| Page (PDF) | 7 |
|---|---|
| Certificate Number | 2889 |
| Name of Deceased | Dericksen, Murvin |
| Place of Death | Worcester |
| Town of Death | Synepuxent Md |
| Sex | M |
| Race | color |
| Married, Widowed, or Single | single |
| Date of Birth | 12/26/1903 |
| Age (year, month, days) | 17 yrs 1 mos 24 ds |
| Occupation or Employer | school boy |
| Birthplace | Maryland |
| Father's Name | Edward Derickson |
| Father's Birthplace | Maryland |
| Mother's Name | Phillis Davis |
| Mother's Birthplace | Maryland |
| Informant (Relationship and Address) | Charles Davis; Berlin Md |
| Date of Death | 2/19/1921 |
| Cause of Death and Time Attended by Doctor | lobar pneumonia; 7 ds |
| Immediate, Secondary, or Contributory Cause and How Long | – |
| Physician and Address | CA Holland; Berlin Md |
| Burial Place, Date, Undertaker, and Address | Synepuxant, Md; 2/22/1921; Custis J Evans; 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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