title

Campbell Death Certificate

CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS

 

Arthur Luther Orick
Reg. Number:  55; Reg. District: 72
Certificate Number: 13720


Name: Arthur Luther Orick
Residence: Civil Dist. 1 LaFollette,TN
Sex: Male
Race: white
Date of Birth: 10 Apr 1894
Place of Birth: Winfeild,TN.
Date of Death: 14 Jun 1943
Place of Death: LaFollette,TN.
Age: 49
Marital Status: Married
Spouse, if living: Mrs. Bonnie Orick
Age of Spouse, if living: 31
If Veteran, Name of War: check mark
Social Security Number: left blank
Occupation: farming
Industry or Business: (left blank)
Father's Full Name: Russell Orick
Father's Birthplace: Campbell Co. TN.
Mother's Full Maiden Name: Liza Bailey
Mother's Birthplace: Union Co. TN.
Cause of Death: Pyelitis and Asthma
  • Due to: Enlarged Heart
  • Other conditions: (left blank)
  • Operation?: (left blank)
  • Autopsy?: (left blank)
If death was due to external causes, fill in the following:
  • Accident, Suicide, or Homicide: (left blank)
  • Date of Occurrence: 19
  • Where did the injury occur: (left blank)
  • Did injury occur in or about home, on farm, in industrial place, in public place?: (left blank)
  • While at work: (left blank)
  • Means of Injury: (left blank)
Informant: Mr. Charley B. Orick
Informant Address: LaFollette ,R#2
Burial, Removal, or Cremation: Burial
Date: 16 Jun 1943
Undertaker: Minton Sharp
Address: LaFollette
By: left blank
Date Filed: 03 Jul 1943
Registrar: Alice C. Murray
Signature: P.T. Howard M.D.
Address: LaFollette,Tenn.

Submitter's Name: Sherman Orick Jr.
Submitter's Email: knxorick@aol.com
Relationship to the Deceased: Great Nephew

Comments:


 


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