CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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William Harries
Reg. Number: ; Reg. District:
Certificate Number: 4099
Name: William Harries
Residence: Campbell County
Sex: Male
Race: white
Date of Birth:
Place of Birth: Virginia
Date of Death: 15 May 1910
Place of Death: Powels River Tenn
Age: 77
Marital Status: Married
Spouse, if living: Susan Jane Thomas
Age of Spouse, if living:
If Veteran, Name of War: Civil War C
Reg 1st Tenn Inf
Social Security Number:
Occupation: Farming
Industry or Business: (left blank)
Father's Full Name:
Father's Birthplace:
Mother's Full Maiden Name:
Mother's Birthplace:
Cause of Death: harte 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:
- 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: G W Willoughby Jr.
Informant Address: enumerator for old
7 and 8 siats Campbell Co. TN.
Burial, Removal, or Cremation:
Date: 19
Undertaker: non
Address:
By:
Date Filed: 19
Registrar:
Signature:
Address:
Submitter's Name: Norma Harris
Submitter's Email: watsit2u@hotmail.com
Relationship to the Deceased: gg grandaughter
Comments: All spelling exactly as
on the death certificate. Name should be spelled Harris. Added
in the Civil War info and wifes name from his Civil War pension
file. Note the death certificate says dod is about 15 of May.
I have two signed statements in the Civil War file that states
that these people were present and he died on May 14, 1910.
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