USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1908-1909 > Part 8
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City Hospital
Age
56
.years.
months.
.days
STATISTICAL DETAILS
SEX
COLOR
1
Vale White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
Ireland
NAME OF FATHER Seremach Shea
BIRTHPLACE
OF FATHER#
Orlando
MAIDEN NAME OF MOTHER Mary Murphy
BIRTHPLACE OF MOTHER + Ireland.
OCCUPATION Laboral
INFORMANT § Edward J. Shea
PLACE OF BURIAL OR REMOVAL I
DATE OF BURIAL Har 22 190.
ADDRESS
max . Dermott 7. Forham SX
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. 190 to
.190 Mm 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
(# Cold)
(DURATION) . DAYS
Contributory :
(DURATION) .. DAY8
(Signed).
W/ theig, MS. Medical Exammor
.190 ...... (Address)
1Ga Thernmack h.
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 March 22 190 Edward , Rolfas
Nom
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 countryj also city, town or county, If known.
§ Name and address of person giving statistical details. Il Name of cemetery.
0
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
16
Registered No.
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
martha & merrill
.Registered No. 403
Piace of l
Lowell Gent Hospe
Death * S
Residence
no Chelmsford mars.
Age
.. years
9
.months
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
8,
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE #
no Chelmsford
NAME OF
FATHER
Samuel Merrill
BIRTHPLACE
OF FATHER+
Vynasboro mars,
MAIDEN NAME
OF MOTHER
Mary Ingals
BIRTHPLACE
OF MOTHER +
dynasboro mais.
OCCUPATION
at Home
INFORMANT S Mrs Myron a Queen
PLACE OF BURIAL OR REMOVAL II Tyngsboro' maw.
DATE OF BURIAL
may 19 1909.
UNDERTAKER 2. a Hembeck
ADDRESS
middleux RA
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last
iliness, from
mar 11
1907 to Mar 17 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).
DAY8
Contributory :
(Signed)
Ralph & Stewart
(DURATION)
DAYS
M.D.
marry 1909 (Address)
Lowell Hand Haake-
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 ?
Filedn
Mar 18,99
City
Clerk
* City or town, street and number, If any, If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclai 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 ; aiso city, town or county, If known.
§ Name and address of person giving statistical details. 11 Namo of cemetery.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
95
Date of l
mar 17 1909
Death S
COMMONWEALTH OF MASSACHUSETTS
9.6
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Jonathan
Wright
Registered No.
43×18
Place of )
South Chelmsford mass
Date of
march 17, 1009
Death
S
Residence
South Chelmsford
Age
85
.years.
9
months
.days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME T
HUSBAND'S NAME +
BIRTHPLACE$ Proton mass
NAME OF FATHER John Wright
BIRTHPLACE OF FATHER $ Westford mass
MAIDEN NAME
OF MOTHER
Elizia Autchino
BIRTHPLACE
OF MOTHER $
Westford mass
OCCUPATION
Harmer
INFORMANT §
PLACE OF BURIAL OR REMOVAL II
Forefattura Cementi
Chelmsford Centro
DATE OF BURIAL
March 20, 1909
UNDERTAKER C.m. trung
ADDRESS
33 Prescott
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that + attended deceased during-last
ifness, from 190 ...... 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 : arterio - sclerosis
(DURATION) DAY8
Contributory :
Cerebral throughages.
(DURATION) DAYS
(Signed)
W meigs MS. Theducid Excesso
Welk (.190 2 .. .. (Address).
160 Therack h.
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
March 20
.190
0 9 Edwards. Robbins
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. # 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
Death *
5
1
COMMONWEALTH OF MASSACHUSETTS
97
RETURN OF A DEATH
FULL NAME
Rheuby H Tacnutt
.Registered No.
Date of l
March 28
Death
1909
Residence
West Chelmsford
Age
65
.. years.
11
.months.
21
.days
STATISTICAL DETAILS
SEX Female
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME +
HUSBAND'S NAME +
V.A. Macnutt
BIRTHPLACE #
Drbert, Colchester Co Nova Scotia
NAME OF
FATHER
Isaac Faulkner
BIRTHPLACE
OF FATHER#
Nova Scotia
MAIDEN NAME
OF MOTHER
aun Charlotte Dill
BIRTHPLACE
OF MOTHER #
Nova Scotia
OCCUPATION
at home
INFORMANT §
Mrs. F.E. Bickford
PLACE OF BURIAL OR REMOVAL II West Cemetery
DATE OF BURIAL
March 31 1909
UNDERTAKER
Walter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
to HEREBY CERTIFY that i attended deceased during last iliness, from. 190 Mch 28 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 :
angina Pectoris
(DURATION). .DAYS
Contributory :
3 - 4 days
(DURATION). DAYS
(Signed).
JE Varney
.M.D.
Meh. 30
21. Chelunfehl
190 .... (Address)
SPECIAL INFORMATION only for Hospitais, 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 march 31 1909 Edward& Raffig
Clerk
11
* 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 marrled or divorced woman, or widow. # State or country , also city, town or county, If known.
§ Name and address of person giving statistical details. li Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Chelmsford
(CITY OR TOWN.) 19
Place of l
West Checustard
Death *
5
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Alice Holland
.Registered No.
Place of l
"right St. Forth Chelmsford
Date of ¿
April 7, 109 190
Death
1
Residence
Age
.years
.months.
-
.days
STATISTICAL DETAILS
SEX Tomale
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME t
Alice Larkin
HUSBAND'S NAME t
Storhen Holland
BIRTHPLACE #
England
NAME OF
FATHER
Michael Larkin
BIRTHPLACE
OF FATHER$
Not Known
MAIDEN NAME
OF MOTHER
Ellen - Tot Known
BIRTHPLACE
OF MOTHER +
Not Known
OCCUPATION At . Home
INFORMANT §
Husband Stephen Holland
PLACE OF BURIAL OR REMOVAL !!
Lowell Mass
St . Patrick's Cemetery
DATE OF BURIAL
April 9.10
190.9
UNDERTAKER
ADDRESS
Jameset ON muell Som 3-4 marget St
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from aug249 190 .. to april 1904. that to the best of my knowledge and belief death occurred of the date stated above and that the CAUSE OF DEATH was as follows :
Primary :
Pernicious anaemia
Same months. . (OURATION) .. DAY8
Contributory :
Feibrod of uterus
2 years. (DURATIONS.
(Signed).
....
Dr. James & Saftig.
aw. 1 190G (Address)
22 Vacker 81
SPECIAL INFORMATION only for Hospitals, Institutions, Translents,
or Recent Residents.
How long at
Piace of Death ?
.. years ...................... months.
...................
. days
Where was disease contracted,
If not at place of death ?.
Fileď®
Abril 8
.190.
2. Strand ( det
Clerk
L'oreal
* 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
98
Chelmsford.
20
Death * S
COMMONWEALTH OF MASSACHUSETTS
99 Chelmsford
RETURN OF A DEATH (CITY OR DOWN.)
FULL NAME
Andrew M. Blaisdell
.Registered No.
21
Date of ¿
april 7
.1909
Death )
8
months.
.days
STATISTICAL DETAILS
SEX
COLOR
Write
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Wedound
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE#
Carlisle
NAME OF
FATHER
Jacob Blaisdell
BIRTHPLACE
OF FATHER#
Carlisle
MAIDEN NAME
OF MOTHER
Susan E. Baldwin
BIRTHPLACE
OF MOTHER#
V
OCCUPATION
Harmer
INFORMANT §
Ea Blancodele
PLACE OF BURIAL OR REMOVAL II
Hart Pond Cem.
DATE OF BURIAL
april 11 1909
UNDERTAKER
Walter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from apr. 2 190.9 .. to apr. 7, 1909 that to the bestof my knowledge and belief death occurred on the date stated above, and that the CAUSE OF DEATH was as follows : Primary: Mitral VEguigitation
.(DURATION) . DAYS
Contributory :
(Signed)
t. D. James
M.D.
n. 10
1909 (Address)
No. Exetinaford.
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 abril 11
190
9. Edward Rolfing
Clerk
Gown
* 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
Death * S
Residence
Chelmsford
Age
68
.years.
0
(DURATION)
. DAYS
COMMONWEALTH OF MASSACHUSETTS
100 Chelmsford
(CITY OR TOWN.) 22
FULL NAME
Carl Gustav Laverme
.Registered No.
Date of l
april 8
1909
Death
3
.months.
26
.days
STATISTICAL DETAILS
SEX
Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Widowed
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE # Sweden
NAME OF
FATHER
Saverine
BIRTHPLACE
OF FATHER#
Siwerden
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER+
Sweeden
OCCUPATION
Hammer
INFORMANT § John Carlson
PLACE OF BURIAL OR REMOVAL II Nest Centery
DATE OF BURIAL
april 2 1909
UNDERTAKER
Walter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, frem March 27 190 9 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 : Senile Facessene
3 or 4 junio (DURATION) DAYS
Contributory :
.(DURATION)
.. DAYS
(Signed)
JEVanner
M.D.
april 10
H1, Chelandes
1909 (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, april 12 .1909. Edward. Raffin
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 FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Place of 1 Next Chelmsford
Death * 5
Residence
Next Chelmsford
Age
88
.years.
RETURN OF A DEATH
سكر
COMMONWEALTH OF MASSACHUSETTS
101
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME John & Leaves
Place of 1
Death * S
1
Residence
i mucha Cholamine Wharf.
Age
60
.years
.months ..
days
STATISTICAL DETAILS
SEX
m.
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť HUSBAND'S NAME +
BIRTHPLACE #
Hillion n. H.
NAME OF
FATHER
andrero Dearles
BIRTHPLACE
OF FATHER៛
Not known
MAIDEN NAME
OF MOTHER
Elisabeth Pinball
BIRTHPLACE
OF MOTHER #
Hol ders 721922
OCCUPATION Farmer
INFORMANT § Brother
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from @ fuil /0 190) to Citu 17 .190.09, that to the best of my knowledge and belief death occurred on the date stated above, and that the GAUSE OF DEATH was as follows : Primary : Brauche PreranoMed
Contributory :
(Signed)
a. 6 Faxtes
(DURATION)
. DAYS
M.D.
City 17 190 1 (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 apr 20190 G
bily
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.
anne. O'Donnell tien 324 Market Ul 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
Joursbund mars.
DATE OF BURIAL
UNDERTAKER
ADDRESS
190 .. 04.
Registered No.
569
Date of
Death
1
190
(DURATION).
DAYS
1
A
COMMONWEALTH OF MASSACHUSETTS
102 Chelmsford
RETURN OF A DEATH (CITY OR TOWN.)
24
.Registered No.
Date of l
aprilly
1907
0
months.
2
days
STATISTICAL DETAILS
SEX
male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
Married
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
Chelsea
NAME OF
FATHER
Charles Nichole
BIRTHPLACE
OF FATHER#
Chelsea.
MAIDEN NAME
OF MOTHER
aques Lee
BIRTHPLACE
OF MOTHER #
Boston
OCCUPATION
Lea Merchant
INFORMANT §
Charles Nichols Jr.
DATE OF BURIAL
1909
UNDERTAKER
Walter Perham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from ah. 3th 190.9 .. to
abr. 17 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 :
Cerebral Embolism
.
(DURATION)
14
DAYS
Contributory :
(Signed)
Amara toward
M.D.
am, 19 1909.
1909 (Address)
Chelmsford 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
ahr. 19
.190
Edward J, Robbins
Clerk
1000
* City or town, street and number, If any. If death occurs away from USUAL RESI- DENCE, give facts called for under "Speclai Information." If In a Hospital or Institution, glvo 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
Charles Nichols
Place of l
Death *
S
thecusford
Death 1
Residence
Chelmsford
Age
61
.. years.
PLACE OF BURIAL OR REMOVAL !!
Edson Cem, Lowell apr 19
L .. . (DURATION)
.........
. DAYS
COMMONWEALTH OF MASSACHUSETTS
103 Chelmsford.
(CIIT OR TOWN.)
FULL NAME
Place of Į
6. Chelemsfeld Mars.
Date of ¿
april 22909.
Death
Residence
Anlam S. 6 Chelmsford Age ..
5%
.. years.
months.
16 .days
STATISTICAL DETAILS
SEX Male
COLOR
White
SINGLE, MARRIED, WIDOWED, OR Marica DIVORCED
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # Sweden
NAME OF FATHER
BIRTHPLACE
OF FATHERE
Sweden
MAIDEN NAME OF MOTHER Hannah Peterson
BIRTHPLACE
OF MOTHER #
Suveden
OCCUPATION
Carpenter
INFORMANT §
Einest & Johnson . Chelmsford.
PLACE OF BURIAL OR REMOVAL II
Odson Cinatury 1
DATE OF BURIAL april 25,0g
UNDERTAKER If my Saunders.
ADDRESS 12 Hurd Sh
XivEll
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. Seit 231 1908 to Shr. 22- 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 : Bright Decrease
(DURATION)
DAY8
Contributory :
Valvular disease 8
iteach
(DURATION). DAYS
(Signed)
M.D.
1909 (Address) 295-Central Ser
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®
al. 24
190
9. Edward Se rothen
Clerk
* City or town, street and number, if any. If death occurs away from USUAL RESI- DENCE, givo 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, cr widow.
# State or country; also city, town or county, If known.
§ Namo 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
RETURN OF A DEATH Peter M. Johnson
17%
Registered No.
Death *
COMMONWEALTH OF MASSACHUSETTS
104 Chelmsford
(CITY OR TOWN.)
FULL NAME
Emily E. Reed
Place of l
Chelmsford
Death *
5
Residence
Age
7/
.years
10
... months.
26
.. days
STATISTICAL DETAILS
SEX Female
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Wilno
MAIDEN NAME +
Emerson
HUSBAND'S NAME t
Charles Reed
BIRTHPLACE #
Chelmsford
NAME OF
FATHER
Oven Emerson
BIRTHPLACE
OF FATHER#
Chelmsford
MAIDEN NAME
OF MOTHER
Louisa Butterfield
BIRTHPLACE
OF MOTHER #
OCCUPATION
at Home
INFORMANT §
Mas J.S. Brown
PLACE OF BURIAL OR REMOVAL II
Forefactura Cere.
DATE OF BURIAL
May 8
190.7.
UNDERTAKER
Walter Parlava
ADDRESS
Chelmsford.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from oct. 1 May 5th 1909 190 S ... 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 : arteriosclerosis
(DURATION) ..
DAY8
Contributory :
agr.
{DURATION)
. DAYS
(Signed).
amara toward
M.D.
hermaford
190.9 .. (Address)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients,
or Recent Residents.
How long at
Place of Death ?
. years.
months.
...............
.days
Where was disease contracted,
If not at place of death ?.
Filed
many 8
190.
...
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
RETURN OF A DEATH
Registered No.
26
Date of l
May5
.1909
Death
S
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 afu, 25 1909 to May 7 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 : Cicuta gastro-Enteritis
(DURATION)
15
DAYS
Contributory :
(DURATION). ........ 0AY8
(Signed)
James f. Hoban.
M.D.
May 7 190% (Address)
4. chelmsford
SPECIAL INFORMATION only for Hospitals, Institutions, Translents, or Recent Residents.
How long at Place of Death 7 . years.
. months .. ..................... days
Where was disease contracted, If not at place of death ?.
Filed
May 8
00 9 Edward Vi Harting
Clerk
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
St Patrick @ :. 1
موم
190.
UNDERTAKER
ADDRESS
105
RETURN OF A DEATH
(CITY OR TOWN.)
27
Registered No
Place of l
Death * S
Princeton 50
Death
.190
Residence
Princator 2
Age.
.....
6
.years ..
N
.. months.
........ .days
STATISTICAL DETAILS
SEX
Vale
COLOR
Thito
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Single
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE# Terti Chelmsford
NAME OF
FATHER
Patrick T Ich
BIRTHPLACE
OF FATHER$
Ireland
MAIDEN NAME
OF MOTHER
Alice Mecabe
BIRTHPLACE
OF MOTHER $
OCCUPATION at Home
INFORMANT §
Patric!
father
* 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.
Lowell
COMMONWEALTH OF MASSACHUSETTS
FULL NAME
Date of ¿
1
1
COMMONWEALTH OF MASSACHUSETTS
106
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Frederick
W. Wright
Registered No.
431
Place of l
South Chelmsford Mass
Date of l
may 9. 190
9
Death S
Residence
South Chelmsford
Age 53
.. years
months. .................. days
STATISTICAL DETAILS
L SEX male
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME Ť
HUSBAND'S NAME +
BIRTHPLACE# Chelmsford maso
NAME OF
FATHER
Jonathan Wright
BIRTHPLACE OF FATHER Chelmsford mass
MAIDEN NAME OF MOTHER Eliza a. Hildrette
BIRTHPLACE OF MOTHER+ 6 helms
ford max
OCCUPATION Harmer
INFORMANT §
Herbert a. Wright
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. 1909 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 :
Pulmonary Julescolores
one year
(DURATION).
.. . . . . . . . . .. DAYS
Contributory :
.( OURATION). ...... DAYS
(Signed).
& EVarney
M.D.
May 10 190 9
(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 man 10
190.,
9. Edward 1. Rotting
-
voir Clerk
PLACE OF BURIAL OR REMOVALITIS Apretathin camel
DATE OF BURIAL
Chelmsford Bemthe May 11, 1909
. 190 ..
UNDERTAKER lim. young
ADDRESS 33 Prescrit 1 ali Name of cemetery.
* 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.
MARGIN RESERVED FOR BINDING
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
Death * S
COMMONWEALTH OF MASSACHUSETTS
107
No. Chelmsford (CITY OR TOWNS
RETURN OF A DEATH
FULL NAME
Wilfred Leroy Senior
Place of Į
Death *
No. Chelmsford
Residence
No. Chelmsford
Age.
X
.years.
16
.months.
.. days
STATISTICAL DETAILS
SEX
COLOR
10
SINGLE, MARRIED,
WIDOWED, OR
.
DIVORCED
Single
MAIDEN NAME T
HUSBAND'S NAME +
BIRTHPLACE + No. Chelmsford, Mases
NAME OF
FATHER
James A. Senior.
BIRTHPLACE
OF FATHER#
England.
MAIDEN NAME
OF MOTHER
Mabel Webley.
BIRTHPLACE
OF MOTHER
England.
OCCUPATION
INFORMANT § Jas. A. Senior.
PLACE OF BURIAL OR REMOVAL !! Riverside Cemetery. No. Chelmsford.
DATE OF BURIAL
May 13. 1909.
UNDERTAKER
Gro. Healey.
ADDRESS
79 Branch SA.
PHYSICIAN'S CERTIFICATE
.. to I HEREBY CERTIFY that I attended deceased during last illness; from 190 May 12 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 :
Membranous Group
12 hours.
. (DURATION). .......... .... . DAYS
Contributory :
(DURATION). DAYS
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