CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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Dan Blankenship
Reg. Number: 39; Reg. District:
71
Certificate Number: 11299
Name: Dan Blankenship
Residence: Newcomb, Campbell Co, TN
Sex: Male
Race: White
Date of Birth: 19 Jun 1858
Place of Birth: Scott County, TN
Date of Death: 22 Jun 1943
Place of Death: Newcomb, Campbell Co,
TN
Age: 85
Marital Status: Married
Spouse, if living: Emma (Baird) Blankenship
(later Grant)
Age of Spouse, if living: 6X
If Veteran, Name of War:
Social Security Number:
Occupation: Retired
Industry or Business: (left blank)
Father's Full Name: Canada Blankenship
Father's Birthplace: Roanoke, VA
Mother's Full Maiden Name: Malinda Trammell
Mother's Birthplace: Scott County, TN
Cause of Death: Uraemia
- Due to: Kidney trouble and hypertension
- Other conditions: (left blank)
- Operation?: No
- Autopsy?: No
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: J. R. Blankenship
Informant Address: 20550 (xxxxx) (xxxx)
Rd., St. Clair Shores, Mich.
Burial, Removal, or Cremation: Newcomb
Cemetery, Newcomb, TN
Date: 24 Jun 1943
Undertaker: Wm. R. Ed(xxx)or
Address: Jellico, TN
By: (illegible)
Date Filed: 30 Jun 1943
Registrar: L. L. Ridenour by Mrs. L.
L. Ridenour
Signature: W. D. Gibson
Address: Jellico, TN
Submitter's Name: John C. Carter
Relationship to the Deceased: Great-Great-Grandnephew
Comments: (xxxx's represent illegible
letters or characters). Other sources have shown his father,
Canada Blankenship's birthplace to be in NC, not VA.
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