| Page (PDF) | 21 |
|---|---|
| Certificate Number | 106059 |
| Name of Deceased | Forman, Edward J |
| Place of Death | Worcester |
| Town of Death | Newark Md |
| Sex | M |
| Race | col |
| Married, Widowed, or Single | x |
| Date of Birth | 8/3/1916 |
| Age (year, month, days) | 2 mos 4 ds |
| Occupation or Employer | x |
| Birthplace | Maryland |
| Father's Name | James Foman |
| Father's Birthplace | Maryland |
| Mother's Name | Sadie Purnell |
| Mother's Birthplace | Md |
| Informant (Relationship and Address) | James Purnell; Newark Md |
| Date of Death | 10/7/1916 |
| Cause of Death and Time Attended by Doctor | gastro entitis 2 ds |
| Immediate, Secondary, or Contributory Cause and How Long | malnutrition |
| Physician and Address | Marvill Lingo; Newark Md |
| Burial Place, Date, Undertaker, and Address | Cedar Chapel; 10/8/1916; JW Burbage & Bro; Berlin Md |
| 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.
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