PERSONAL AND STATISTICAL PARTICULARS
Place of death: County: Shelby, City: Memphis, (No. 1154 Walker Ave., 14 Ward)
Full name: Saml. O. Baucum
Sex: Male
Color: White
Age: 53 years
Single, married, widowed, or divorced: Married
Birthplace: NC
Name of father: Wm. Baucum
Birthplace of father: NC
Maiden name of mother: Rebecca Broadway
Birthplace of mother: NC
Occupation: Night Watchman
Length of residence in city: 15 years

MEDICAL CERTIFICATE OF DEATH
Date of death: Feb. 17, 1911
I HEREBY CERTIFY, That I attended deceased from Feb. 6, 1911, to Feb. 17, 1911, that I last saw him alive on Feb. 17, 1911, and that death occurred on the date stated above at --.
The cause of death was as follows: Tuberculosis