title

Knox Death Certificate

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

 

Ethel Orick
Reg. Number:  NA; Reg. District: NA
Certificate Number: NA


Name: Ethel Orick
Residence: 4406 Maude Booth Way,Knoxville TN.
Sex: Female
Race: white
Date of Birth: 25 Sep 1926
Place of Birth: Duff,TN.
Date of Death: 11 Apr 19
Place of Death: Knoxville,TN.
Age: 78
Marital Status: Widowed
Spouse, if living: Sherman F. Orick
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number: 377-36-3515
Occupation: reception
Industry or Business: Business
Father's Full Name: George Walden
Father's Birthplace: Campbell co. TN.
Mother's Full Maiden Name: Daisy Walls
Mother's Birthplace: Ky.
Cause of Death: Congenital heart failure
  • 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: 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: Brenda Carter
Informant Address: Blaine,TN.
Burial, Removal, or Cremation: cremation
Date: 19
Undertaker: Danny Wilson
Address: 700 W. Central Ave. LaFollette TN.
By: Martin Wilson Funeral Home
Date Filed: 29 Apr 19
Registrar: Kristie Dykes
Signature: James W. Foster M.D.
Address: 2104 E. Magnolia Ave Knoxville,TN.

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

Comments: On date of death and date filed was 2005


 

 


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