| Page (PDF) | 53 |
|---|---|
| Certificate Number | 6855 |
| Name of Deceased | [Smith or Jones] nameless |
| Place of Death | Somerset |
| Town of Death | Dames Quarter |
| Sex | x |
| Race | B |
| Married, Widowed, or Single | x |
| Date of Birth | 5/15/1916 |
| Age (year, month, days) | x |
| Occupation or Employer | x |
| Birthplace | Md |
| Father's Name | Herbert Smith |
| Father's Birthplace | Md |
| Mother's Name | Beulah Jones |
| Mother's Birthplace | Md |
| Informant (Relationship and Address) | Emily Jones; Dames Quarter |
| Date of Death | 5/15/1916 |
| Cause of Death and Time Attended by Doctor | miscarriage at 3-4 months; unknown |
| Immediate, Secondary, or Contributory Cause and How Long | – |
| Physician and Address | EP Simpson; Chance |
| Burial Place, Date, Undertaker, and Address | cremated at home; 5/16/1916; x |
| Length of Residence, Where Disease Contracted, Former Residence | – |
| Other Notes | – |
If you are citing this record, please use the following format:
[Author (if known)], Maryland Death Certificates (Somerset, Wicomico, Worcester Counties), 1910-1922, [Date (if known)], Enduring Connections: Exploring Delmarva’s Black History, Nabb Research Center, Salisbury University.
Pinned records can be viewed at any time by clicking the More menu in the top right corner of the page, then selecting My Pinned Records.