USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 7
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(DURATION)
0AY8
Contributory :
Semila Debillig
(OURATION). . DAY 8
(Signed)
Jas je Hoban
M.D.
.190 ...
(Address) Ve Oxelmsford
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. 9
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, glve 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
FULL NAME
Luther, Filmore
Death * S
Residence 11
Age
70 years
COMMONWEALTH OF MASSACHUSETTS
( 8 )
Chelmsford
(CITY OR/TOWN.)
FULL NAME
Place of l
Nr. Chelmsford Mars
Death * S
Residence
No. Chelmsford Years
Age
years
.months
.. days
STATISTICAL DETAILS
SEX
Frale
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE#
10. Chelmsford
NAME OF
FATHER
Harry Dawson
BIRTHPLACE OF FATHER៛ Vince Edward Island
MAIDEN NAME
OF MOTHER
mildred Davis
BIRTHPLACE
OF MOTHER$
maine
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
invitide Compleny
No Chelmsford mars.
DATE OF BURIAL
Jan. 16
190%.
UNDERTAKER
J. S Notton
ADDRESS
No. Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from.
190
Jan 15
to
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 :
Stillborn
premative brith
(DURATION). . DAYS
Contributory :
(Signed)
FC Varney
.(DURATION).
DAYS
M.D.
Jan. 16 1909 (Address) No. 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
Jan. 16
90% Command & Robbery
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. ![ 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 Dawson
.Registered No.
Date of l
Jan, 15
.190
Death
一
COMMONWEALTH OF MASSACHUSETTS
(82)
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Lillian Eliza Santamour
Registered No.
Piace of }
Death *
Chelmsford Centre
Date of l
Jan. 1st
1909
Death
1
Residence
Chelmsford Centre
Age
.years.
months.
days
STATISTICAL DETAILS
SEX
Female
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Chelmsford
NAME OF
FATHER
Fr. Willie Santamour
BIRTHPLACE OF FATHER$ Chelmsford
MAIDEN NAME
OF MOTHER
Orina Halster
BIRTHPLACE
OF MOTHER#
OCCUPATION
Tyngsboro
INFORMANT §
Fre H. Santamour
PLACE OF BURIAL OR REMOVAL II pruebathen Cometing Chelmsford mars.
DATE OF BURIAL
Jan. 19.
9
190.
UNDERTAKER
Halter Berham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from Jan. 14 . 1909 to Jan. 18 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 :
asthemia
. (DURATION).
2
.DAYS
Contributory :
Inanition
(DURATION)
. DAYS
(Signed)
arthur J. Scoloria
.M.D.
Jan. 19, 1909
.(Address
ss Chelmsford 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 Jan. 19
190
9 Edward & Robbins
Jon
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.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Gertrude Man Jordan
(CITY OR TOWN.) 6
.Registered No.
Place of l
Hast Chelmsford mars.
Death *
5
Residence
Hast Chelmsford mais.
Age
.years ..
months
2hours we days
STATISTICAL DETAILS
SEX
Female
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE#
Hast Chelmsford
NAME OF
FATHER
Herbutol Jordan
BIRTHPLACE
OF FATHER+
Lamerce mars.
MAIDEN NAME
OF MOTHER
Ida May Bliss
BIRTHPLACE
OF MOTHER #
Lawrence Marc.
OCCUPATION
INFORMANT §
Emily George
PLACE OF BURIAL OR REMOVAL !!
West Cheleford
DATE OF BURIAL
Jan. 24
1909
UNDERTAKER
Herbat N. Jordan
ADDRESS
ezt Chelmsford
PHYSICIAN'S CERTIFICATE
to I HEREBY CERTIFY that I attended deceased during last illness, from 190 Jan. 23 190% 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 :
Fremative Bith
lived 2 hours
(DURATION).
DAYS
Contributory :
(DURATION). ........... DAYS
(Signed)
Fr. I. Gage
M.D.
Jan. 23.
190€
.(Address).
No. Chelineford
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
.years
......
months.
................
. days
Where was dlsease contracted,
If not at place of death ?.
Filed
Jan
0 9 Edward). Roffing
Jour,
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
Chelmed ard
Date of l
Jan. 23.
1902
Death
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
FULL NAME
Charles Elroy King
Registered No ...
Date of l
9
Death 5
190/
Residence
Chellesford
Age
58
.years.
7
.months.
days
STATISTICAL DETAILS
SEX
Male
COLORO
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME 1
HUSBAND'S NAME t
BIRTHPLACE # Concord N.H.
NAME OF
FATHER
ambrose King
BIRTHPLACE
OF FATHER+
Vermont
MAIDEN NAME
OF MOTHER
Susis J. Randall
BIRTHPLACE
OF MOTHER #
71.74.
OCCUPATION
Painter
INFORMANT § Mrs. C. E. King
PLACE OF BURIAL OR REMOVAL !! PineRidge Cem.
DATE OF BURIAL
Heb 4
190.9
UNDERTAKER Walter Perkau
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Stan. 27 1909 to feb. 2 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 : Pneumoni
(DURATION)
.. DAYS
Contributory :
(Signed)
Amara Howard.
(DURATION). DAYS
M.D.
16. 3 1909 (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
tel. 3
1909 Edward Setting
Cowon 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 detalls. Il Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK. - THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Chelmsford 84
(CITY OR /TOWN.) 7
Place of ) Chelmsford Centre
Death * 5
COMMONWEALTH OF MASSACHUSETTS
850
RETURN OF A DEATH
north Chelmsford. (CITY OR TOWN.)
FULL NAME
Ane
Registered No.
Place of
North chehusford, mars
Death *
Residence
north Cheluns ford.
Age
Still horn
.. months ..
.days
STATISTICAL DETAILS
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
NAME OF FATHER Harold arthur Hue
BIRTHPLACE OF FATHER$ montreal, Canada
MAIDEN NAME OF MOTHER Ruth mo Jave Gordon
BIRTHPLACE
OF MOTHER#
Fort Philip, Nova Scotia
OCCUPATION
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
north chelmsford!
UNDERTAKER
ADDRESS
g. S. Watton
PHYSICIAN'S CERTIFICATE
to I HEREBY CERTIFY that I attended deceased during last illness, from 190 Self.200 1909, that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was asifollows : Primary : Stillborn .
........ ...... . ( DURATION). DAYS
Contributory :
(DURATION). ....... DAYS
(Signed)
M.D.
July 11
190.9 .. (Address)
n. chiliesfind
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
Ful. 13,
90 % Edward Roffing
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 cemstery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
ALL NAMES TO BE IN FULL
DATE OF BURIAL Sasat 26,00 8 190 ..
Date of Sept. 25
Death
COMMONWEALTH OF MASSACHUSETTS
86 Chelmsford
(CITY OR TOWN.) 8
Registered No.
Date of l
Heb. 10
1909
Death
S
.years
6
months
16
.days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE#
Kimista, Sweden
NAME OF
FATHER
Carl andson
BIRTHPLACE
OF FATHER+
Sweeden
MAIDEN NAME
OF MOTHER
Mary Anderson
BIRTHPLACE
OF MOTHER#
Sweden
OCCUPATION
Granite Cutter
INFORMANT §
Mrs. C.a. arvidsson
PLACE OF BURIAL OR REMOVAL II Nest Cemetery
DATE OF BURIAL
Heb 13
190.9.
UNDERTAKER
Walter Peshows
ADDRESS
Chelunsford
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. Jan. 8 1909 to Funk, 10, 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 : myocarditis-
(DURATION) DAYS
Contributory :
(Signed)
Anhn G. Sarkana
... (DUBATION)
......
.DAYS
M.D.
Firb. 10, 1909 (Address)
Chukua ford, Rusas
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years ..
. months. ........ day
Where was disease contracted,
If not at piace of death ?.
......
Filed
Fel-13
190.
09 durand ) 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 detalis. 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
FULL NAME
Carl a, arvidson
Place of }
Treat Chelmsford
Death *
5
Residence
West Chelmsford
Age
6/
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Thomas
RETURN OF A DEATH If M= Quanes
(CITY OR TOWN.)
9
Place of l
Death * S
Residence
nº Chelmsford
Age
56
.years ..
.months .......
- ......
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE; MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME T
HUSBAND'S NAME t
BIRTHPLACE# Fillon N. M.
NAME OF
FATHER
Peter
BIRTHPLACE
OF FATHER#
Ireland
MAIDEN NAME
OF MOTHER
, Paris nº Quanly
BIRTHPLACE
OF MOTHER#
OCCUPATION
INFORMANT § Brother
PLACE OF BURIAL OR REMOVALID
DATE OF BURIAL
Sr. Fabrick Pendler . Feb.19
1909
UNDERTAKER
C.t. Molloy
ADDRESS
Farele Mans
PHYSICIAN'S CERTIFICATE
-
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 :
Chronic Bronchitis.
Contributory :
arteriosclerosis
(DURATION).
........... DAY8
(Signed)
Amara Howard
M.D.
(DURATION) ......... DAY8
106.17 1909 (Address)
Chelmsford.
SPECIAL INFORMATION only for Hospitals, Institutlons, 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
tich 18
1909 Edward XoSoffium
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. || Name of cemetery.
87
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Registered No.
Middlesex St.
Date of ¿ Feb. 16
Death S
1909
COMMONWEALTH OF MASSACHUSETTS
88
RETURN OF A DEATH
(CITY OR TOWN.)
66 +
FULL NAME
Registered No.
Place of )
Date of ¿
Death *
Death ...
Residence
Age
.... years.
.. months .. ... days
STATISTICAL DETAILS
SEX
COLOR
WIDOWED, OR DIVORCED
MAIDEN NAME + Luiz Russeau
HUSBAND'S NAME + Joseph Porerge
BIRTHPLACE #
Civiliza
NAME OF FATHER
BIRTHPLACE OF FATHER#
MAIDEN NAME OF MOTHER
BIRTHPLACE OF MOTHER #
мала
OCCUPATION House Recker
INFORMANT § 3. P
Jehn B.
PLACE OF BURIAL OR REMOVAL II Tioseph Gencelery
DATE OF BURIAL
Heb- 20 210 109
UNDERTAKER
siph levert
ADDRESS
57 chever
PHYSICIAN'S CERTIFICATE
1 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 : Senility
. (DURATION) DAY8
Contributory :
2
(DURATION). DAY8
(Signed) ...
Anti J. Scolonia.
M.D.
Fick, 19, 1909, (Address)
Charlene ford, 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
Feb. 19
.190/
9 Edward I. Rolfun
-
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. II Name of cemetery.
5
11 Th. 190
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
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
Single
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
Chelmsford Mass.
NAME OF
FATHER
Thomas Shochan
BIRTHPLACE
OF FATHER+
Ireland
MAIDEN NAME OF MOTHER Johannah Tolch
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION
INFORMANT §
Seamstress
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Fl. 13 190.7.to 46.24 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 :
Gastritis
.(DURATION)
8
DAY8
Contributory :
Chronic diarrhoca
DAYS
(Signed)
Amara Howard
.M.D.
716.24 90 9 (Address)
Chilmatra.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
. years.
months. ..................... days
Where was disease contracted,
if not at place of death ?.
Filed
Feb. 24
209 Edward . Roffing
Joan
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 cemete
1
COMMONWEALTH OF MASSACHUSETTS
89
Chelmsford
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Annie T. Shechan
Registered No
11
Place of )
Chelmsford Centre
Date of ¿
Death
1
Feb.24. 109
.190
Death *
5
Residence
I4 Hasting St. Lowell
53
-
months.
days
Age
-years.
STATISTICAL DETAILS
Brother John C. Sheehan
PLACE OF BURIAL OR REMOVAL I Lowell Mass
St. Patrick's Cemetery
DATE OF BURIAL
Feb 26
C)
9
190
UNDERTAKER
ADDRESS
m
SEX
Female
mito
COMMONWEALTH OF MASSACHUSETTS
90
RETURN OF A DEATH
FULL NAME
Henry Prescott Davis
.Registered No ..
Place of l
Death *
S
Chaluford
Residence
Chelmsford
Age
80
3
.. years
.months ..
21
.days
STATISTICAL DETAILS
SEX
-Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widowed
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Harvard
NAME OF
FATHER
Henry Davis
BIRTHPLACE
OF FATHER$
Harvard
MAIDEN NAME OF MOTHER Hannah Biles
BIRTHPLACE
OF MOTHER+
New Salen Mark.
OCCUPATION
Harmer
INFORMANT § a. H. Davis
PLACE OF BURIAL OR REMOVAL II Horefathers Com
DATE OF BURIAL
March 2 1909
UNDERTAKER Walter Perhave
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last illness, from. Dance til -27 1909 190 8 to that to the best of my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows :
Primary : Semile degeneration.
(DURATION). ..... . DAYS
Contributory :
.(DURATION) DAYS
(Signed)
Amora toward
M.D.
tel. 28
190 ... (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
nur. 2
1909. Edmand S. 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 detalls. || Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
1
Chelmsford
(CITY OR TOWN.) 12
Date of
Heb 27
.. 1909
Death
-
COMMONWEALTH OF MASSACHUSETTS
91
Chelmsford
RETURN OF A DEATH
FULL NAME
asenathe Manning Chamberlain
Place of l
Death *
S
..
Chelmustard
Residence
Chelmsford
Age
80
.. years.
8
.months.
20
days
STATISTICAL DETAILS
SEX themale
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Single
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # Chelmsford
NAME OF
FATHER
Benji Chamberlain
BIRTHPLACE
OF FATHER#
6
MAIDEN NAME
OF MOTHER
asenathe Manning
BIRTHPLACE
OF MOTHER#
Chelmsford
OCCUPATION
at home
INFORMANT §
E.C Wright
PHYSICIAN'S CERTIFICATE
[ HEREBY CERTIFY that I attended deceased during last illness, from. .....
1905 ... to 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 : Himmiplegia-
(DURATION)
Contributory :
(DURATION) ....... DAYS
(Signed)
Autor y Scolonia-
M.D.
March 1, 190 (Address).
Chebusfor mass.
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at Place of Death ? .. months. years. ................ days
Where was disease contracted, If not at place of death ?.
Filed
Mar 2.
09 Edward . Robbing
-Con
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 II Torefactors Com.
DATE OF BURIAL
March 3 1909
UNDERTAKER Walter Perhaus
ADDRESS
(CITY OR TOWN.) 13
Registered No.
Date of l
Heb 28
1907
Death
1
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME xeon Vous
Place of l
Death *
5
Residence
Age
.years.
.months.
days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # iswell
NAME OF FATHER Napoleon Manreau
BIRTHPLACE OF FATHER ֏ Canada
MAIDEN NAME OF MOTHER Prodie Lemay
BIRTHPLACE OF MOTHER +
Canada
OCCUPATION at- home
INFORMANT § Napoleon
Manseau
PLACE OF BURIAL OR REMOVAL II
Chelmsford Mass
UNDERTAKER joseph albert
ADDRESS
57 le hever
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from 190
.. to March 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 : whooping Cough. .....
. (DURATION). .......... .. DAY8
Contributory :
(Signed)
Auturis. Servera
.(DURATION) DAY8
M.D.
March 1909, (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 Das: 2, 1909 Eduard & Rolfmy
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, glve 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. 1
92
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
Powell (CITY OR TOWN.)
Manseau
Registered No
Date of ¿
Death 1 .1
auch /s
3
1
Jemay
DATE OF BURIAL March 20109 -1909
2
L
COMMONWEALTH OF MASSACHUSETTS
93
RETURN OF A DEATH
Chelmsford (CITY OR TOWN.)
FULL NAME Hannah J. Leahey
Registered No.
Place of }
Death
Church St. Forth Chelmsford
Death S ..
11
"
Age ..
59
.. years ..
.months. ................ .days
STATISTICAL DETAILS
SEX
Pomalo
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME Ť
Hannah Sullivan
HUSBAND'S NAME t
James Leahey
BIRTHPLACE #
Ireland
NAME OF
FATHER
Michael Sullivan
BIRTHPLACE
OF FATHER$
Ireland
MAIDEN NAME OF MOTHER
Ellen Lynch
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION
At Home
INFORMANT §
Husband James Lethey
PLACE OF BURIAL OR REMOVAL I!
St. Patrick's Cemetery
DATE OF BURIAL
March IO
9
190
UNDERTAKER
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Mar .1909 to Mar 8 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 : Pneumo
(DURATION)
DAY8
Contributory :
(DURATION). DAYS
(Signed)
James
M.D.
Mar 8 190 ... (Address)
Nochelmsford 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
Mar 10
.190,6
· Edward . Kufru
Clerk
* Clty 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.
It Name of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
Date of ¿
March 8th, '09 190
Residence
1
1
COMMONWEALTH OF MASSACHUSETTS
94
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Jennie Thea
Place of )
Death *
5
Chemsford Centre
Date of
Thearch
10
Death 1
190 C
Residence
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