USA > Massachusetts > Middlesex County > Chelmsford > Deaths 1910-1911 > Part 3
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Chelmsford Centre
Date of l
march 19 1850
Death
Residence
Westford It Chelmsfordoss.
Age 50
... years ..
:months ..
.days
STATISTICAL DETAILS
SEX
COLOR
10
PENGER , MARRIED,
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE# Lowell
NAME OF
FATHER
James Dollard
BIRTHPLACE OF FATHER# Arefund
MAIDEN NAME OF MOTHER Bridget Murphy
BIRTHPLACE
OF MOTHER#
Ireland
OCCUPATION Curative
INFORMANT § Wife
PLACE OF BURIAL OR REMOVAL 11
DATE OF BURIAL
It. PatrickLowell March2 01900
UNDERTAKER
M. H. The Donough
ADDRESS
108 ocham et
PHYSICIAN'S CERTIFICATE
.I HEREBY CERTIFY that I attended deceased during last illness, from March 19 1900 to March /9/ 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 :
Apoplexy
about one hour (DURATION).
.... DAY8
Contributory :
(DURATION) .. DAYS
(Signed).
Autun & Scorona.
............ M.D.
March 20,1900 (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
mar ..
10 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 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
-
COMMONWEALTH OF MASSACHUSETTS
188 Chelmsford
RETURN OF A DEATH
(CITY OR TOWN.) 29
FULL NAME
Sarah Elizabeth Montgomery
.Registered No.
Date of l
March 22 1990
Death §
.years.
8
months.
days
STATISTICAL DETAILS
SEX
HEmale
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Widow
MAIDEN NAME +
Sarah & Stiles
HUSBAND'S NAME t
Jonathan Montgomery
BIRTHPLACE #
Strafford n.H.
NAME OF
FATHER
Joseph stites
BIRTHPLACE
OF FATHER#
Stratford D.H.
MAIDEN NAME
OF MOTHER
Betsy th all,
BIRTHPLACE
OF MOTHER #
Strafford n.H.
OCCUPATION
at home
INFORMANT § lo hr E. Dame
PLACE OF BURIAL OR REMOVAL II trafford cerut Stratford U.H.
DATE OF BURIAL
March 25 80
UNDERTAKER Halte Puchar
ADDRESS
Chelmsford
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from march 1900 to. March 21, 1900, 216 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 : Diabetic Coma.
... (DURATION) .. DAYS
Contributory :
(DURATION).
DAYS
(Signed)
Anh & ScoParia
.... M.D.
March 22
2, 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. 23, 1900 Edward S. 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
Place of 1
So Chelmsford
Death *
S
Residence
So Chelifund
Age.
82
€
/
COMMONWEALTH OF MASSACHUSETTS
189 Chelmsford. ..
(CITY OF
TOWN.) 30
FULL NAME
Felix Lovely
Registered No.
Place of 1
Death *
Chehuxford Mars
Date of l
Mar. 29
......
.19 0
Death
Residence
.
Age
89
.years ...
7
.. months. 0 .days
STATISTICAL DETAILS
SEX
COLOR
W
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE#
Montreal, Canada
NAME OF
FATHER
Unknown
BIRTHPLACE
OF FATHER#
Canada
MAIDEN NAME
OF MOTHER
Unknow
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
4
tarner
INFORMANT §
Mis John Middleton
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that i attended deceased during last illness, from 190 ..... to March9000, 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).
DAY8
Contributory :
(Signed)
Anten G, Scolaria
Q (DURATION).
.. DAYS
M.D.
Max. 30, 1900 (Address).
Chalutford, Mass.
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 ?
Filed Mar. 31 1900 Edward &. Robbins
Clerk
PLACE OF BURIAL OR REMOVAL II fuit actieis cem,
DATE OF BURIAL
Mar. 31
1900
UNDERTAKER
Walter Parliam
ADDRESS
Chelmsford.
* 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
1
RETURN OF A DEATH
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
STATISTICAL DETAILS
SEX
71
COLOR
20
WIDOWED, OR
DIVORCED
MAIDEN NAME +
Mary E. Goding
HUSBAND'S NAME +
Caleb Qagood
BIRTHPLACE#
Cambridge, Mass.
NAME OF
FATHER
Henry Golding
BIRTHPLACE
OF FATHER#
Brunswick me.
MAIDEN NAME
OF MOTHER
Elizabeth Phillies
BIRTHPLACE
OF MOTHER#
maine
OCCUPATION
at home
INFORMANT §
V.S. Parklara.
PLACE OF BURIAL OR REMOVAL !!
Edson Ces. Lowell Ma life. 7
DATE OF BURIAL
1900
ADDRESS
UNDERTAKER
Walker Becham Chelmsford, mas.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last iliness, from .! March 21 1900 to. apr. 4 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 : Traumatisme ofstrach- Senility
.. (DURATION) 14
..... DAYS
Contributory :
(Signed) ..
Arthur4, comma
P (DURATION).
.. DAYS
.M.D.
aller, 7, 1900 (Address).
Clubresford, 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
am. Z.
1960 Edward J. Roffing
Clerk
Com
* 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.
190
RETURN OF A DEATH
(CITY OR TOWN.) 31
FULL NAME
Mary Elizabeth Isgood
.Registered No .....
Place of 1
Chelunsford Mass.
Date of
Upv. 5
.198 0
Death * S
Death
-
0
.months.
18
.days
Residence
Age
74
.. years.
COMMONWEALTH OF MASSACHUSETTS
THE COMMONWEALTH OF MASSACHUSETTS
19% Chelmsford
RETURN OF A DEATH
(CITY OR TOWNS 32
FULL NAME
Place of l
Death * S
Jungles are worth Chele fond
/
Residence
Áge ..... ,
.. years ..
.months.
.days
STATISTICAL DETAILS
SEX
Male
COLOR
what,
SINGLE, MARRIED, WIDOWED, OR DIVORCED,
MAIDEN NAME +
HUSBAND'S NAME t
BIRTHPLACE # forth Chelives And
NAME OF
FATHER
Peter Gay
BIRTHPLACE
OF FATHER#
Ruland
MAIDEN NAME
OF MOTHER
falls Harrington
BIRTHPLACE
OF MOTHER #
Queland
OCCUPATION
INFORMANT §
Father
!
PLACE OF BURIAL OR REMOVAL Il
DATE OF BURIAL
April/ 2016
UNDERTAKER/ Af Somwell Nous
ADDRESS
PHYSICIAN'S CERTIFICATE
1 HEREBY CERTIFY that I attended deceased during last
illness, from.
.. 19
to ..
.... 19
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 Bom.
(DURATION). ... DAYS
Contributory :
IT.
(DURATION).
.. DAY8
1
(Signed).
M.D.
aper 6 19/ (Address).
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
How long at
Piace of Death ?
. years ..
.months .. days
Where was disease contracted, if not at place of death ?.
Filed april 7
6
19/0
Edward . Japón
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 ALL NAMES TO BE IN FULL
FILL OUT WITH INK. - THIS IS A PERMANENT RECORD
.Registered No ..
Date of ¿
April 6
.. 19/0
Death
-
192
COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Louis Lafontan
33
.. Registered No.
Place of 1
So Chemetod Mars.
Date of l
March 5
....
19 6 0,
Death S
1
5
.months.
... days
STATISTICAL DETAILS
SEX
male
COLOR
White
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
Married
MAIDEN NAME t
V
HUSBAND'S NAME t
V
BIRTHPLACE #
Thue Rivers Canada
NAME OF
FATHER
Theles There Lafontan
BIRTHPLACE
OF FATHER#
Canada
MAIDEN NAME
OF MOTHER
Rosela Durant
BIRTHPLACE
OF MOTHER #
Canada
OCCUPATION
Stone butter.
INFORMANT §
Emanda Giroud Lafontan
PLACE OF BURIAL OR REMOVAL I!
Nashua n.H.
DATE OF BURIAL
april 13 196.0
UNDERTAKER
Eco W. Hualey
ADDRESS
79 Branch
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended d oused during last illness, 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 : accidental Drowning
Contributory :
... (DURATION)
.. DAYS
(Signed).
A Meia, MA. Medical Examin M.D.
april 18 1900 (Address)
160 Hymack
4
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 12 060 Edward ). Klaus
Clerk
C
* 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
Death * S
Residence
10 Perham St. Nashua Age 38
.years.
(DURATION). DAYS
193
COMMONWEALTH OF MASSACHUSETTS
CITY OF LOWELL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Millian & Redmond
(6)
Registered No ..
Date of l
Cifuil 15
1900
Death
2
.months.
.days
STATISTICAL DETAILS
SEX
COLOR
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE # South Chelmsford North
NAME OF
FATHER
Hilliam Redmond.
BIRTHPLACE OF FATHER # South Chihansford.
MAIDEN NAME
OF MOTHER
may Henderson
BIRTHPLACE
OF MOTHER +
10 Ireland.
OCCUPATION
armer
INFORMANT § Frather
PLACE OF BURIAL OR REMOVAL I!
DATE OF BURIAL
It out loud Cun Chelmsford ( 1 pr.17 1900
UNDERTAKER
ADDRESS
2. 3. Curry 60 58 Trescott LA
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last
illness, from ....
.190.
.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 :
accident
Fracture of Cervical + Dorsal Vertebrae due to falling bulkhead docx DURATION). .. DAYS
Contributory :
( OURATION)
DAY8
(Signed).
I.V. nuigs M. D. med Ex
M.D. Wme 16 1900 (Address) The Merrimack It Lowle
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 Cpu 18 1960 Girarsimars
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
Place of )
Lowell Hasht
Death * S
Residence
So Chehanford "mare
Age
35
.years.
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
Single.
MAIDEN NAME +
HUSBAND'S NAME +
BIRTHPLACE #
North Chelmsford, Mare
NAME OF
FATHER
James A. Senior.
BIRTHPLACE
OF FATHER#
England.
MAIDEN NAME
OF MOTHER
Helena Mabel Webley.
BIRTHPLACE
OF MOTHER #
England.
OCCUPATION None.
INFORMANT §
James A. Senior.
PLACE OF BURIAL OR REMOVAL !!
Riverside Cemetery. April 18- 1980.
DATE OF BURIAL
UNDERTAKER
Gro. Matealey.
ADDRESS
79 Branch St.
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. Citral 13 . 1900 to Ctul/6/2010 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 :
Hepatitis
.
one work.
.. (DURATION). DAYS
Contributory :
... (DURATION) .. DAYS
(Signed)
M.D.
abril 17 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 april 18 1960 Edward &. Robbing
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.
194
RETURN OF A DEATH
North Chelmsford.
(CITY OF TOWN.) 35
FULL NAME
Harold Nelcon Senior.
.Registered No ..
Place of 1
North Chelmsford, Messe.
Date of l
April 16. 1900.
Death S ..
Residence
North Chelmsford, Mass.
..... Age.
.... years ..
.months ..
.days
COMMONWEALTH OF MASSACHUSETTS
Death * S
THE COMMONWEALTH OF MASSACHUSETTS
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Stephanie Saignon-
.Registered No.
36
Place of l
Chequefort, mais
Date of ¿
Apr. 19,
Death
19/0,
Residence
Thelunsford, mars.
Age.
59
11
.months.
11 days
STATISTICAL DETAILS
SEX Female
COLOR /
SINGLE, MARRIED, WIDOWED, OR DIVORCED
m.
MAIDEN NAME + Stephanie Smith.
HUSBAND'S NAME +
BIRTHPLACE #
It . Où, P.Q.
NAME OF
FATHER
BIRTHPLACE OF FATHER# St. Pri, Q.Q.
MAIDEN NAME
OF MOTHER
Marguriette Demers.
BIRTHPLACE
OF MOTHER #
St. Pri, P.Q.
OCCUPATION House wife -
INFORMANT § Emile E. Pagno
PLACE OF BURIAL OR REMOVAL I
Edson Century
DATE OF BURIAL
Apr. 23, 1910.
UNDERTAKER
F. a Newtech
ADDRESS
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. .19 to Apr. 19, 7.19/ 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 :
Venuplegia
about 7 months
.. (DURATION) ...
.- DAYS
Contributory :
... (DURATION) .. ... DAY8
(Signed) .!
Auchin 4, Scofora,
M.D.
Apr. 19,
1, 19/ 0 (Address).
Chelmsford, 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 april 21, 1910 Grward & Coffing
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.
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
195
Death * S
.. years.
COMMONWEALTH OF MASSACHUSETTS
196
RETURN OF A DEATH (CITY OR TOWN.) 2
FULL NAME
Francis Leroy Hennessy Registered No.
37
Place of )
Death * S
Chemsford Mas
Date of l
april 19,1980
Death 1
10
.months.
days
STATISTICAL DETAILS
SEX male
COLOR
white
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE#
Waterville me
NAME OF FATHER alloqui's Hennessy
BIRTHPLACE OF FATHER# North Billerica
MAIDEN NAME OF MOTHER alice Herron
BIRTHPLACE OF MOTHER # Billerica masas
OCCUPATION
INFORMANT § father
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from. Mich. 29 1960 to Con. 19 1964, 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 : Convulsions .
(DURATION).
.DAY &
Contributory : Anaenna
... (DURATION) ..
(Signed) ...
Amara toward
.M.D.
apr. 20 1900 (Address) Chelineford Mans.
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 april 2/ 1960 Edward Potting
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.
UNDERTAKER ADDRESS hoe fill Lermot 70 york ami er cemetery.
Lowell Wase
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
PLACE OF BURIAL OR REMOVAL II
DATE OF BURIAL
april2 190
Residence
Chems Ford Mass Age.
.. years.
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 Mar 18 1910 to May /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 :
Chimie Rheumatism
Tueurs (DURATION). .. DAYS
Contributory :
Heat Diaria
... (DURATION) .. .. DAYA
(Signed).
James of Haban.
f ....... M.D.
May 2 1910 (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
May 3
....
.19/0. Edward . Rafting
Clerk
com
* 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 cometery.
.
Residence
-
=
"1
Age
62
.years ..
.2 .... months ..
.days
STATISTICAL DETAILS
SEX
Fomale
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED Married
MAIDEN NAME + Mary Raymond
HUSBAND'S NAME ! Themas Finch
BIRTHPLACE #
Canada P.Q.
NAME OF FATHER
Demos Raymond
BIRTHPLACE OF FATHER# Canada P.Q.
MAIDEN NAME OF MOTHER Not Known
BIRTHPLACE
OF MOTHER #
Canada P.Q.
OCCUPATION
At Home
INFORMANT § Husband
PLACE OF BURIAL OR REMOVALTASS. St. Patrick's Cemetery
DATE OF BURIAL
May 4, 1910
UNDERTAKER
ADDRESS
THE COMMONWEALTH OF MASSACHUSETTS
197 1
Chelmsford Mass ...
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Mary Finch
38
Registered No ..
Place of l
Ripley St. North Chelmsford
Date of \ May 1, 19IO
19
Death * S
Death S
-
MARGIN RESERVED FOR BINDING FILL OUT WITH INK .- THIS IS A PERMANENT RECORD ALL NAMES TO BE IN FULL
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME Allhouse)
Lecoul
Death * S
Place of )
Princeton It North Chichaforte of)
Residence
-
. Age
4
... years ..
.months
.. days
STATISTICAL DETAILS
SEX
Mall
COLOR
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME t
HUSBAND'S NAME t
BIRTHPLACE# Stanford P.D
NAME OF FATHER Pierre Lecourt
BIRTHPLACE
OF FATHER#
Canada
MAIDEN NAME OF MOTHER Lilida Boucher
BIRTHPLACE
OF MOTHER #
Carrodu-
OCCUPATION
-
INFORMANT §
PLACE OF BURIAL OR REMOVALH St Joseph
DATE OF BURIAL
May 3
1900
ADDRESS
138
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from .. april 30 1900 to Day 2 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 : Membranous Group
Contributory :
(DURATION) ... .. DA¥8
(Signed).
JE Varney
.M.D.
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 may 3 10 Edward V. Rolling
7
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.
UNDERTAKER Adichambault Merrimack Name of cemetery,
1
COMMONWEALTH OF MASSACHUSETTS
198
Registered No.
39
... fay 2 1910
(DURATION).
3
.. DAYS
14 72
١
FILL OUT WITH INK .- THIS IS A PERMANENT RECORD
[12-16-1903-1,000] J 223
EDOM GIVES NATIO SOMERVILLE
FOUNDED 1
A CITY 1878. IJONBUIS IVNOI
ED
COMMONWEALTH OF MASSACHUSETTS
CITY OF SOMERVILLE
RETURN OF A DEATH
FULL NAME
Charles ... Carroll
Registered No ........ 3.54
Death
Place cf }
Home for the Aged, 186 Highland Ave. , SomervilleDeath April 13 90 1910.
Place of
Home for the Aged. 186 Highland Ave.
Residence
('No.)
Somervi (Stred) Mass
(Town of City and State)
Age 80 years - months.
.. days
STATISTICAL DETAILS
SEX
COLOR
white
SINGLE, MARRIED,
WIDOWED, OR
DIVORCED
single
MAIDEN NAME If a married or divorced woman, or widow
HUSBAND'S FULL NAME
BIRTHPLACE
Give state or country ; also city, town, or county, if known
Ireland
NAME OF
FATHER
Lawrence Carroll
BIRTHPLACE
Give state or country ; also city, toin, or county, if known
OF FATHER
Ireland
MAIDEN NAME
OF MOTHER
Elisabeth McSherry
BIRTHPLACE
Give state or country ; also city, town, or county, if known
OF MOTHER
Ireland
OCCUPATION
None
INFORMANT'S
Person giving statistical details
NAME Sister Catherine
ADDRESS
186 Highland Ave.,
Somerville
(No.) ( Street )
. (Town or City)
PLACE OF BURIAL OR REMOVAL
DATE OF BURIAL
Apr. 14
.- 190_
Lowell, Mass. ( Town or City, and State)
UNDERTAKER'S NAME
John S. McGowan
ADDRESS
13 Stone Ave .,
Somerville
(No.) ( Street )
( Town or City)
PHYSICIAN'S CERTIFICATE
I HEREBY CERTIFY that I attended deceased during last illness, from ... NOV. 1909 to April 13 9019,10 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 : ( If a soldier or sallor who served In the war of the rebelllon both the primary and contributory causes of death must be given. )
Primary :...
Carcinoma of chest wall
( DURATION )
.DAYS
Contributory :
( DURATION )
DAYS
(Signed)
Chas ..... E. Mongan
M. D.
( Address )
24 .... Central .... S.t ...... Somerville
(No.)
(Street)
(Town or City)
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residents.
Previous Residence
NO . Chelmsford
How long at
1910
Place of Death ?
Years,
8
.. Months,.
Days
Where was disease contracted,
if not at place of death ?
Received
April 14.
1910.
Wm. P.Mitchell Agent of Board of Health; appointed to issue burial permits
Filed
April 15
190- 1910.
City Clerk
male
MARGIN RESERVED FOR BINDING ALL NAMES TO BE IN FULL
199
(Cemetery)
قادر على
1
COMMONWEALTH OF MASSACHUSETTS
200
RETURN OF A DEATH
(CITY OR TOWN.)
FULL NAME
Elizabeth Mc Larney
.. Registered No ..
4.1
Place of l
Centre St Chamaford Centre Date of War
Death
Residence
Centre Sp chemiferd Centie Age 88
.. years ..
2 months ...
n.dgys
STATISTICAL DETAILS
SEX female
COLOR
White
SINGLE, MARRIED, WIDOWED, OR DIVORCED
MAIDEN NAME + HUSBAND'S NAME +
BIRTHPLACE ± heland
NAME OF
FATHER
Patrick Mc Larney
BIRTHPLACE
OF FATHER#
Ireland
MAIDEN NAME OF MOTHER Mary
BIRTHPLACE
OF MOTHER #
Ireland
OCCUPATION
at Home
INFORMANT § James A, Mi harney
PLACE OF BURIAL OR REMOVALI It Vatuck
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