Addie Blackburn Woods Death Certificate                                                                                                                              

 

STATE OF TENNESSEE

State Board of Health     Bureau of Vital Statistics

CERTIFICATE OF DEATH

{Marshall County Certificate # 492}

 

Full Name:  Addie Blackburn Woods                        Date of death:  June 7, 1919

Place of death:  Belfast,  Civil District 5,  Marshall County

Sex:                                   F

Color or Race:                 White

Marital Status:                Widowed

Date of birth:                   October 29, 1846

Age at date of death:       73 years, 7 months, 8 days

Occupation:                     At home

Birthplace:                       Marshall Co., Tenn.

 

Name of Father:               Gideon Dysart

Birthplace of Father:       Marshall County, Tenn.

Mother's maiden name:  Elizabeth Coffey

Birthplace of Mother:     Tennessee

Informant:                       John B. Woods        Belfast, Tenn.

________________________________________________________________________

MEDICAL CERTIFICATE OF DEATH

I HEREBY CERTIFY, That I attended deceased from Feb 15, 1919, to June 7, 1919, that I last saw her alive on June 7, 1919, and that death occurred, on the date stated above at 11 a. m.

The CAUSE OF DEATH * was as follows:

                                               

Signed:   J. W. Reed, M. D.    Belfast, Tenn

________________________________________________________________________

Place of burial:  Round Hill                 Date of burial:   June 8, 1919

Undertaker:      W. A. Bills                  Lewisburg

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Submitted by Dick Wood