Campbell County Death Certificates

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

 
Elizabeth Green
Reg. Number:  13; Reg. District: 40701
Certificate Number: 408

Name: Elizabeth Green
Residence: LaFollette, TN
Sex: Female
Race: White
Date of Birth: 16 Aug 1857
Place of Birth: Campbell County, TN
Date of Death: 05 Aug 1917
Place of Death: LaFollette, TN
Age: 60
Marital Status: Single
Spouse, if living:
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation:
Industry or Business: (left blank)
Father's Full Name: Mike Green
Father's Birthplace: Campbell County, TN
Mother's Full Maiden Name: Rebecca Drake
Mother's Birthplace: Campbell County, TN
Cause of Death: Tuberulosis of bowels
  • 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: Dr. Chas Rogers
Informant Address: LaFollette, TN
Burial, Removal, or Cremation: Wells Springs, TN
Date: 06 Aug 1917
Undertaker: none
Address:
By: Dr Chas Rogers
Date Filed: 08 Sep 1917
Registrar: W. G. Meador
Signature:
Address:

Submitter's Name: Bob Leach
Submitter's Email: bleach@rose.net
Relationship to the Deceased: Great Grandson

Comments: Death certificate for Elizabeth: Info on the certificate was provided by a Dr. Chas. Rogers. It is strange that one of her six kids did not provide the info. The death certificate lists birth place for her, her father and mother as Campbell Cty, TN but according to the census records she was born in VA, Michael (certificate list him as Mike) in KY and Rebecca in NC. She was buried the day after she died and there was no attending undertaker. The certificate also listed her as single (not married, divorced, or widowed) so I assume she was never married. Her children, according to the census, using the surname of Green were John E., Rebecca J., William, James, Eliza, James F. Green.


 


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