County: Okaloosa
District No. 3401
Precinct: Laurel Hill
Precinct No. 34057
Full Name of Deceased: Samuel Jackson Clark
No veteran's info
Sex: Male
Race: White
Marital status is indicated by name of wife: Derah [Dora] Alice Harris, who is age 74 and living.
Birth Date of Deceased: May 25, 1867.
Age at Death: 76.
Birthplace: Okaloosa County.
Occupation: Farmer
Father's Name and Place of Birth: Charlie Clark of Georgia
Mother's Maiden Name and Birth Place: Gennie Bars. Clark (BP unknown)
Informant's Signature: Ruth Clark of Laurel Hil, FL.
Date of Burial: 2/25/43
Place: Almarante Cem.
Funeral Director: L. C. McLaughlin
Address: Crestview, FL
Filed 3/5/43 by M. Morrison.
Usual Residence of Deceased: FL, Okaloosa, Laurel Hill, FL (RR)
Date of Death: Feb 21, 1943 at 12:30p.m.
No docotr in attendance.