CERTIFICATE OF
DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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Angelina Ivey
Reg. Number: 51; Reg. District:
72
Certificate Number: 9593
Name: Angelina Ivey
Residence: R #1 LaFollette, Tenn
Sex: Female
Race: W
Date of Birth: 10 Aug 1864
Place of Birth: Union County, Tenn
Date of Death: 22 May 1929
Place of Death: R #1 LaFollette, Tenn
Age: 74 yrs. 7 mo. 12 days
Marital Status: Widowed
Spouse, if living: John Ivey
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: Housewife
Industry or Business: (left blank)
Father's Full Name: Joe Lassley
Father's Birthplace: Tenn
Mother's Full Maiden Name: Unknown
Mother's Birthplace:
Cause of Death: Flu complicated Myocaditis
- 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: Mrs. Gillis Boruff
Informant Address:
Burial, Removal, or Cremation: Fincastle
LaFollette R #1
Date: 24 May 1939
Undertaker: Minton Sharp
Address: LaFollette, Tenn
By:
Date Filed: 02 Jun 1939
Registrar: Alice C. Murray
Signature: P.T. Howard, M.D.
Address: LaFollette, Tenn
Submitter's Name: Bobbie Ivey-Lewallen
Submitter's Email: tngranny3@yahoo.com
Relationship to the Deceased: great
granddaughter
Comments: Angelina's date of death
should be 1939 instead of 1929. As you can tell from the date
of burial, 1929 is WRONG. Here is some more info that was on
the death certificate: "I hereby certify that I attended the
deceased from May 15, 1939 to May 20, 1939. I last saw her alive
on May 20, 1939." & signed by Dr. Howard. There is also a 93D
written next to the cause of death. I have no idea what that
means. Mrs. Gillis Boruff (Ida) was Angelina's daughter. One
last comment by me: Angelina is buried in Glade Springs Cemetery,
located in the area of Fincastle.
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