CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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Lilly Poor
Reg. Number: 45; Reg. District:
second
Certificate Number: 7
Name: Lilly Poor
Residence: Anderson County
Sex: Female
Race: white
Date of Birth: 1898
Place of Birth: Tennessee
Date of Death: 29 Mar 1916
Place of Death: Andersonville, Anderson
County, TN
Age: 18
Marital Status: Married
Spouse, if living:
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: housework
Industry or Business: (left blank)
Father's Full Name: ? Gross
Father's Birthplace: Tennessee
Mother's Full Maiden Name: Lilly Gross
Mother's Birthplace: Tennessee
Cause of Death: Puerperal Eclampsia
- 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. W. J. Elliott
Informant Address: Andersonville, Anderson
County, TN
Burial, Removal, or Cremation: Burial
Date: 30 Mar 1916
Undertaker: J. Allen Carden & Son
Address: Andersonville,TN
By:
Date Filed: 18 Apr 1916
Registrar: J allen Carden
Signature: J allen Carden
Address:
Submitter's Name: S. W. Settles
Submitter's Email: antdarn@aol.com
Relationship to the Deceased: cousin
Comments: Full Name of Deceased:
Lilly Donna Poor(e) Father's Name: William F. Gross, killed
in the Fraterville Mine Accident May 19, 1902. Mother's Name:
Hannah Jane Suttles/Settles Husband's Name: Henry Poor(e) Burial:
Indian Creek, TN Removal: Indian Creek Memorial, Campbell County,
TN, but family members says that Lilly and Henry are interred
at the Cumberland View Cemetery, Campbell County, TN
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