title

Campbell Death Certificate

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

 

Cecil Nelson
Reg. Number:  89; Reg. District: 72
Certificate Number: 26826

Name: Cecil Nelson
Residence: LaFollette RFD #2
Sex: Male
Race: White
Date of Birth: 15 Sep 1935
Place of Birth: Tenn
Date of Death: 04 Nov 1937
Place of Death: LaFollette TN
Age: 2 years 1 month 29 days
Marital Status: Single
Spouse, if living: none
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation:
Industry or Business: (left blank)
Father's Full Name: Henderson Nelson
Father's Birthplace: Tenn
Mother's Full Maiden Name: Tiney Hill
Mother's Birthplace: Tenn
Cause of Death: Laryngeal Diphtheria
  • Due to:
  • 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: Luna Welmore (?)
Informant Address: LaFollette TN Rt 1
Burial, Removal, or Cremation: Burial
Date: 05 Nov 1937
Undertaker: Agee Furniture & Twd.(?) Co.
Address: LaFollette, TN
By:
Date Filed: 16 Dec 1937
Registrar: U.S. Carden
Signature: R.J. Buckman
Address: LaFollette TN

Submitter's Name: Suzanne Pratt
Submitter's Email: swmpratt@swmpratt.com
Relationship to the Deceased: none

Comments: Source; Campbell County Death Certificate

 


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