Campbell Death Certificate
CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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William Henderson Nelson
Reg. Number: 114; Reg. District: 71
Certificate Number: 8967
Name: William Henderson Nelson
Residence: LaFollette Rural
Sex: Male
Race: Whitee
Date of Birth: 25 Feb 1886
Place of Birth: Campbell TN
Date of Death: 29 Apr 1945
Place of Death: LaFollette, Rt. 1
Age: 59 years 2 months 4 days
Marital Status: Married
Spouse, if living: Kizzie E. Nelson
Age of Spouse, if living: 55
If Veteran, Name of War: checked
Social Security Number: 316-18-4885
Occupation: Farmer
Industry or Business: (left blank)
Father's Full Name: Henderson Nelson
Father's Birthplace: Campbell TN
Mother's Full Maiden Name: Nancy Elizabeth Petree
Mother's Birthplace: Campbell TN
Cause of Death: Heart Failure
- Due to: Pneumonia and Influenza
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Other conditions: (left blank)
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Operation?: (left blank)
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Autopsy?: (left blank)
If death was due to external causes, fill in the following:
- Accident, Suicide, or Homicide: (left blank)
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Date of Occurrence: 19
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Where did the injury occur: (left blank)
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Did injury occur in or about home, on farm, in industrial place, in public place?: (left blank)
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While at work: (left blank)
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Means of Injury: (left blank)
Informant: Mrs. Kizzie E. Nelson
Informant Address: LaFollette, TN
Burial, Removal, or Cremation: Burial at Victory Cemetery LaFollette, TN
Date: 01 May 1945
Undertaker: Agee & Walters
Address: LaFollette, TN
By: Oba Walters
Date Filed: 05 Jun 1945
Registrar: Alice C. Murray
Signature: cannot read
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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