Campbell County Death Certificates

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

 
Golda Goins
Reg. Number:  20701; Reg. District: 1
Certificate Number: 8

Name: Golda Goins
Residence: LaFollette, Tennessee
Sex: Female
Race: white
Date of Birth: 10 May 1915
Place of Birth: Campbell County, TN
Date of Death: 14 Apr 1917
Place of Death: LaFollette, Tennessee
Age: 2
Marital Status: Married
Spouse, if living:
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation:
Industry or Business: (left blank)
Father's Full Name: Wyett Goins
Father's Birthplace: Campbell County, Tennessee
Mother's Full Maiden Name: Nancy Belle Wilson
Mother's Birthplace: Campbell County, TN
Cause of Death: Broncho-Pneumonia
  • Due to: (left blank)
  • 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:
  • 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: Wyett Goins
Informant Address: LaFollette, Tennessee
Burial, Removal, or Cremation: Burial
Date: 15 Apr 1917
Undertaker: None
Address:
By:
Date Filed: 05 May 1917
Registrar: U.S. Carden
Signature: U.S. Carden
Address:

Submitter's Name: S. W. Settles
Submitter's Email: antdarn@aol.com
Relationship to the Deceased: Aunt by marriage

Comments: child is buried at the Old section of the Woodlawn Cemetery in an unmarked grave.

 

 


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