| Page (PDF) | 3 |
|---|---|
| Certificate Number | – |
| Name of Deceased | Infant |
| Place of Death | Somerset |
| Town of Death | Mt Vernon |
| Sex | M |
| Race | Colored |
| Married, Widowed, or Single | Infant |
| Date of Birth | 6/24/1911 |
| Age (year, month, days) | 4 days |
| Occupation or Employer | Infant |
| Birthplace | Somerset Co |
| Father's Name | Preston Barclay |
| Father's Birthplace | Somerset Co |
| Mother's Name | Mamie Jones |
| Mother's Birthplace | Wicomico |
| Informant (Relationship and Address) | - |
| Date of Death | 6/29/1911 |
| Cause of Death and Time Attended by Doctor | Convulsion |
| Immediate, Secondary, or Contributory Cause and How Long | – |
| Physician and Address | H. A. Barnes, Princess Anne, Md |
| Burial Place, Date, Undertaker, and Address | Mt Vernon Md 6/29/1911 Dashiell Bros undertaker, P. Anne 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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