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STATE OF MINNESOTA
Division of Vital Statistics
Certificate of Death
26871

No. in Registration Book: 611

PERSONAL AND STATISTICAL PARTICULARS

1. Place of Death
County: St. Louis
City: Duluth
No. 2^nd Ave. E. and 1^st St.
2. Full Name: Elmer Jackson
Residence: Topeka, Kansas
Length of residence in city or town where death occurred: 2 days
3. Sex: Male
4. Color or Race: Black
5. Single, Married, Widowed or Divorced: Single
6. Date of Birth: April 19, 1897
7. Age: 23 years, 1 month, 26 days
8. Occupation of Deceased
Trade, Profession or particular king of work: Laborer
General nature of industry,...: Circus
Name of Employer: John Robinson Show
9. Birthplace: Missouri
10. Name of Father: Clifton Jackson
11. Birthplace of Father: Missouri
12. Maiden Name of Mother: Rachael Smith
13. Birthplace of Mother: Kansas
14. Informant: Clifton Jackson
15. Filed: E.W. Fahey, M.D., Director of Public Health

MEDICAL CERTIFICATE OF DEATH

16. Date of Death: June 15, 1920
17. The Cause of Death was as follows: Strangulation by hanging to light pole.

(lynched)
18. [Left Blank]
(signed) C.F. McCombs, M.D.
Duluth, Coroner
19. Place of Burial, Cremation, or Memorial: Park Hill Cemetery
Date of Burial: June 24, 1920
20. Undertaker: Grady & Horgan
Address: Duluth