Campbell County Death Certificates

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

 
Dock John Monday
Reg. Number:  20701; Reg. District: 1st civil
Certificate Number: 65-005841

Name: Dock John Monday
Residence: Campbell Co. Tenn
Sex: Male
Race: white
Date of Birth: 23 Jan 1872
Place of Birth: Claiborne Co. Tenn
Date of Death: 31 Mar 1965
Place of Death: LaFollette, Campbell Co. Tenn
Age: 93
Marital Status: Widowed
Spouse, if living: Frances Monday
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: farmer
Industry or Business: (left blank)
Father's Full Name: John Monday
Father's Birthplace:
Mother's Full Maiden Name: Mary Turner
Mother's Birthplace:
Cause of Death: not listed
  • 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. Luther Carroll
Informant Address: Speedwell Tenn
Burial, Removal, or Cremation: Burial
Date: 02 Apr 1965
Undertaker: Cross Funeral Home
Address: LaFollette Tenn
By:
Date Filed: 09 Apr 1965
Registrar: Nancy Beever?
Signature:
Address:

Submitter's Name: Carol Woodward
Submitter's Email: carol@tc3net.com
Relationship to the Deceased: cousin

Comments: Died in LaFollette Hospital

 

 


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