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

Alvis Goins
Reg. Number:  430; Reg. District: 40701
Certificate Number: 15


Name: Alvis Goins
Residence: Campbell County TN
Sex: Male
Race: White
Date of Birth: Sep 1851
Place of Birth: Campbell County TN
Date of Death: 22 Sep 1916
Place of Death: TN
Age: 65
Marital Status: Married
Spouse, if living: Blank
Age of Spouse, if living:
If Veteran, Name of War: Blank
Social Security Number: Blank
Occupation: Farmer
Industry or Business: (left blank)
Father's Full Name: James Goins
Father's Birthplace: Campbell Co. Tenn.
Mother's Full Maiden Name: Irwin
Mother's Birthplace: Blank
Cause of Death: Kidney Trouble
  • 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: 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: W.G. Meador
Informant Address: LaFollette Tenn.
Burial, Removal, or Cremation: LaFollette Tenn.
Date: 23 Sep 1916
Undertaker: Blank
Address: Blank
By: Blank
Date Filed: 10 Oct 1916
Registrar: W.G. Meador
Signature: W.G. Meador
Address: Blank

Submitter's Name: Pam Shown
Submitter's Email: tnmtnpj@yahoo.com
Relationship to the Deceased: ggneice

Comments: Alvis Goins' Mother was not an Irwin




 


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