USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 2
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(Signed)
M.D.
.190 ..... (Address).
SPECIAL INFORMATION only for Hospitais, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
months
4
days
1
Where was disease contracted,
If not at place of death ?
Filed
fick ?
1960 Edward & Rettung
Cierk
* 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. # Stato or country; also city, town or county, If known.
§ Name and address of person giving statisticai 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
Death * S
Death
COMMONWEALTH OF MASSACHUSETTS
174
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Catherine (though
Registered No ....
15
Place of Conector at North Cheinfaldet
Date of l
Fat->
1960
Death
Residence
Age
.years ...
.. months.
days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR < DIVORCED
MAIDEN NAME
HUSBAND'S NAME t
BIRTHPLACE # North Chemfand.
NAME OF FATHER
Thomas At hunchlap
BIRTHPLACE OF FATHER# Lavell
MAIDEN NAME
OF MOTHER
Anniety Lland
BIRTHPLACE
OF MOTHER +
Canada
OCCUPATION
INFORMANT § Father
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Inky. 3 1900 to July ) ...... 190.0., 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 : congenital delikely.
.. (DURATION). DAYS
Contributory :
congenital meccsetin
.(DURATION) ................. DAYS
them of war
(Signed). M.D. July) 1900 (Address) H. Chatcontent
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
days
months.
Where was disease contracted, If not at place of death ?.
Filed
1960 Canard S. Robbing
Com Clerk
PLACE OF BURIAL OR REMOVAL II
At Patrick
Lowsee
DATE OF BURIAL
Fel-8
1900)
UNDERTAKER
ADDRESS
* 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. I] Name of cemetery.
ALL NAMES TO BE IN FULL
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
-
14
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. May 23 1909 to Jan. 26 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 :
Exhaustion from Chronic
alcoholism
2 yrs - 4 mos
., ... (DURATION) ...
DANS
Contributory :
Chronic Dementia (alcoholic.)
(DURATION).
2.ye
DAYS
(Signed)
Edward French
M.D.
Jan. 26 1900 (Address).
Medfield
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Place of Death ?
years.
10
.months.
days
Where was disease contracted,
If not at place of death ?.
Filed.
Feb. 2 1960 Stillman J. Shear
(
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.
175
RETURN OF A DEATH
(CITY QR TOWN.)
9 /6
FULL NAME
Place of )
Medfield Insane asylum
Date of ¿
Jan. 26
1900
Death * S
Residence
Chelmsford Mas ..
Age
53
.. years ..
months &
.. days
STATISTICAL DETAILS
SEX
m
COLOR
W
STABLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
Boston
NAME OF
FATHER
Unknown
BIRTHPLACE
OF FATHER#
11
MAIDEN NAME
OF MOTHER
11
BIRTHPLACE
OF MOTHER #
OCCUPATION
Teamster.
INFORMANT § Danvers State Hospital
PLACE OF BURIAL OR REMOVAL II
Vine Lake Cem, Medfild
DATE OF BURIAL
Feb. 2
196.0
UNDERTAKER
a. B. Parker
ADDRESS
Medfield
COMMONWEALTH OF MASSACHUSETTS
Medfield
Willis
Fr. Griffin
Registered No ..
Death
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 A DEATH
FULL NAME
Florence B, the bluse
.Registered No.
Date of l
Death S
....
1900.
Residence
No. Chelms, Mass
Age ..
29
..... years ..
2 months ...
29 days
STATISTICAL DETAILS
SEX 7
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME Ť
Florence B. Eaton
HUSBAND'S NAME t
Um. 2) Mature
BIRTHPLACE # Lowell Man.
NAME OF
FATHER
William a. Calon
BIRTHPLACE
OF FATHER$
Newton Mass.
MAIDEN NAME
OF MOTHER
Clara M. Olney
BIRTHPLACE
OF MOTHER #
no. Billerica Mans.
OCCUPATION Housewife
INFORMANT § Him & mcclure
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Pierside Carn. no. Chiedo Feb. 4 1960
UNDERTAKER
A.a. Weinlich
ADDRESS
80 Midde Sr
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
iliness, from.
July 2
1900 to July 7
.. 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 :
(DURATION)
DAYS
/
Contributory :
(DURATION).
DAY8
(Signed)
FElaunay
M.D.
1900 (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
tier. 9,
......
1900 Ederand J. Robbing
Con 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. Il Name of cemetery.
(
176 Vouell
(CITY OR TOWN.) 30% 17
Place of l
No. Chelimo. Mass
Death * S
-
COMMONWEALTH OF MASSACHUSETTS
177 Chelmsford
(CITY OR TOWN.)
FULL NAME
Mary Spaulding Lowering
.Registered No.
1
Date of l
Death
Heb 7
190 0
.. years.
4
.months.
.. days
STATISTICAL DETAILS
SEX HEmale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widowed
MAIDEN NAME Ť
Mary Spaulding
HUSBAND'S NAME t
Henry Lovering
BIRTHPLACE #
Billerica
NAME OF
FATHER
Jacob Spaulding
BIRTHPLACE
OF FATHER#
Billerica
MAIDEN NAME
OF MOTHER
Mary ann Esty
BIRTHPLACE
OF MOTHER #
Billerica
OCCUPATION
at home
INFORMANT §
Must Lovering
PLACE OF BURIAL OR REMOVAL II
Forefathers Com, Chelucfog
DATE OF BURIAL
HEGIO
1980
UNDERTAKER
Malta Perhow
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Jan. 30- 1980 to Heb 7h 1960, 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).
8
.. DAYS
Contributory :
Senile
..... (DURATION) ..
DAYS
(Signed).
Amare toward
M.D.
Fib. 9 1980 (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 Heb. 10 1900 Edward & Robbins
Form
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
1.8
Place of 1
Checksford
Death * S
Residence
Chelmsford
Age
77
-
COMMONWEALTH OF MASSACHUSETTS
1.78 No Chelmsford. .. .
RETURN, OF A DEATH
FULL NAME
Arville L. Hout.
(CITY OR TOWN.)/ 19
Place of l
Death *
$10 Gay Bt. No. Chelms Ford.
Date of }
Death
Feb., 8.
......... 1960.
Residence
Age
.. years.
1
.. months ..
16
.days
STATISTICAL DETAILS
SEX
-
COLOR
Dr.
DIV
SINGLE, MARRIED,
WIDOWED, OB .
DIVORCED Single.
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
No. Chelmsford.
NAME OF
FATHER
John A. Hoyto.
BIRTHPLACE
OF FATHER$
New Brunswick.
MAIDEN NAME
OF MOTHER
Polly Flannery.
BIRTHPLACE
OF MOTHER #
England.
OCCUPATION
None.
INFORMANT §
John A. Hoy O.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from Jab, 4
1960 to July 8
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:
Coucoubriones
Primary :
in 4 horas
.. (DURATION).
DAYS
Contributory :
Whooting Cough
1
.. (DURATION).
2 wee
.. DAY8
(Signed).
M.D.
Fring 8
.190 ...... (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
Tel. 9 900 Eduard Posting
1900 award
Clerk
L
* 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 countrys also clty, 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
PLACE OF BURIAL OR REMOVAL !! Riverside bemeters JA, Chelmsford.
DATE OF BURIAL
Feb, 10, 19/0.
UNDERTAKER
Gro Matealey.
ADDRESS
79 Branch &
Registered No ....
COMMONWEALTH OF MASSACHUSETTS
1.79
RETURN OF A DEATH
(CITY OR TOVA.) 20
FULL NAME
Warak P Stuart
.Registered No.
Place of l
Death * S
Chelmsford, mais
Date of het 13
190/0
Residence
Age.
74
.. years ..
.months
.days
STATISTICAL DETAILS
SEX
COLOR
w
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Saralid. leworker
HUSBAND'S NAME t
John Stuart
BIRTHPLACE#
Jacke mille. me.
NAME OF
FATHER
Charles leworker
BIRTHPLACE
OF FATHER#
MAIDEN NAME
OF MOTHER
Unknown
BIRTHPLACE
OF MOTHER #
OCCUPATION (et home)
INFORMANT §
If M. Stuart
Filed
Feb. 17 1960 Edward , Robbing
Town Clerk
PLACE OF BURIAL OR REMOVAL II Edson leme Lowell
DATE OF BURIAL
Feb. 17 19010
UNDERTAKER
ADDRESS
Walter Tenham (helgen) ) Name of cemetery.
whan
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from . Feb 8, 1900 to 4 cb 13, 1960 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 :
Epidemia Influenza
..... (DURATION).
DAYS
6
Contributory :
Clonic Bronchitis
Indefinite -
.... (DURATION).
.. DAY8
(Signed)
Artur 9, comma
M.D.
Feb, 16 1960 (Address)
Chebuford, 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 ?.
* 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
9
COMMONWEALTH OF MASSACHUSETTS
180 y a well.
(CITY OR TOWN.)
21
.Registered No ..
Place of )
Wat Pleasant ft. o. Chel mo Date of
Death * S
Residence
144 Ad como It. Howell.
38.0m.
2
months.
.days
STATISTICAL DETAILS
SEX
M.
COLOR
W.
SINGLE, MARRIED, WIDOWED, OR- DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE #
treland.
NAME OF
FATHER
Michael
BIRTHPLACE
OF FATHER#
Azland.
MAIDEN NAME
OF MOTHER
Hary Will
,
BIRTHPLACE
OF MOTHER #
freland.
OCCUPATION
faberEr
INFORMANT §
Wife.
PLACE OF BURIAL OR REMOVAL II
St. Patricks
DATE OF BURIAL
CAEb. 16.
19.00
UNDERTAKER
Cx Halloy
ADDRESS
Ja well
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Place 3, 1940 to Tel. 14, 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 :
monary Tuberculosis
. (DURATION) DAYS
Contributory :
Hemorrhage
... (DURATION). DAYS
(Signed).
Cassidy
M.D.
Feb. 14, 1900 (Address) 26 Runals Blof, Lowell
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
tiel, 15 1960 Edward ). Rolling
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 details. [{ 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
Steffen
f Icanley
F & B.14.
.1900
Death S
Age
.. years.
1
COMMONWEALTH OF MASSACHUSETTS
Chelucofund.
(CITY OF/TOWN.) 22
FULL NAME.
Sarah Carter Litchfield
.. Registered No
Place of l
Death * S
Chelmsford, Mass.
Date of l
Heb 27
1900
Death 5
10
21
.months.
.. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, WIDOWED, OR- BIVORCED
MAIDEN NAME +
Savale Elégaberto Cartão
HUSBAND'S NAME Paul F. Litchfield
BIRTHPLACE #
Barnet It.
NAME OF
FATHER
John Carter.
BIRTHPLACE
OF FATHER#
Barnet,
It.
MAIDEN NAME
OF MOTHER
Elizabeth Hopkins
BIRTHPLACE
OF MOTHER#
Peacham, Vt.
OCCUPATION
at Home
INFORMANT §
Trace Litchfield
PLACE OF BURIAL OR REMOVAL II
heene Cen
Carlisle, Mais.
DATE OF BURIAL
Mar. 21 19010
UNDERTAKER
Walter Pecham
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last illness, from. Jan 1960 to Fab 27 1960 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 : Cardiac Embolism.
.. (DURATION).
. DAYS
Contributory :
arteriosclerosis
School years. (DURATION).
(Signed).
Amara forward
.. M.D.
....... 199.( (Address).
Clubmustard,
SPECIAL INFORMATION only for Hospitals, institutions, Transients, or Recent Residents. How long at Place of Death ? . years .. days months.
Where was disease contracted,
If not at place of death ?.
Filed Mar. 2 19010 Edward S. Softma
60
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 statisticai 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
Residence
Age.
74
.years.
COMMONWEALTH OF MASSACHUSETTS
182
RETURN OF A DEATH
(CITY-OR TOWN.)
FULL NAME
Martha S. 1320,102.
Registered No.
23
Death * S
Place of )
What Chelverdad Dans
Date of l
Her. 28
.. 196
Death
Residence
... years ..
3
.. months .. 22 .days
STATISTICAL DETAILS
SEX
COLOR
Female. VIhita
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + Marchal. Calvert
HUSBAND'S NAME t
17
BIRTHPLACE #
1 miele. Mars
NAME OF FATHER Millioner W. Ecalment
BIRTHPLACE OF FATHER$ England. vd.
MAIDEN NAME OF MOTHER Martha-Hildreth
BIRTHPLACE
OF MOTHER
Mantard Mans
OCCUPATION
INFORMANT §
Enma. Brown.
" fert Chelmar Mar.2.
DATE OF BURIAL
UNDERTAKER
1
1
PHYSICIAN'S CERTIFICATE
| HEREBY CERTIFY that I attended deceased during last illness, from. nen 6 1960 to July 28 ... 190.0. 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 :
4 most
. (OURATION) .. .+ DAYS
Contributory :
(OURATION) OAYS
(Signed)
M.D.
.1900 (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
mar. 2 1980
Edwards, Robfun
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 detalis. |[ Name of cemetery.
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL I
That Chamqual Comipre Claro-3 1960
ADDRESS
COMMONWEALTH OF MASSACHUSETTS
183 Chelmsford
(CITY OR TOWY.) 24
FULL NAME Storengo Smeetter
Place of l
Chelmsford, mais.
.. Registered No ..
Date of May, 2
.190 0
Death
.years.
9
18
months ..
.. days
STATISTICAL DETAILS
SEX
COLOR
W
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE+
Westford, Mass.
NAME OF
FATHER
Nathaniel Sweetser
BIRTHPLACE
OF FATHER
Unknown
MAIDEN NAME OF MOTHER Nancy Hutchins thuch 4.
BIRTHPLACE OF MOTHER # Westford, Mass.
OCCUPATION
Retired
INFORMANT §
adams
How and Sweetser
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
Faut Pond Cem. So. Shelangt Mar. 6
1900
UNDERTAKER
ADDRESS
Walter Puchar Chehisfirst.
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 :
Miocarditis
... (DURATION). DAYS
Contributory :
arteriosclerosis
.... (DURATION)
... DAYS
(Signed)
Actual. Scobama
.. M.D.
..... 190℃ .. (Address).
Chelmsford, mares
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. 6
1900 Edward "offins
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 * S
Age.
78
Residence
11
RETURN OF A DEATH
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
THE COMMONWEALTH OF MASSACHUSETTS
184
Lamil
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Orlando H 200 9C
201-25
.Registered No ..
Place of l
Death * S
Residence
Chelmsford Mass.
.Age ..
69
.. years ..
months.
.. days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE#
Croydon, D. H.
NAME OF
FATHER
William Dodge
BIRTHPLACE
OF FATHER#
Grunden N. It.
MAIDEN NAME
OF MOTHER
Lucinda Stockrell
BIRTHPLACE
OF MOTHER #
Lebanon N. H.
OCCUPATION Retired
INFORMANT §
Thro. O. N. Norge
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. March 1909 to Much 4, 1910, 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 : (Uteriosclerose 1
(DURATION) .. DAYS
Contributory :
Hemiplegia
3 20 ElKes
(DURATION) 24 hours.
(Signed) .....
....
.. M.D.
Mai. et.
Chilensford, mars.
, 19/0 (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
Mar. 7 1910 Edward Robbing
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 ; also city, town or county, If known.
§ Name and address of person giving statistical detalls, li Name of cemetery.
PLACE OF BURIAL OR REMOVAL II
Edson Cemetery
DATE OF BURIAL
Thai. 7
. 1910.
UNDERTAKER
I.a. Heinbeck
ADDRESS
So Midex, St.
Death
5
Date of l
Man. 4 19 !!
4
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
.
COMMONWEALTH OF MASSACHUSETTS
185 Chelmsford
RETURN OF A DEATH
FULL NAME
Williamy Augustus Ingham
(CITY OR TOWN.) 26
Place of 1
Chelmsford
Death * S
Residence
Chelmsford
Age
67
... years ..
10
.months.
16
.. days
STATISTICAL DETAILS
SEX
Mals
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME t HUSBAND'S NAME t
BIRTHPLACE #
Strong The.
NAME OF
FATHER
I'm Ingham
BIRTHPLACE
OF FATHER#
Com ME.
MAIDEN NAME
OF MOTHER
Martha Northley
BIRTHPLACE
OF MOTHER#
avon me.
OCCUPATION
Merchant
INFORMANT §
Ms M.a. Ingham
PLACE OF BURIAL OR REMOVALI
Forell Cem. Lowell
DATE OF BURIAL
March 19
196.Q.
UNDERTAKER
Walter Puchar
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from.
Much 190 8 to March 16 1990, 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 :
(DURATION) ..
. DAYS
Contributory :
Carchi Dilatation
(OURATION).
.. DAYS
(Signed)
M. D.
March 18 1900 (Address).
22 (Eutral
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
Mas. 18 1900 Edward J. Rotfins
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.
Registered No.
Date of l
March 16 1900
Death
THE COMMONWEALTH OF MASSACHUSETTS
186 Vouell
RETURN OF A DEATH
(CITY OR TOWN.)
Samil M. Coburn
Registered No 2027
Place of 1
Death * S
Residence
Chein three Phas Age.
129
... years
.. months ..
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED, -WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME t
BIRTHPLACE #
Pelharn
nick.
NAME OF
FATHER
Daniel Coburn
BIRTHPLACE OF FATHER# Pelham, n.W.
MAIDEN NAME
OF MOTHER
BIRTHPLACE
OF MOTHER#
Telham, S. W
OCCUPATION Meat Cette
INFORMANT §
1
PLACE OF BURIAL OR REMOVAL !! Westhammam.
DATE OF BURIAL
than.19, 1916
UNDERTAKER I. G. Weinleck
ADDRESS
So Mider. Lo
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from Jeb 26, 19/0 to March 1619/0, 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 :
. (DURATION) LES
DAYS
Contributory :
(DURATION) ....... DAY8
(Signed)
WeSaw, w
.M.D.
March 17 1910 (Address) 222Lei
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 1/ 19/10
Edward . Bobbing
Form 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 detalis. [ Name of cemetery.
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
FULL NAME
Chelen ford, mas.
Date of l
Man. 16
19 10
Death
1
A
COMMONWEALTH OF MASSACHUSETTS
18%
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
William 7, Dollard
Registered No.
28
Place of }
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