Campbell County Death Certificates

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

 
Houston Ivy
Reg. Number:  2; Reg. District: 40701
Certificate Number: 359

Name: Houston Ivy
Residence: LaFollette
Sex: Male
Race: White
Date of Birth: 1832
Place of Birth: Don't Know
Date of Death: 11 Jan 1920
Place of Death: Left Blank
Age: 87
Marital Status: Married
Spouse, if living:
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: Farmer
Industry or Business: (left blank)
Father's Full Name: Don't Know
Father's Birthplace: Left Blank
Mother's Full Maiden Name: Sarah Ivy
Mother's Birthplace: Tenn
Cause of Death: Old age or indigestion
  • 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: Left Blank
Informant Address: Left Blank
Burial, Removal, or Cremation: Fincastle,Tenn
Date: 13 Jan 1920
Undertaker: G.W.Mars
Address: Left Blank
By: Left Blank
Date Filed: Feb 1920
Registrar: Helen Meador
Signature:
Address:

Submitter's Name: Connie Paul
Submitter's Email: RCPaul143@aol.com
Relationship to the Deceased: G-G Granddaughter

Comments: Has his birth on certificate as 1832 but on his tombstone his birth is June 10,1833.



 


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