USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 5
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Primary : Desense of heart sice diey
3 or 4 years
.(DURATIONS. . DAYS
Contributory
. (DURATION). ... DAYS
(Signed)
JE Varney
1 ... M. D.
..
. 190 .... (Address). n. Chillwerden.
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 any 17 .190 & Edward J. Robbins
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.
John A Wenback So Middles per game
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
RETURN OF A DEATH
FULL NAME
Ja
James William Odell
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL.
1
COMMONWEALTH OF MASSACHUSETTS
Gamere
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
george
George W. Chamberlain
.. Registered No.
229
Place of l
Jamere Insane Herapital
Death *
5
Residence
Dobrelinaford
Age
82
.. years ..
.months
.days
STATISTICAL DETAILS
SEX
16
COLOR
VY.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Harried
MAIDEN NAME Ť HUSBAND'S NAME Ť
BIRTHPLACE # action, please.
NAME OF
FATHER
BIRTHPLACE
OF FATHER+
Acton . Hase-
MAIDEN NAME
OF MOTHER
abigail adame
BIRTHPLACE
OF MOTHER #
Stone House-
OCCUPATION
Farmer, miner, Saleemans
INFORMANT § Katherine &. Dowdell
PLACE OF BURIAL OR REMOVAL II
Temple, V.H.
DATE OF BURIAL
ang. 23 08
UNDERTAKER
1.r. H. Leurby
ADDRESS Janvire. Daca
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. July
190.0 ... to Dung. 23 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 :
Inserting
Dencial make
(DURATION). .. DAYS
Senile Sementrá
Contributory :
3-5 Leave-
(DURATION). ........... DAY8
(Signed)
"Ichas. 19. Sullivan
M.D.
aug. 24 1908. 190% (Address)
Hachome back.
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. 1908 1900 Julia Deale
. 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
Date of l
Unng. 23
.1908
Death
٦١ ٨٣٥١
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE#
NAME OF FATHER idoltine ; + netto
BIRTHPLACE OF FATHER$
inacía
MAIDEN NAME OF MOTHER Georgina Marin-
BIRTHPLACE OF MOTHER#
Canada
OCCUPATION at home
INFORMANT § Georgiana Moselle
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, fro Det.6 1908 to to
Vett. 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 :
1
6
(DURATION).
.DAY8
Contributory :
·(DURATION) ... ........ DAY8
(Signed)
J. K. Lage
M.D.
Seht.9 1908 (Address) to. Thewindward Mars
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: 10
198 Edward & Robbing
... 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.
55
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Hirelto
Registered No.
Place of )
farthchelmsford Plass
Date of ¿ Sept 80A 908 Death
Death *
..
5
Residence
Age
1
years.
.. months
12 .days
STATISTICAL DETAILS
PLACE) OF BURIAL OR REMOVAL II artaseph 4 enelery
DATE OF BURIAL
190 ..
UNDERTAKER
ADDRESS
Enver, A
COMMONWEALTH OF MASSACHUSETTS
55
SEX 11
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.) 14:33
FULL NAME
Place of
Death * S
Residence
Chelmsford mars.
Age
24
.. years
.months.
.days
STATISTICAL DETAILS
SEX 7.
COLOR
11.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
m.
MAIDEN NAME Ť
HUSBAND'S NAME +
Marklin Omur Lavare
BIRTHPLACE# Lowell
NAME OF
FATHER
James Mullin
BIRTHPLACE
OF FATHER#
Irland
MAIDEN NAME OF MOTHER
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION at Home
INFORMANT S Hanstand
PLACE OF BURIAL OR REMOVAL !!
DA Patrich Bem Lour
DATE OF BURIAL Exp 14 190 .. 0.
UNDERTAKER
1
0
ADDRESS Lowell
PHYSICIAN'S CERTIFICATE
I HEREBY /CERTIFY that I attended deceased during last illness, from Lub.11 1900 ... to Ust. 11 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 :
Cerebral Thrombosis
(DURATION).
.. DAYS
Contributory :
Valvular dicare of Heart
(DURATION)
. DAYS
(Signed)
Loc V. meigo
M.D.
NA 12 90
8 (Address)
168 Munmack
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 Sep 14 908 Grind, Hadmars
City Clerk
* 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. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
16.
.Registered No.
Date of ¿
D.p. 11
8
Death 1
190
ILgauran
+
36
.....
COMMONWEALTH OF MASSACHUSETTS
57
RETURN OF A DEATH
(CITY OR TOWN.) 57
FULL NAME
arthur Scoloria
Registered No.
Place of l
South Chelmsford
Date of l
Seht. 17
1908
Death
.. years.
10
.. months.
8
.days
STATISTICAL DETAILS
SEX
COLOR
male White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE # St Johns n B.
NAME OF
FATHER
John Scoloria
BIRTHPLACE OF FATHER# England
MAIDEN NAME
OF MOTHER
Edith Lower
ower
BIRTHPLACE
OF MOTHER#
England
OCCUPATION Carpenter
INFORMANT § John P. Scoloria
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 .. to
Sept. 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 : Crostatine Disease
Indefinite
(DURATION).
DAYS
Contributory :
(Signed)
Antan G. Scolonia -
(DURATION) ........ DAY8
M.D.
Sich 18, 908 (Address) Chilis food, Miles.
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. 18
1908
(Odnard) Raffina
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 Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # Stato or country; also city, town or county, If known.
§ Name and address of person giving statistical details.
ADDRESS
58 Prescott 97me of cemetery,
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
PLACE OF BURIAL OR REMOVAL II Heart Pond Cem.
DATE OF BURIAL
Sept 2 0 1008
UNDERTAKER
J. B. Currier Co
Death * S
Residence
"
Age
69
COMMONWEALTH OF MASSACHUSETTS
58
RETURN OF A DEATH
(CITY OR TOWN.)
Registered No/ 23>
5 Date of Sept. 17 1908
Death ,
ʻ
Age.
.. years ..
months.
.days
STATISTICAL DETAILS
SEX
COLOR
Firmala Ithuta
OTRYGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
Elizabeth miller
HUSBAND'S NAME t John Part
BIRTHPLACE # Lowall Mass
NAME OF FATHER
Javanas miller
BIRTHPLACE OF FATHER# Oveland
MAIDEN NAME OF MOTHER many murray
BIRTHPLACE OF MOTHER + Oraland
OCCUPATION at Home
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL II Edson Pametery
DATE OF BURIAL
Sept 2008
UNDERTAKER
ADDRESS
7. 9. Higgmot fo Kewell maso
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Sept. 11 .. to 1908 Sept. 17, 1900; 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 : Dysentery
.(DURATION) ............. DAY8
Contributory :
(Signed) ..
Anche G Scolina
... (DURATION). .... ... DAY8
.M.D.
Sept. 18, 1908 (Address) Chalusford, Mais,
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
Sehit. 19
8 Eduard 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 details. 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, Elizabeth form
Place of ) South St. Chelmsford Panter Man Death * 5 .
Residence
١
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
male
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME
BIRTHPLACE # Lavell Mars
NAME OF FATHER alexis L. Fecteau
BIRTHPLACE OF FATHER# Iparada
MAIDEN NAME OF MOTHER Heillie Langlois
BIRTHPLACE OF MOTHER +
(Canada)
OCCUPATION Lavell maggie
INFORMANT § Father
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL Chefe1-22 1908
UNDERTAKER
ADDRESS
738
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Sifet. 2 190 ℃ .. to Sept. 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: Dysentery -
(DURATION). 17
DAY8
Contributory :
(Signed).
Anh & Sarkana
.. (DURATION). . DAY8
M.D. Jeg1, 20,1908 (Address)Cehelma Road, MAco
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 Sept.21
1908
Edward V. Robbing
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. Inga 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.
59
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
59
Registered No ..
Place of l
Ghehnfard Center
Date of ¿
Death
190
8
Death *
S
Residence
Manew Ara Chelunford Centroga
years
.months. N
days
FULL NAME
Samuel P. Fecteau
14
COMMONWEALTH OF MASSACHUSETTS
60
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME asa
Swain
Registered No. 431
Place of
Chelmsford mass
Date of l
Death Left 19, 1908
Death *
..
5
Residence
Chelmsford mass
Age
78
.years.
.months .. ................... days
STATISTICAL DETAILS
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
married
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Sanborton n. H.
NAME OF FATHER ala Suain
BIRTHPLACE OF FATHER+
na
une
MAIDEN NAME OF MOTHER Lydia Justin
BIRTHPLACE OF MOTHER # Sanborton n. H.
OCCUPATION Inventor
INFORMANT § Widow
PLACE OF BURIAL OR REMOVAL II Edson Gernetery
DATE OF BURIAL depat 21 1908
UNDERTAKER ADDRESS Lo. m. Song 33 Prescott ymy
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from .. Sekt 14 1908 to Lebt, 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 : Cerbral Hemorrhage
5
(DURATION). DAY8
Contributory :
(DURATION). .. DAYS
(Signed
af Fischer G. Scobona
.M.D.
Lift 21, 1908 (Address) Chelmsford Modo.
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
Seht, 21
1908 Edward Rolfing
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 clty, town or county, if known.
§ Name and address of person giving statistical details, ILName of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
6
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
COLOR
Minutt; MARRIED, WIDOWED, OR
MAIDEN NAME Ť
HUSBAND'S NAME +
Helind Have Ohlen
BIRTHPLACE # Solvesborg Surdes
NAME OF FATHER Sauce Tartare.
BIRTHPLACE OF FATHER# Swide
MAIDEN NAME OF MOTHER
Marina. Repo
BIRTHPLACE OF MOTHER # Sivedere
OCCUPATION a
INFORMANT §
ampada R Lugar
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from an. 20 art.2 190.8. to 1908, that to the best of my knowledge and belief death occurred ou the date stated above, and that the CAUSE OF DEATH was as Tonoy
Primary : Cancer of bladder
8 months
(DURATION)
Contributory :
acr
.(DURATION). ... DAY 9
(Signed). amaca toward M.D.
out 2
190 ..... (Address)
Chamafinal
SPECIAL INFORMATION only for Hospitals, 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 Oct. 5, 19.º. Edu 1908.
Clerk
* City or town, street and number, if any. If death cours away from USUAL RESI- DENCE, give facts called for under "Special information," If in a Hospital ort 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.
----
Date of {
Death * 5
Death S
Oct 20106
Residence 1
1
.Age
.years. 9
months
6
days
(CITY OR TOWN.)
FULL NAME
RETURN OF A DEATH Helen J. Ohlson
.Registered No., 61
Place of ) East Chelmsford Mass
6
COMMONWEALTH OF MASSACHUSETTS
PLACE OF BURIAL OR REMOVAL II Edson Cemetery
DATE OF ORIAL Oct 5 8
UNDERTAKER
Winback
ADDRESS 80. Widde
73
SEX Female What
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Lucinda Voce Fletcher
.Registered No.
62
Place of Death *
So Chelmsford Mare.
Date of Death
Oct 15
Age
79
. years.
1
.months
.days
STATISTICAL DETAILS
SEX Female
COLOR. White
SINGLE MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME Ť
Lucinda vose
HUSBAND'S NAME T
Benjamin M Fletcher
BIRTHPLACE #
Chelmsford Ibaes.
NAME OF FATHER Josiah Vose.
BIRTHPLACE
OF FATHER+
*== Stoughton
MAIDEN NAME
OF MOTHER
Mary Merriam
BIRTHPLACE
OF MOTHER #
Stoughton.
OCCUPATION
Housekeeper
INFORMANT § Ella M Landers.
PLACE OF BURIAL OR REMOVAL II
Hart Pond.
DATE OF BURIAL
October 17 1008
UNDERTAKER
& BCourrier Go.
ADDRESS
Lowell Mare.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended, deceased during last illness, from. MirEM 1908 to for. 15th 190.X., 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 :
+
Mintis.
(DURATION).
DAY8
Contributory :
aurio étenveis
+ autres insufficiency (DURATION)
0.5. wale
. DAYS
M.D.
(Signed)
2-05 16 1908 (Address)
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
Oct. 16.
08 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. Il Name of cemetery.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
62
10
COMMONWEALTH OF MASSACHUSETTS
63
No. Chelmsford.
(CITY OR TOWN.) 63
FULL NAME
Charles Barkman
Registered No.
Place of
} No. 6 helmeford
Death *
Residence
No. Chelmsford
Age
.years.
months.
.days
STATISTICAL DETAILS
SEX
M.
COLOR
et.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single.
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE#
Cambridge, Mace.
NAME OF
FATHER
Henry Barkman.
BIRTHPLACE OF FATHER# Cambridge, Mass.
MAIDEN NAME
OF MOTHER
Edna Miller.
BIRTHPLACE
OF MOTHER+
Auburn, A.J.
OCCUPATION No.
INFORMANT §
Henry Barkman,
PLACE OF BURIAL OR REMOVAL Ii Cambridge Cemetery! Cambridge, Mace.
DATE OF BURIAL
Oct, 25. 1908.
UNDERTAKER GeomHealey.
ADDRESS Viaranch
PHYSICIAN'S CERTIFICATE
to I HEREBY CERTIFY that I attended deceased during last illness, from 190 Oel. 23 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 :
Concrelations
Contributory :
(Signed)
JE Varney
... (DURATION)
.. DAY8
M.D.
Oct.23 908 (Address)
n. Chebukford
SPECIAL INFORMATION only for Hospitals, 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 Oct. 23
8 Edward Nothing
Clerk
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speciai Information." If In a Hospital or Institution, give Its NAME Instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, If known.
§ Name and address of person giving statistical detalis, || Name of cemetery.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
RETURN OF A DEATH
Date of
Oct, 23.
.1908.
Death
9
(DURATION)
DAY8
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
Female
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME +
Abbie J. Hurley
HUSBAND'S NAME +
Jeremiah Driscoll
BIRTHPLACE #
Ireland
NAME OF
FATHER
John Hurley
BIRTHPLACE
OF FATHER+
Ireland
MAIDEN NAME OF MOTHER
Not Known
BIRTHPLACE
OF MOTHER #
11
OCCUPATION At Home
INFORMANT §
Daughter Mrs. Nera Donahoo
PLACE OF BURIAL OR REMOVALI Lowell
St. Patrick's Cemetery
190.
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Cant 5, 1908 to. 6=1,23 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 : Care Bral Hemorrhage
from Gat 5 08 to Cat 03' DURATION)
. . DAY8
Contributory :
(DURATION). . DAY8 (Signed) James Edward Slang
M.D.
24
.190 × (Address)
322 mer, 1St.
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. 24
of Edward J. Robbins
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 giving statistical detalls. Il Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD .
COMMONWEALTH OF MASSACHUSETTS
64
Chelmsford
RETURN OF A DEATH
(CITY OR TOWN.)
64
FULL NAME
Abbia T. Driscoll
Registered No.
Place of l
Chelmsford Mass.
Date of l
Oct.23d 108
190
Death
1
Residence
85
Age
.years.
months ...
days
Death
5
11
DATE OF BURIAL
Oct 26
8
1
سيد السمنك
603
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.) 1683
Registered, No,
Date of l
Och.
28
8
190
Death *
Residence
South Chelmsford man.
Age
56
.. years
.months.
.days
STATISTICAL DETAILS
SEX
m
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
m,
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE# Ireland.
NAME OF
FATHER
John O' Brien
BIRTHPLACE
OF FATHER+
freland,
MAIDEN NAME
OF MOTHER
Nora Commars.
BIRTHPLACE
OF MOTHER #
Juland,
OCCUPATION Laborer
INFORMANT S Mrs Margaret O'Brien
PLACE OF BURIAL, OR REMOVAL !!
Dr Patrick Lem, Lowil
DATE OF BURIAL Och. 30
190.
UNDERTAKER
ADDRESS
Thomas &. M. Dermott 70 Forham &
PHYSICIAN'S CERTIFICATE
HEREBY CERTIFY that I attended deceased during last illness, from Och. 23 190 8 to Ud. 28 190. 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 : Unammonia
(DURATION).
DAYS
Contributory :
(Signed)
Peter a Golburg
-(DURATION)
.. DAYS
M.D.
Oct. 30190 8 (Address)
It Jahris Hardly
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 Och. 30 08
City
Cierk
* 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 statisticai details. Name of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
1
Dermis & O' Brien
FULL NAME
Place of )
At Johns Torskt.
Death
5
HIVE & 30 000-12
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
Female
COLOR
Whit
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME $ HUSBAND'S NAME t
BIRTHPLACE#
England
NAME OF
FATHER
John Hersen
BIRTHPLACE
OF FATHER+
Ireland
MAIDEN NAME OF MOTHER Margaret Dillon
BIRTHPLACE
OF MOTHER +
Ireland
OCCUPATION Operative
INFORMANT §
Sister Ellen Herson
PLACE OF BURIAL OR REMOVAL Il
St . Patrick'sCemetery
DATE· OF BURIAL
Oct 31
8
190 ..
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from Sucht. 7 .1906 to Get. 29, 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 :
Chronic
Bronchitis
4 months
(DURATION) DAY8
Contributory :
Pulmonary Congestion
(DURATION). 5- . DAY8
(Signed)
Jas.
J. Hobar
M.D.
6+30
€
.190 .. 2. (Address).
no
Dralunsford.
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
2/3
years. .... ..........
months ..
..................... days
Where was disease contracted, if not at place of death ?.
Filed
Oct. 30
208. Edward & Robbin
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.
66
Chelmsford
l'ass.
(CITY OR TOWN.)
FULL NAME Margaret V. Herger
.Registered No.
Place of l
Death *
5
Church .... St ... North ... Chelmsford
Death
Oct.29 '08 190
Residence
Age
33
.years.
-
.months.
.days
66
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