| Page (PDF) | 5 |
|---|---|
| Certificate Number | 17801 |
| Name of Deceased | Bivens, infant |
| Place of Death | Somerset |
| Town of Death | Pocomoke RFD |
| Sex | boy |
| Race | colored |
| Married, Widowed, or Single | x |
| Date of Birth | 11/11/1921 |
| Age (year, month, days) | 9 ds |
| Occupation or Employer | x |
| Birthplace | Somerset |
| Father's Name | Ira Bevans |
| Father's Birthplace | Somerset |
| Mother's Name | Ida Cottman |
| Mother's Birthplace | Somerset |
| Informant (Relationship and Address) | Renzie Waters; Pocomoke RFD |
| Date of Death | 11/11/1921 |
| Cause of Death and Time Attended by Doctor | falling of the head; no furth information; no physician |
| Immediate, Secondary, or Contributory Cause and How Long | – |
| Physician and Address | Samuel Scott; dep local reg |
| Burial Place, Date, Undertaker, and Address | Tinleys; 11/12/1921; Ballard Bros; Pocomoke RFD |
| 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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