Campbell County Death Certificates

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

 
James Brock
Reg. Number:  ???; Reg. District: 40705
Certificate Number: 33

Name: James Brock
Residence: Jellico, Tennessee
Sex: Male
Race: White
Date of Birth: 25 Dec 1858
Place of Birth: Tennessee
Date of Death: 15 Dec 1922
Place of Death: Jellico, Tennessee
Age: 64
Marital Status: Widowed
Spouse, if living: Sarah Elizabeth Ivey
Age of Spouse, if living: ---
If Veteran, Name of War:
Social Security Number:
Occupation: carpenter
Industry or Business: (left blank)
Father's Full Name: Isaac Brock
Father's Birthplace: Tennessee
Mother's Full Maiden Name: Unknown
Mother's Birthplace:
Cause of Death: Bright's (Chronic)
  • Due to: (left blank)
  • Other conditions: paralysis
  • 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: Will Brock
Informant Address:
Burial, Removal, or Cremation: Jellico, Tennessee
Date: 16 Dec 1922
Undertaker: Jellico Funeral Company
Address: Jellico, Tennessee
By: D.W. Moon
Date Filed: 13 Oct 1923
Registrar: L.L. Relinces?
Signature:
Address:

Submitter's Name: Donna (Brock) Strong
Submitter's Email: dstrong@worldnet.att.net
Relationship to the Deceased: Great-grandfather

Comments: James Brock is believed to be buried at Jellico Cemetery. However, there is no headstone.

 

 


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