Knox Death Certificate
CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
Reg. Number: NA; Reg. District: NA
Certificate Number: NA
Name: Ethel Orick
Residence: 4406 Maude Booth Way,Knoxville TN.
Sex: Female Race: white Date of Birth: 25 Sep 1926 Place of Birth: Duff,TN. Date of Death: 11 Apr 19 Place of Death: Knoxville,TN. Age: 78 Marital Status: Widowed Spouse, if living: Sherman F. Orick Age of Spouse, if living: If Veteran, Name of War: Social Security Number: 377-36-3515 Occupation: reception Industry or Business: Business Father's Full Name: George Walden Father's Birthplace: Campbell co. TN. Mother's Full Maiden Name: Daisy Walls Mother's Birthplace: Ky. Cause of Death: Congenital heart failure
If death was due to external causes, fill in the following:
- Due to: (left blank)
Other conditions: (left blank)
Operation?: (left blank)
Autopsy?: (left blank)
Informant: Brenda Carter Informant Address: Blaine,TN. Burial, Removal, or Cremation: cremation
Undertaker: Danny Wilson Address: 700 W. Central Ave. LaFollette TN. By: Martin Wilson Funeral Home Date Filed: 29 Apr 19 Registrar: Kristie Dykes Signature: James W. Foster M.D. Address: 2104 E. Magnolia Ave Knoxville,TN.
- 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)
Submitter's Name: Sherman Orick Jr.
Submitter's Email: firstname.lastname@example.org
Relationship to the Deceased: Son
Comments: On date of death and date filed was 2005
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