months
26
days
STATISTICAL DETAIL
SEX Female
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + Olive Thomas
HUSBAND'S NAME Napolion Jemay
BIRTHPLACE #
Canada
NAME OF FATHER
Jeseph thomas
BIRTHPLACE OF FATHER #
Canada
MAIDEN NAME OF MOTHER
Not Nur
BIRTHPLACE OF MOTHER #
Canada
OCCUPATION House Jeper
INFORMANT S Napo Jemmay
PLACE OF BURIAL OR REMOVAL IN
DATE OF BURIAL 50kg .... 190 ..
Theline fond line
UNDERTAKER Tough Letter
ADDRESS
or Pheemen
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 of follows :
Primary : Myocarditis Maplintia
?
(DURATION) DAYS
Contributory
. (DURATION). ... DAYS
(Sighed)
# E. Vaney
.M. D.
June 3 5.1908 .. (Address). ... No, Evelinford. 07:15
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 June 4 190 8 Edward Rotting Com Clerk.
"City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
|| Name of cemetry.
CITY OF LOWELL
41
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Registered No. 41
COMMONWEALTH OF MASSACHUSETTS
ITY 42 CITY OF LOWELL
Registered No .. 301
Place of Death *
Date of Death
Jun tune. 12 1908
Age
7.6
years.
6
months
11
days
STATISTICAL, DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME +
BIRTHPLACE #
Quewester Man
NAME OF FATHER
Enco Coro
Godfrey
BIRTHPLACE OF FATHER $
Brewster Maso.
MAIDEN NAME OF MOTHER
Hopkino
BIRTHPLACE OF MOTHER #
OCCUPATION
Retired
INFORMANT § Down Headson
PLACE OF BURIAL OR REMOVAL |1 Wakefield, Mass.
DATE OF BURIAL June 15, 1908
ADDRESS
UNDERTAKER Oliver Walton.
Wakefield, Mano.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from. May1) Para 12 8 1906.to 190. that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATHI was of follows : -
Primary :
4 works
.(DURATION) .. . DAYS
Contributory
organic desero I heard. Kleding
grol ,curata (DURATION).
.. ... DAYS
(Signed)
... M. D.
n. Chelquefort
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 ?.
Filekl June 13 190 8 Edward . Rolling
Tom Clerk.
*City or Town, street and number, if any. If death occurs away from USUAL RESIDENCE, give facts called for under " Special Information.' If in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or Country ; also city, town or county, if known.
§ Name and address of person giving statistical details.
If Name of cemetry.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
RETURN OF A DEATH
FULL NAME
Warren 2. Godfrey
North Chelmsford, Has.
m
.190 .... (Address).
How long at
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
FULL NAME
Emily
RETURN OF A DEATH Celdrich
Registered No. 1301
Place of Death *
Heat Chelmsford Apass
Date of Death 1
June 20, 1908
tus Age
72 years
6
months
21 days
L
STATISTICAL DETAIL
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Emily aldrich
HUSBAND'S NAME +
Unknown
BIRTHPLACE #
West Mylan, CA. H.
NAME OF FATHER
Unknown
BIRTHPLACE OF FATHER Į Unknown
MAIDEN NAME OF MOTHER Unknown
BIRTHPLACE OF MOTHER ₮
Unknown
OCCUPATION at home home
INFORMANT § Mas Mandode Me Kenson
PLACE OF BURIAL OR REMOVAL !! Edson Cemetery.
DATE OF BURIAL June 2.5 190 8
UNDERTAKER L. a. Weinbach
ADDRESS
80 Middr. St.
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 of follows :
Primary :
Hepatic erlee
36 hours
. (DURATION) DAYS
Contributory
.(DURATION).
. . DAYS
(Signed)
June 2/ 190 8 (Address).
..
n.Chiliurfen
.. 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
June 23
.190
8. Samand . Bobbing
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.
CITY OF LOWELL
COMMONWEALTH OF MASSACHUSETTS
43
8
COMMONWEALTH OF MASSACHUSETTS
Chelmsford
44
164611
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME William Fay
Registered No.
Date of ¿
June 28 8
190
Death *
5
=
Residence
Ag
.years.
.. months ..
.days
STATISTICAL DETAILS
SEX
Male
COLOR
Whit
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACE#
Lowell Mass.
NAME OF FATHER
John Fay.
BIRTHPLACE OF FATHER#
Ireland
MAIDEN NAME OF MOTHER
Bridget Larney
BIRTHPLACE OF MOTHER +
Ireland
OCCUPATION
Farmer
INFORMANT § Wife, Mrs. Bridget Fay
PLACE OF BURIAL OR REMOVAL II
Lowell
St.Patricks Cemetery
DATE OF BURIAL
June 29
8
190.
UNDERTAKER J.F.O'Donnell & Sons
ADDRESS
324 Market St
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Jan.
190 & .. to June 28 .190.8 .. , that to the best of my knowledge and bellef death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary ; Pernicious anaemia1.
8 mos
(DURATION).
. DAYS
Contributory :
Chronic Bronchitis
(DURATION). DAY8
(Signed).
Amasa Stoward
M.D.
June 29
190.2 (Address)
Chilmetord
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 June 29
198 Edward J. Potom
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 l
Chelmsford Centre
Death S
47
-
?
COMMONWEALTH OF MASSACHUSETTS
45
RETURN OF A DEATH
FULL NAME Mabel Pearl Deverill.
Place of l
Death *
5
Chelmsford Center
Date of ¿
Death
Residence
29 G. r. owell, Mace
a Age
15
.. years.
.. months
16
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, - WIDOWED, OR DIVORCED
Single
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE# Lowell, Mass.
NAME OF FATHER Maynard J. Deverill.
BIRTHPLACE OF FATHER# Halifaxe. A. S.
MAIDEN NAME OF MOTHER Bertha Snow.
BIRTHPLACE OF MOTHER # Halifax. A.S.
OCCUPATION School Girl.
INFORMANT § Bertha Pnow.
PLACE OF BURIAL OR REMOVAL II Educated Cemetery July 310.89
UNDERTAKER
Groft. Healey.
ADDRESS 79 Branching
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Joue 8, 1908 to Mels 1, 195. 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 :
Unphong thekiss.
about 3ups/5 (DURATION)
..... .. ... . .. DAYS
Contributory :
.(DURATION). .... DAYS (Signed) Anhu & Sedlena.
M.D.
Yry 2,1908 A .. (Address) Chicanations max
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Piace of Death ? ........ years. 1 months. ... days
Where was disease contracted, If not at place of death ?
Filed July 2 08. Edward S Roffins
Clerk
Town
* 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
1
Chelmsford benter (CITY OR TOWN.) 45-
Registered No.
July 1, 1908
3
DATE OF BURIAL
1
ONUNIS &C
L
L
L
(
COMMONWEALTH OF MASSACHUSETTS
46
Chelmsford
(CITY OR TOWN.) 46
Place of }
Death * Chelmsford
Residence
Chelmsford
6
Ag
.years
6
.months.
19
.days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED,
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACE #
Chelmsford
NAME OF
FATHER
Oliver Eriksen
BIRTHPLACE
OF FATHER#
Norway
MAIDEN NAME OF MOTHER Mina Peterson
BIRTHPLACE
OF MOTHER #
Norway
OCCUPATION
INFORMANT § Oliver Eriksen
PLACE OF BURIAL OR REMOVAL !!
Pine Ridge Cem.
DATE OF BURIAL
July5
- 1908
UNDERTAKER Walter Derham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during-leet
illness, from 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 : Qceceless
Primary :
Lightning Shake
(DURATION). ........ .... .. DAYS
Contributory :
(DURATION) .DAYS
(Signed)
f.V. Mery associate Medical Exam
July 3 1908 (Address) 160 Mammack In
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
5
.190.
8. Edward & Rotting
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.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
RETURN OF A DEATH
FULL NAME
Olaf Elroy Eriksen
Registered No.
Date of ¿
July2
1908
Death S
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Lavell 47
(CITY OR TOWN.) 4%
Place of l
Date of l
Death * S
Residence
614 Market SI Lowell Man
(35
.years.
months.
.................. days
STATISTICAL DETAILS
SEX
Male
COLOR
state
SINGLE, MARRIED, WIDOWED OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME t
BIRTHPLACEİ
NAME OF FATHER John Coucoumbos
BIRTHPLACE OF FATHER# Greece
MAIDEN NAME
OF MOTHER
Dontnon
BIRTHPLACE
OF MOTHER #
OCCUPATION Mill operative
INFORMANT S
Thomas Fechagas
PLACE OF BURIAL OR REMOVAL !!
UNDERTAKER Gazon Cem
DATE OF BURIAL
Juli: 14,
08
ADDRESS
Forthe Closest 57 her Name of cemetery,
1
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Inly 10. 1908 to Inl 10 905 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 :
(Pulmonar.
5
(DURATION). . DAYS
Contributory :
(DURATION) .. .DAY8
(Signed)
& Ruthie Lage
M.D.
July 13
00 8 (Address)
6 H Central SI
SPECIAL INFORMATION only for Hospitals, 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
July 13
198 Edward Robbins
Corn 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
FULL NAME
Danteles boutsouvirs
Registered No.
July 13en 908
Death
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
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 :
Veritonitis
Contributory :
abscess of Liver
.. (DURATION))
(DURATION)
.. DAYS
(Signed)
d. V. Meigs
M.D.
July 22 1908
.. (Address)
16. Merrimack It
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
... years.
months
/2
.days
Where was disease contracted, If not at place of death ?
Filed Fairly 22 19of Girard Vai
City
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 clty, town or county, if known.
§ Name and address of person giving statistical detalls.
11.8
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Sarah Gaudette
1113
Place of ) At Johnis Workt.
Death *
5
Grotten Road no. Chelmsford man
43
Age
.. years.
. days
STATISTICAL DETAILS
SEX y.
COLOR
I.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Coté
HUSBAND'S NAME + Lectance Saudette
BIRTHPLACE# Canada.
NAME OF
FATHER
Cyprien Coté
BIRTHPLACE
OF FATHER+
Canada
MAIDEN NAME
OF MOTHER
Dormitile Valenais
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
House work
INFORMANT S Husband
PLACE OF BURIAL OR REMOVAL !!
DATE OF BURIAL ?
DeJoseph Game Chelmsford July 2400$
UNDERTAKER
a. Archambault
ADDRESS
1738 Messinach Name of cemetery,
Registered No.
Date of ¿
July 22 1908
Death
1
.months.
~
Residence
MAIDEN NAME +
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL.
FULL NAME
Piace of Death * ninh Chelisting
Date of Death. fairly 26 - 08
Age.
Stillben
years.
months days
STATISTICAL DETAIL
SEX
COLOR
Wick
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE Nord Chelucfeny,
NAME OF FATHER
Fred & Blodgett
BIRTHPLACE OF FATHER Treat ford
MAIDEN NAME OF MOTHER Selina Bredateni
BIRTHPLACE OF MOTHER # England
OCCUPATION
INFORMANT § Fred & Blodgets
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
190
ADDRESS
UNDERTAKER (1/21/FolTe
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from 190. to parlay 26 190 8 that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATHI was of follows :
Primary :
Stillborn
Contributory
.(DURATION) ... DAYS
(Signed)
July 26
n. Chilisferd
1900 ... (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Former or Usual Residence .. Place of Death ? . Days
Where was disease contracted, if not at place of death ?..
Filed July 26
.190
8 Edward S. Poibing
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 inarried 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.
49
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Blodgett
CITY OF LOWELL 49
Registered No ...
1
. (DURATION) DAYS
.M. D.
How long at
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
4
STATISTICAL DETAILS
SEX Male White COLOR
SINGLE, MARRIED, WIDOWED OR DIVORCER Married iu
MAIDEN NAME
HUSBAND'S NAME t
BIRTHPLACE# England
NAME OF FATHER
Elisha J. Brake
BIRTHPLACE OF FATHER$
England
MAIDEN NAME OF MOTHER Harriet Legros
BIRTHPLACE OF MOTHER+
England
OCCUPATION Storia Cute
INFORMANT §
Elisha J. Brake
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that Latter osasod during fast
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 : Suicide
Distil that would the Bracket
Contributory : ....
( DURATION) . DAY8
(Signed) .. TU Meigs Medical Examines July 2) 190g (Address) 160 Themnack L.
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
July 28
1908 Edward S. Robbins
Down Clerk
PLACE OF BURIAL OR REMOVAL II Www. Chelmsford
DATE OF BURIAL
July 25,0 8
UNDERTAKER
J. a. Weinbuck
ADDRESS
To huddlesy
* 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.
ALL NAMES TO BE IN FULL
50
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH Elisha P. Braks
(CITY OR TOWN.)
Registered No. 50
Place of l
No. Chelinford Mais
190
Date of l
July 26
8
Death \
Residence
No. Chelmsford
Age
29
.. years. 6 ml months. .days
FULL NAME
Death *
S
1
٠٠
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of l
Checranford
Date of l
Death *
S
Residence
no. Chelmsford
Age
3
.years. 56 ... mouths. .days
STATISTICAL DETAILS
SEX male
COLOR White
SINGLE, MARRIER WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
No. Chelmsford
NAME OF FATHER Elisha P. Brake
BIRTHPLACE OF FATHER+
England
MAIDEN NAME OF MOTHER ada Decarteret
BIRTHPLACE OF MOTHER #
England
OCCUPATION
INFORMANT § Elisha
J Brake
PLACE OF BURIAL OR REMOVAL !! W. Chelmsford
DATE OF BURIAL July 28 1908
ADDRESS
J. a. Winbeck# 80 middlesy Rt
PHYSICIAN'S CERTIFICATE
HEREBY CERTIFY the tandad
wing last
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 ; Distal That hound of being
(DURATION).
DAYO
Contributory :
(DURATION). . DAYS
(Signed). Y.V meny Medical Examens
Thay 27 1908 (Address)
1611 Thesnack The
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 July 29
190:
08 Edward Jobbing
Clerk
Jour
* 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.
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 details. Name of cemetery.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD .
51
Walting Brake
Registered No. 5/
Death )
July 27 1908
-
٠٠٠
COMMONWEALTH OF MASSACHUSETTS
52
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Edward Legande
.Registered No.
52
Place of l
north chel
Death *
S
..
Residence
Age
92
.. years
.. months.
days
STATISTICAL DETAILS
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR- DIVORCED-
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE #
Canada
NAME OF FATHER
BIRTHPLACE OF FATHER#
Canada
MAIDEN NAME OF MOTHER Unknown
BIRTHPLACE OF MOTHER+
Lanac anadta
OCCUPATION Retireel
INFORMANT § Mrs. Emma La france.
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
St. Patricks cemeter l, Mand Jules 31 1908
UNDERTAKER J.S. Wolton
ADDRESS No Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
July 22
190 8 to
199. ... , 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 :
Nemuplegia
(DURATION).
DAYS
Contributory :
(Signed).
FP Jagu
M.D.
(DURATION). .......... DAY8
/1930 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 July 31 08 Eduard & Rabbins 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. 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
Death
July 29
.190
COMMONWEALTH OF MASSACHUSETTS
CITY 53 OF LOWELL
53
Registered No.
Place of Death *
No Chelmsford
Date of Death
11 aug 15
Age
79
years
months ..
28
days
STATISTICAL DETAIL
SEX
COLOR
Male White
SINGLE, MARRIED, WIDOWED, OR- DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE ₮ King Co N.B.
NAME OF FATHER Kat Knows
BIRTHPLACE OF FATHER #
-
V
MAIDEN NAME OF MOTHER
1 1
BIRTHPLACE OF MOTHER #
-
OCCUPATION
(Frames
INFORMANT S Mrs C 2° De Rachu
PLACE OF BURIAL OR REMOVAL II
DATE OF· BURIAL Westford mon ary 18
. 190.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from Guy 15 1908 Aug 15 .to 190. that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was of follows :
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