title

Campbell Death Certificate

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

 

Nick Nelson
Reg. Number:  194; Reg. District: 40705
Certificate Number: 12057

Name: Nick Nelson
Residence: Jellico Campbell TN
Sex: Male
Race: White
Date of Birth: 01 Aug 1884
Place of Birth: Union TN
Date of Death: 05 Apr 1948
Place of Death: Jellico Campbell TN
Age: 73 years 8 months 4 days
Marital Status: Married
Spouse, if living: Linda Ford Nelson
Age of Spouse, if living: 78
If Veteran, Name of War:
Social Security Number:
Occupation: odd jobs
Industry or Business: (left blank)
Father's Full Name: William Nelson
Father's Birthplace: Tennessee
Mother's Full Maiden Name: Jane Anderson
Mother's Birthplace: Tennessee
Cause of Death: Carcinoma of prostrate

  • 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: Mrs. Nick Nelson
Informant Address: Elk Valley, Tenn.
Burial, Removal, or Cremation: Burial at Ford Cemetery
Date: 08 Apr 1948
Undertaker: Llewellyn's Funeral
Address: Jellico Tenn
By: L.F. Mann
Date Filed: 05 Jul 1948
Registrar: Eloise P. Jones
Signature: Charles A. Prater
Address: Jellico, TN

Submitter's Name: Suzanne Pratt
Submitter's Email: swmpratt@swmpratt.com
Relationship to the Deceased: none

Comments: Source: Campbell County Death Certificate

 


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