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

Name: Joe Harrison Clark
Residence: Loudon Tn
Sex: Male
Race: W
Date of Birth: 15 Nov 1897
Place of Birth: Loudon Co TN
Date of Death: 16 Sep 1955
Place of Death: Sweetwater Hospital
Age: 57
Marital Status: Married
Spouse, if living: Mary Lee Hensley Clark
Age of Spouse, if living: 56
If Veteran, Name of War:
Social Security Number: 409-01-0715
Occupation: Farmer
Industry or Business: (left blank)
Father's Full Name: William Jacob clark
Father's Birthplace: Roane Co.TN
Mother's Full Maiden Name: Rebecca Davis Varner Clark
Mother's Birthplace:
Cause of Death: Carcinoma of Stomach

• 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: 10 May 1955
• Where did the injury occur: (left blank)
• Did injury occur in or about home, on farm, in industrial place, in public place?: Home
• While at work: (left blank)
• Means of Injury: (left blank)

Informant: Mrs Joe H Clark
Informant Address: Philadelphia, TN
Burial, Removal, or Cremation: Burial
Date: 18 Sep 1955
Undertaker: J.E. Young
Address:
By:
Date Filed: 07 Oct 1955
Registrar: Gracie?? Sheets, Deputy
Signature:
Address:

Submitter's Name: Steve Clark
Submitter's Email: greyfix@ charter.net
Relationship to the Deceased: Grandson

Comments: Funeral Home: Kyker's SweetwaterTN Cemetary: Roberson's Rev. Joe Clark was pastor at Free Will Baptist Church ( PaintRock?? TN)