title

Anderson Death Certificate

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

 
Rubie Melton
Reg. Number:  ; Reg. District:
Certificate Number: 52-0461
Name: Rubie Melton
Residence: Lake City, TN
Sex: Female
Race: white
Date of Birth: 17 Feb 1896
Place of Birth: Tennessee
Date of Death: 20 Mar 1952
Place of Death: Lake City, TN
Age: 56
Marital Status: Married
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: James Melton
Father's Birthplace:
Mother's Full Maiden Name: Mary J. Hatmaker
Mother's Birthplace:
Cause of Death: Cerebral Hemorrhage
  • 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: Minnie Keys Melton
Informant Address:
Burial, Removal, or Cremation: Leach Cemetery, Lake City TN
Date: 23 Mar 1952
Undertaker: Paul Martin
Address: Lake City TN
By:
Date Filed: 19
Registrar:
Signature:
Address:

Submitter's Name: Campbell Genweb
Submitter's Email: campbell@tngenweb.org
Relationship to the Deceased:

Comments:



 


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