| Page (PDF) | 31 |
|---|---|
| Certificate Number | – |
| Name of Deceased | Smith, Jerry |
| Place of Death | Somerset |
| Town of Death | Princess Anne |
| Sex | M |
| Race | Black |
| Married, Widowed, or Single | S |
| Date of Birth | 8/30/1909 |
| Age (year, month, days) | 2 yrs 8 mos 14 days |
| Occupation or Employer | - |
| Birthplace | Somerset Co |
| Father's Name | John Smith |
| Father's Birthplace | Somerset Co. |
| Mother's Name | Laura Crotine? |
| Mother's Birthplace | Somerset Co. |
| Informant (Relationship and Address) | Lois M Smith, Princess Anne, Md |
| Date of Death | 5/12/1911 |
| Cause of Death and Time Attended by Doctor | (No Dr. in attendance) Acute Indigestion, has been sick all life, 3 days |
| Immediate, Secondary, or Contributory Cause and How Long | Asthma |
| Physician and Address | T. J. Smith, M.D. Princess Anne, Md |
| Burial Place, Date, Undertaker, and Address | Princess Anne 5/14/1911, James J. Dennis undertaker, Princess Anne |
| 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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