CERTIFICATE OF
DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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Winnie Scarbow
Reg. Number: (left blank);
Reg. District: 20705
Certificate Number: File No. 51
Name: Winnie Scarbow
Residence:
Sex: Female
Race: white
Date of Birth: 10 Apr 1902
Place of Birth: Campbell County, TN
Date of Death: 08 Nov 1918
Place of Death: Jellico, TN
Age: 16 years 6 months 28 days
Marital Status: Single
Spouse, if living:
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: (unable to decipher)
Industry or Business: (left blank)
Father's Full Name: A. Scarboro
Father's Birthplace: Indiana
Mother's Full Maiden Name: Maggie Wilson
Mother's Birthplace: Claiborne County,
TN
Cause of Death: influenza
- 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: Maggie Scarboro
Informant Address: Jellico, TN
Burial, Removal, or Cremation: Jellico,
TN
Date: 09 Nov 1918
Undertaker: Ellian Funeral Co.
Address: Jellico, TN
By:
Date Filed: 20 Dec 1918
Registrar: D. W. Moon
Signature: W. Taylor (?)
Address: Jellico, TN
Submitter's Name: Glenda Scarborough
Submitter's Email: jayhawk@insightbb.com
Relationship to the Deceased: nephew's
spouse
Comments: certificate issued in Campbell
County, TN 5th civil district, primary registration district
4, number 199 is stamped ion the upper righthand corner. Winnie's
father's name in Alvin Scarborough.
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