title

Campbell County TN Death Certificate

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

 
Lucyndica Holt
Reg. Number:  40700; Reg. District: left blank
Certificate Number: 316

Name: Lucyndica Holt
Residence: Jellico
Sex: Female
Race: white
Date of Birth: 12 Nov 1869
Place of Birth: KY
Date of Death: 10 Mar 1925
Place of Death: Jellico
Age: 55yrs 4mos
Marital Status: Married
Spouse, if living: Noah Holt
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: Housekeeper
Industry or Business: (left blank)
Father's Full Name: TYE
Father's Birthplace: Tenn
Mother's Full Maiden Name: Nancy Goins
Mother's Birthplace: VA
Cause of Death: Mitrel incufficiency
  • Due to: can't read
  • 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: Syntea Holt
Informant Address: Jellico
Burial, Removal, or Cremation: Holt Cem
Date: 12 Mar 1925
Undertaker: Lewellyn
Address: Jellico
By:
Date Filed: 22 Apr 1925
Registrar: cant read
Signature:
Address:

Submitter's Name: Carl Davis
Submitter's Email: ciddddavis@citlink.net
Relationship to the Deceased: distant relative

Comments: This was Lucinda Tye Holt married to Noah Holt


 


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