| Page (PDF) | 57 |
|---|---|
| Certificate Number | 2736 |
| Name of Deceased | Sample, Job |
| Place of Death | Somerset |
| Town of Death | Crisfield; Rear back |
| Sex | M |
| Race | negro |
| Married, Widowed, or Single | single |
| Date of Birth | 3/20/1898 |
| Age (year, month, days) | 19 yrs 10 mos 20 ds |
| Occupation or Employer | truck or deck hand on steamboat |
| Birthplace | Davis? Wharf Va |
| Father's Name | Toab Sample |
| Father's Birthplace | VA |
| Mother's Name | Frannie Hack |
| Mother's Birthplace | VA |
| Informant (Relationship and Address) | Fannie Sample; Crisfield Md |
| Date of Death | 2/10/1917 |
| Cause of Death and Time Attended by Doctor | peritonitis; 1 mos 5 ds |
| Immediate, Secondary, or Contributory Cause and How Long | – |
| Physician and Address | WJ Barkley; 309 W Md Ave |
| Burial Place, Date, Undertaker, and Address | Lawsonia; 2/12/1917; RJ Adams; Crisfield |
| 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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