Infant Clark (3664)

Item

Official death certificate for Infant Clark. Identifier number 3664.

Title

Infant Clark (3664)

Description

Death certificate for Infant Clark. Born 01-03-1923. Died 01-04-1923.

Identifier

3664

County of Death

Ware

City of Death

Waycross

Address of Death

1201 Byck St

Militia District No.

A1231

Registration District No.

1231

Last Name

Clark

Residence

Waycross

Gender

Female

Color or Race

Colored

Marital Status

Single

Date of Birth

January 3, 1923

Occupation

No

Employer

No

Birthplace

Ga [Georgia]

Name of Father

Jim Clark

Birthplace of Father

Ga [Georgia]

Maiden Name of Mother

Francis Virgin

Birthplace of Mother

Ga [Georgia]

Informant

Francis Virgin

Informant Address

904 Glenmore St

Date Filed

January 5, 1923

Registrar

J. R. Scully

Date of Death

January 4, 1923

Cause of Death

Premature [birth]

Medical Doctor

John R. Scully [J. R. Scully], L.R.

Medical Doctor Address

Waycross, Ga

Place of Burial

Red Hill Cemetery

Date of Burial

January 5, 1923

Undertaker

None