Full Name: John Smith
Certificate Number: D-68000
Date of Death: September 29, 1922
Gender: Male
Race: Black
Marital Status: W
Age at Death: 1871 51
Place of Birth: Oklahoma
Place of Death: Municipal Hospital
Primary Cause of Death: Heart Block
Father’s Name: William Smith, Oklahoma
Mother’s Maiden Name: Mary Smith, Oklahoma
Occupation: Laborer
Date of Burial: 10/2/1922
Informant: Municipal Hospital Records
Undertaker: Daniel Easton, 916 Pennsylvania Ave
Death Record Series ID: CM1132-149.xlsx
Last Residence: Pennsylvania Ave, 1221
