Loudon County Genealogy & History Website Loudon County Death Certificates
 

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

 

Mary Lee Clark
Reg. Number:  88-045261; Reg. District:
Certificate Number:

Name: Mary Lee Clark
Residence: 220 Jim Hartsook Lenoir City Tn
Sex: Female
Race: Irish
Date of Birth: 16 Nov 1898
Place of Birth:
Date of Death: 09 Dec 1988
Place of Death: St. Mary's Hosp. Knoxville TN
Age: 90
Marital Status: Married
Spouse, if living: Joe Harrison Clark
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number: 408055801
Occupation: Looper
Industry or Business: Industry
Father's Full Name: Richard Hensley
Father's Birthplace:
Mother's Full Maiden Name: Sarah Moore
Mother's Birthplace:
Cause of Death:
  • 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: Dorthy Likes
Informant Address: same
Burial, Removal, or Cremation: burial
Date: 13 Dec 1988
Undertaker: ??Timberlake Lic#:1076
Address: Kyker 113wN.St.Sweetwater Tn 37874
By:
Date Filed: 05 Jan 1989
Registrar: Lorieta Tadlock
Signature:
Address:

Submitter's Name: Steve Clark
Submitter's Email: greyfix@ charter.net
Relationship to the Deceased: Grandson

Comments:





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