| Page (PDF) | 77 |
|---|---|
| Certificate Number | 15904 |
| Name of Deceased | [Wallace], nameless |
| Place of Death | Somerset |
| Town of Death | Wenona |
| Sex | M |
| Race | B |
| Married, Widowed, or Single | single |
| Date of Birth | 10/30/1916 |
| Age (year, month, days) | 30 minutes |
| Occupation or Employer | x |
| Birthplace | Md |
| Father's Name | Robert Wallace |
| Father's Birthplace | Md |
| Mother's Name | Rosina Costen |
| Mother's Birthplace | Md |
| Informant (Relationship and Address) | Rosina Wallace; Wenona |
| Date of Death | 10/30/1916 |
| Cause of Death and Time Attended by Doctor | premature birth, 5th month |
| Immediate, Secondary, or Contributory Cause and How Long | – |
| Physician and Address | EP Simpson; Chance Md |
| Burial Place, Date, Undertaker, and Address | Deals Island; 10/31/1916; LG Webster; Deals Island |
| 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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