title

Anderson Death Certificate

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

 

David Henry Yarber
Reg. Number:  #102; Reg. District: 6th
Certificate Number:

Name: David Henry Yarber
Residence: Clinton TN
Sex: Male
Race: White
Date of Birth: 27 Sep 1912
Place of Birth: Clinton Tennessee
Date of Death: 10 May 1914
Place of Death: Clinton TN
Age: 1 Year : 7 Months : 13 Days
Marital Status: Single
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: M.F. Yarber
Father's Birthplace: Anderson TN
Mother's Full Maiden Name: Luvernia Arms
Mother's Birthplace: Morgan TN
Cause of Death: Infection And Toxemia From Interocolitis
  • 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: M.F.Yarber
Informant Address: Clinton TN
Burial, Removal, or Cremation: burial
Date: 11 May 1914
Undertaker: O.S. Dugge
Address: Cliniton TN
By:
Date Filed: 19
Registrar:
Signature:
Address:

Submitter's Name: Susie Bullock
Submitter's Email: susiebullock@comcast.net
Relationship to the Deceased:

Comments:


 


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