| Page (PDF) | 49 |
|---|---|
| Certificate Number | 17596 |
| Name of Deceased | Roberts, infant |
| Place of Death | Somerset |
| Town of Death | Shelltown |
| Sex | M |
| Race | black |
| Married, Widowed, or Single | infant |
| Date of Birth | 10/18/1921 |
| Age (year, month, days) | 21 ds |
| Occupation or Employer | x |
| Birthplace | Md |
| Father's Name | John Robert |
| Father's Birthplace | Md |
| Mother's Name | Ada Jackson |
| Mother's Birthplace | Md |
| Informant (Relationship and Address) | John Roberts; Shelltown Md |
| Date of Death | 11/8/1921 |
| Cause of Death and Time Attended by Doctor | congenital weakness; 21 ds |
| Immediate, Secondary, or Contributory Cause and How Long | twin pregnancy |
| Physician and Address | IAB Allen; Marion Md |
| Burial Place, Date, Undertaker, and Address | Ebenezer Church Cemeteary; 11/9/1921; Frank Gale; Shelltown 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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