USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 6
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Date of ¿
11
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
67
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Rosanna Maquine
67
Registered No.
Place of l
Highland St Ho chemeford
Date of ¿
Och 30 190 8
Death
Residence
Highland Stro Checked
Age
68
.years
months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE MARRIED, WIDOWED, OB DIVORCED
MAIDEN NAME T Rosanna MiLeague
HUSBAND'S NAME Ť Bernard maguire
BIRTHPLACE # Ireland
NAME OF FATHER Peter Me Leagui
BIRTHPLACE OF FATHER+ Ireland
MAIDEN NAME OF MOTHER Man elisper
BIRTHPLACE OF MOTHER # Deland
OCCUPATION at Home
INFORMANT § Husband
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190 ..... to Del.18 Qel.34 190 .. 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 :
Cholo cyclitis
.
3mm 4 mesas
(DURATION) . DAY8
Contributory :
gull bence
nicy years
.(DURATION) ........ DAY8
FE Varney
/ .. M.D.
(Signed).
Del 31
190 (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
Oct2. 30
190 8 Edward te Potting
Clerk
PLACE OF BURIAL ÓR REMOVAL !!
DATE OF BURIAL
190
ADDRESS
5
* 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.
20 Gahan | Name of cemetery,
-
-
UNDERTAKER Theo IM Dermat
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Death * 5
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
(CITY OR TOWN.)
1 Utta. V. Hood
FULL NAME
Place of }
t"
Lowell Gent, Nosft.
Date of l
nas.
8
Death
Residence
North Chelmsford mais
Age
.. years
months.
days
STATISTICAL DETAILS
SEX
T.
1
COLOR
1.
SINGLE, MARRIED, WIDOWED, OR DIVORCED
1
MAIDEN NAME +
Smith
HUSBAND'S NAME +
Daniel (1, Hood
BIRTHPLACE #
Perdusking me
NAME OF
FATHER
alexander Smith
BIRTHPLACE
OF FATHER#
Bath me
MAIDEN NAME
OF MOTHER
Elisabeth Fackrow
BIRTHPLACE
OF MOTHER +
Unknown
OCCUPATION Cet Homme
INFORMANT § Husband
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 : Labar Inarmonia
Contributory :
(Signed)
Ralph b. Alwart
(DURATION)
. DAYS
M.D.
now. 121 00 8 (Address) Lowell Mind. Markt
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
new.3
1908 Eurora , Vadman
buty
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 detalls. II/ Name of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
PLACE OF BURIAL OR REMOVAL !!
Odsonly Lowill,
DATE OF BURIAL
8
190
UNDERTAKER 2. a. Weinbeck
ADDRESS
68
RETURN OF A DEATH
Registered No ...
1699
Death *
190
(DURATION).
DAY 8
DU MOMENT
:
COMMONWEALTH OF MASSACHUSETTS
Chelmsford 69
(CITY OR TOWN.)
69
Registered No.
Place of )
Chelmsford Mass
Date of l
Nov. 14
1908
Death 1
Residence
Chahmsfuld
Age
years.
months.
.days
STATISTICAL DETAILS
SEX
Female
COLOR
White
SINGLE, MARRIED,
DIVORCED Single
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE #
Chelmsford Mass
NAME OF
FATHER
John Flawell
BIRTHPLACE
OF FATHER#
Engformal
MAIDEN NAME
OF MOTHER
Calharna Denabey
BIRTHPLACE
OF MOTHER#
eraland
OCCUPATION
INFORMANT § John Flewell
PLACE OF BURIAL OR REMOVAL II
St-Paths Century
Lawell mais
DATE OF BURIAL
1av. 16,
8
190
UNDERTAKER
Juli 7 Pages
ADDRESS
495 Gorham Le-
Lawell Mass
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from nov. 15 1908 to Nov. 151908, 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 : Still born.
. (DURATION) ...... . DAY8
Contributory :
(DURATION).
DAY8
(Signed).
Amaca ) toward
M.D.
Duv. 15 90
.. 190 8 CAO
.. (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
Nov. 15
308 Edward , 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. Il 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
Flanell
FULL NAME
Death *
1
1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF À DEATH
(CITY OR TOWN.)
FULL NAME Anastasia 3. Thompson
Piace of l
Death *
5
Church St. North Chelmsford
Death
S
.. months.
days
STATISTICAL DETAILS
SEX
Fomale
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME t
HUSBAND'S NAME +
BIRTHPLACE + Kingston Prince Edward Island
NAME OF FATHER
John Thompson
BIRTHPLACE
OF FATHER#
Newfoundland
MAIDEN NAME
OF MOTHER
lary Murphy
BIRTHPLACE
OF MOTHER+
Prince Edward Island
OCCUPATION House work
INFORMANT §
Sister Mrs Frank F. Willey
PLACE OF BURIAL OR REMOVAL II LOWeII St. Patrick's Cemetery
DATE OF BURIAL
NOV 37 1908
UNDERTAKER
ADDRESS
324 Maurit VA
PHYSICIAN'S CERTIFICATE
190
I HEREBY CERTIFY that I attended deceased during last
illness, from
no. 1
18 to
.to
nov 24 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 :
Tuberculosis
24
.(DURATION).
DAY8
Contributory :
for 3 or 4 semillas previous
. (DURATION).
.. DAY8
(Signed)
I ENlainey
M.D.
nov 24 90 8 (Address)
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
NOV.25
.. 190
8 Edward Rafting
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Special Information." if in a Hospital or Institution, give its NAME instead of street and number.
t In case of married or divorced woman, or widow.
# State or country; also city, town or county, if known.
§ Name and address of person giving statistical details. Il Name of cemetery.
70
Chelmsford
Registered No. 70
Date of l
Nov.24 108
190
Residence
Age
28
.. years.
7/
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mary M. Doncrich
Place of )
Death *
5
Harrin Que, Chelmsford 72ans
Age
47
.years
.months.
.days
STATISTICAL DETAILS
SEX
4
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
Hart
HUSBAND'S NAME + John M Donough
BIRTHPLACE#
Ireland,
NAME OF FATHER John Hart
BIRTHPLACE
OF FATHER#
freland
MAIDEN NAME
OF MOTHER
Margaret "M" Donald
BIRTHPLACE
OF MOTHER +
Friland
OCCUPATION at Home
INFORMANT § Husband
PLACE OF BURIAL OR REMOVAL K De Patrich, Gem. Lowell
DATE OF BURIAL
Dec 11
190
UNDERTAKER M.r. M. Danach
ADDRESS
108 Gorham I
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that Iattended 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 :
Odhasure
(DURATION)
DAYS
Contributory :
(DURATION)
.DAY8
(Signed).
a. V. Megs M.D. Med. Exr
.M.D.
210.10 1900 (Address)
160 Merrimack
Rt
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 De0,11 1908
Dily
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
Registered No.
1872
Date of ¿
Dec 6 or 7
190 8
Death
Residence
=
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
Inale
COLOR
White
SINGLE, MARRIED, WIDOWEDA OR DIVORCED Married
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE # maine
NAME OF
FATHER
Winslow Holmes
BIRTHPLACE
OF FATHER$
Maine
MAIDEN NAME OF MOTHER Joann
BIRTHPLACE
OF MOTHER +
maine
OCCUPATION
Engineer
INFORMANT § Widow
PLACE OF BURIAL OR REMOVAL II Hermon maine
DATE OF BURIAL
Dec: 17
190 ....
8
UNDERTAKER
b.In. Young
3. 3 Prescott Name of cemetery,
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from august- 1905 .. to Dec 15 908 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 : Baconator ataxia:
he has been able to work.
Contributory :
Section of Leveditany
.. (DURATION) ... DAYS
(Signed)
La Varney
M.D.
Dee 17 1908 (Address)
M. Cheharford
...
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
DEc. 17
+ Edward Robbing
. Com Clerk
* City or town, street and number, if any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If in a Hospital or 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.
72
Sowell
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Holmes
Registered No. H 31
Place of )
north Chelmsford mass
Date of ¿ Dec 15: 908
Death *
S
Residence
Forth Chelmsford Age
71
Death 5
9
months. 5- .days
.years.
... (DURATION) ...
DAYS
ADDRESS
COMMONWEALTH OF MASSACHUSETTS
To arthur Garland 1.3.
6.20 Pensobreof los
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME 1
Elizabeth & Johnson
HUSBAND'S NAME t
John Parkhet
BIRTHPLACE İ Lancaster, Mars.
NAME OF FATHER
BIRTHPLACE
OF FATHER#
Bancaster, Mass.
MAIDEN NAME OF MOTHER Mary Lyon
BIRTHPLACE
OF MOTHER #
alstead, J. H.
OCCUPATION
INFORMANT §
1. Roland Park hurst.
DATE OF BURIAL
8
190.
UNDERTAKER
ADDRESS
Waller Perham Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Dec-15
190.8 .. to Dec. 16 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 : Senile
(DURATION). .DAYS
Contributory :
(Signed).
Chmura toward
A ... . (DURATION).
DAYS
M.D.
Dec. 17
.190.§ ... (Address).
Chelmsford
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
220: 19
Of Edward Rotling
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.
73
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Place of l Death * S
Challmustard Mass.
Date of l
Dec. 16
190 8
Death 5
Residence
Chelmsford, mais,
Age.
91
years ..
months.
20
.days
COMMONWEALTH OF MASSACHUSETTS
Elisabeth Sider Parkhurst
Registered No.
73
PLACE OF BURIAL OR REMOVAL !!
Forefathers, Chelucland, DEC. 19
maru.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.
Residence
Age
80
.years.
8
.months. ....... ... days
STATISTICAL DETAILS
COLOR SEX female white
SINGLE, MARRIED, +WIDOWED, OR DIVORCED
MAIDEN NAME +
Sarah Stanton
HUSBAND'S NAME 1 John Warley
BIRTHPLACE# Somersetshire England
NAME OF FATHER Joseph Stanton
BIRTHPLACE OF FATHER₮ Somersetshire
MAIDEN NAME OF MOTHER Sarah Coates
BIRTHPLACE OF MOTHER # Somersetshire
OCCUPATION atHome
INFORMANT § Ethel Warley
PLACE OF BURIAL OR REMOVAL !! 1
DATE OF BURIAL Dec. 27108 190.
ADDRESS F.a. Nunback soliddr. det.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last 190 .. illness, from Dee / 190% .... to Ale22 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 : Organic desear 1 heart.
(DURATION).
21
DAYS
Contributory :
(DURATION). OAYS
» (Signed)
M.D.
Nee 23
.190 ...... (Address).
nichelation
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 ·
Dec 26
of Edward & Potting
Clerk
Vama
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclal Information." If In a Hospital or Institution, give Its NAME instead of street and number.
t In case of married or divorced woman, or widow. # State or country ; also city, town or county, if known.
§ Name and address of person giving statistical detalls. Il Name of cemetery.,
74
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Sarah Warley
74
Registered No.
-
Place of
North Chelmsford Mass
Death *
S
Death
Date of
¿December, 23 /908
y
T
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
John B. Craig
Registered No.
Date of
DEe 25
1908
Death S
5
13
.. months.
.days
STATISTICAL DETAILS
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widowed
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
Waterville n.H.
NAME OF
FATHER
John Craig
BIRTHPLACE
OF FATHER+
Boston Mass
MAIDEN NAME
OF MOTHER
Susan Quinby
BIRTHPLACE
OF MOTHER#
Laconia, n.7%.
OCCUPATION
Retired
INFORMANT §
Grace C. Perham
PLACE OF BURIAL OR REMOVAL !! Bellevue Cemetery
UNDERTAKER Walter Perhay
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Dec. 21 190 8 to Dec. 25 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).
5
. DAY8
Contributory :
ald ach.
(Signed)
amara toward
M.D.
De.26
190 8 (Address).
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
gcc. 26
190
8. Grund Raffina
Clerk
Form
* 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.
75
Chelmsford
(CITY OR TOWN.) 75
Place of l Chelmsford Central
Death *
S
Residence
Chelinford
Age
79
... years.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
DATE OF BURIAL DEe 27 190.0.
.(DURATION).
.........
. DAYS
COMMONWEALTH OF MASSACHUSETTS
76
RETURN OF A DEATH
(CITY OR TOWN.) 76
Registered No.
Place of )
Death *
S
Chelmsford mass
Date of ¿
alec 19
1908
Death S ..
Residence
160 Forward x
Age.
23
.. years.
.months ... .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE # Ireland.
NAME OF FATHER Jamel Brennan
BIRTHPLACE OF FATHER$
Ireland
MAIDEN NAME OF MOTHER Chave Bryan
BIRTHPLACE OF MOTHER # Ireland
OCCUPATION Albuativo
INFORMANT § Brother
PLACE OF BURIAL OR REMOVAL II St Patricks
DATE OF BURIAL
Dec.31
190 cf
UNDERTAKER
ADDRESS
not Much moreg × 108 Lockar
PHYSICIAN'S CERTIFICATE
1
HEREBY CERTIFY N
+
otto
conced during lost
illanca from
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 : Exposure
(tr cald)
. (DURATION). ......
. DAY8
Contributory :
(DURATION) ......... DAY8 (Signed) W. Meigs MS. Medical Examerano. Lrc. 30 190 ... (Address) 160 Therenack &
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 Dec. 31 1908 8 Edward 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. Il Name of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
FULL NAME
Patrick & Brennan
3
1
COMMONWEALTH OF MASSACHUSETTS
chelmsford ??
RETURN OF A DEATH
FULL NAME
abbie ( Berry
(CITY OR TOWN.) 77
Registered No.
Place of 2
South Chelmsford, Mais.
Death *
S
Residence
So. Chelmsford
Age
50
3
.years.
.. months.
days
STATISTICAL DETAILS
SEX
71
COLOR
w
SINGLE, MARRIED,
WIDOWED, OR
DIVOROED
Single
MAIDEN NAME Ť HUSBAND'S NAME t
BIRTHPLACE #
Pittsfield, Maine
NAME OF
FATHER
John Barry
BIRTHPLACE
OF FATHER+
Limington. Me.
MAIDEN NAME
OF MOTHER
Nancy Carr
BIRTHPLACE
OF MOTHER#
ansow, Me.
OCCUPATION
at Home.
INFORMANT §
Warren Berry
Filed
DEC. 30
198 Edward & Roofing
Gran
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.
Chelmsford Name of cemetery,
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from
190
to DEC. 20, 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 :
Contributory :
Myocarditis
2 ... (DURATION). . DAY8
(Signed)
Auchun G. Scolonia, M.D.
W3c.30, 1908 (Address)
Chehereford, 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 ?.
PLACE OF BURIAL OR REMOVAL II
Pittsfield, Maine
DATE OF BURIAL
Klec. 31
190 .. 8
UNDERTAKER
Walter Techang
ADDRESS
Death
S
Date of ¿
Lee. 28
.19008
6
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
.. (DURATION).
. .. DAYS
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
COLOR
qr.
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married.
MAIDEN NAME T
HUSBAND'S NAME t
BIRTHPLACE #
Smithfield, Me.
NAME OF
FATHER
- Downe.
BIRTHPLACE
OF FATHER$
Maine.
MAIDEN NAME
OF MOTHER
Unknown.
BIRTHPLACE
OF MOTHER #
Maine.
OCCUPATION
Retired Fireman.
INFORMANT §
Gro. A Downer"
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Westlawn Cemetery Jan, 5. 1909.
UNDERTAKER Geo MAHealey.
ADDRESS
79 Branch St.
PHYSICIAN'S CERTIFICATE
[ HEREBY CERTIFY that I attended deceased during last illness, from Nov 9 1908 to Jan.1 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 : Valvular disease :) Heart. with Renal Insufficiency
. (DURATION).
DAYS
Contributory :
Cerebral Softening
(DURATION). DAYS
(Signed)
B. N. Byana
M.D.
famil
1909 (Address)
24 B. 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
Jan. 2
190
Edward to Atting
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.
§ Namo and address of person giving statistical details. || Name of cemetery.
78
Chelmsford (CITY OR TOWN.)
RETURN OF A DEATH
FULL NAME
Horatio B. Downs.
1
Registered No.
Place of l
Smith Ave. Diet. 2. Chelmsford
Death *
Residence
Smith Avec. Dies 2. Chelmsford.
Age
74
.years.
6
months.
5
.. days
Date of ¿
Jan,
1.
.1909.
Death
1
District $2.
COMMONWEALTH OF MASSACHUSETTS
1
COMMONWEALTH OF MASSACHUSETTS
79
RETURN OF A DEATH
(CITY-OR TOWN.)
(3)
Place of ) East Chelmsford, Mas
Date of l
Death Tan. 6 190 7.
.. months. .days
STATISTICAL DETAILS
SEX
m
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE # King fuld, The
NAME OF FATHER
Thy Lane
Ihm
BIRTHPLACE OF FATHER#
Tingfield Me
MAIDEN NAME OF MOTHER Sarah Preston
BIRTHPLACE
OF MOTHER #
Ping Fuld, We.
OCCUPATION Retired
INFORMANT § Mr. Jonica Lane
PLACE OF BURIAL OR REMOVAL II Westlaun Cem,
DATE OF BURIAL
Lan, 8, 1909
ADDRESS
UNDERTAKER
.a. Herback to Meads SX
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. 230 30, 1908 to Han.61909 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 : Fiberia Pathisis -
Indefinite, about 15 mm. . (DURATION). DAYS
Contributory : Ordene offwegs
.(DURATION). .. DAYS
(Signed)
Autre G. Lcorona
M.D.
Jan. 7,1909
Columbus fond, mas.
......
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
Jan. 8
1909 Edward. Rolling
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.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
FULL NAME
Hizan I Lane
Death * S
Residence
11
Age 74 years
Registered No. 301
١
-
COMMONWEALTH OF MASSACHUSETTS
80
Lowell
RETURN OF A DEATH
(CITY OR TOWN.)
301 ( B )
Registered No.
Place of )
(North Chelmsford Man
Date of : Jan, 8,
Death
199
.. months. .days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME 1
BIRTHPLACE # Hallclaro, NIC
NAME OF
FATHER
âmes Gilmore
BIRTHPLACE
OF FATHERX
MAIDEN NAME OF MOTHER Lecars French
BIRTHPLACE
OF MOTHER #
Khiknow
OCCUPATION Machinist
INFORMANT § office a. Hall
PLACE OF BURIAL OR REMOVAL II
Machua, 4,26.
DATE OF BURIAL
Jan. 11.
1909
UNDERTAKER L.a. Heinbeck to Wider, Sx ADDRESS
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from nov 15 190 6 to Jan .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 :
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