| Page (PDF) | 11 |
|---|---|
| Certificate Number | – |
| Name of Deceased | Collick, Samuel |
| Place of Death | Worcester |
| Town of Death | Stockton |
| Sex | M |
| Race | Black |
| Married, Widowed, or Single | single |
| Date of Birth | - |
| Age (year, month, days) | 9 weeks |
| Occupation or Employer | - |
| Birthplace | Maryland |
| Father's Name | John H. Collick |
| Father's Birthplace | Virginia |
| Mother's Name | Hattie Rowley |
| Mother's Birthplace | Maryland |
| Informant (Relationship and Address) | John H. Collick Girdletree, Md |
| Date of Death | 10/21/1912 |
| Cause of Death and Time Attended by Doctor | caught on fire by accident in room with children & fire took place. No doctor attended died in a few hours after burned. |
| Immediate, Secondary, or Contributory Cause and How Long | – |
| Physician and Address | none |
| Burial Place, Date, Undertaker, and Address | Cool Springs Cemetery 10/23/1912 Rowley & Purnell Stockton, 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.
Pinned records can be viewed at any time by clicking the More menu in the top right corner of the page, then selecting My Pinned Records.