Campbell County Death Certificates

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

 
John Hogan Claiborne
Reg. Number:  ; Reg. District:
Certificate Number: 140

IMAGE

Name: John Hogan Claiborne
Residence: Well Spring
Sex: Male
Race: White
Date of Birth: 20 Oct 1838
Place of Birth: Missouri
Date of Death: 22 Sep 1918
Place of Death: Well Spring
Age: 79 yrs.11mon. 2 days
Marital Status: Married
Spouse, if living: Martha Jane Kilbourn
Age of Spouse, if living:
If Veteran, Name of War: Civil War
Social Security Number:
Occupation: farmer / merchant
Industry or Business: (left blank)
Father's Full Name: Otie Taylor Claiborne
Father's Birthplace: Tennessee
Mother's Full Maiden Name: Mourning Burgess
Mother's Birthplace: Virginia
Cause of Death: fibroid phthisis/valular lesion
  • Due to: (left blank)
  • Other conditions: heart failure/ asthmatic emphsemia
  • 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: John H. Claiborne
Informant Address: Lafollette Tenn
Burial, Removal, or Cremation: Burial
Date: 19
Undertaker:
Address:
By:
Date Filed: 09 Oct 1918
Registrar: Helen ?
Signature:
Address:

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

Comments:


 


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