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All are presumably named after the former county of Middlesex in England.
- A county of Ontario, Canada.
- A historical county of Jamaica.
- One of 8 counties in Connecticut, United States. There is no county seat.
- One of 14 counties in Massachusetts, United States. There is no county seat (formerly two, in Lowell and Cambridge).
- One of 21 counties in New Jersey, United States. County seat: New Brunswick.
- One of 95 counties in Virginia, United States. County seat: Saluda.