CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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James Alvis Goins
Reg. Number: ; Reg. District:
20701
Certificate Number: 62-28975
Name: James Alvis Goins
Residence: LaFollette
Sex: Male
Race: White
Date of Birth: 07 Aug 1879
Place of Birth: Tennessee
Date of Death: 02 Oct 1962
Place of Death: LaFollette
Age: 83
Marital Status: Widowed
Spouse, if living: Phoby Dossett
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number: 408-56-1539
Occupation: Farmer
Industry or Business: (left blank)
Father's Full Name: Isom Goins
Father's Birthplace: Tennesse
Mother's Full Maiden Name: Nell Vina
Large
Mother's Birthplace:
Cause of Death: Acute cerebro-vascular
thrombosis
- Due to: Hypertensive cardiovascular
disease
- Other conditions: (left blank)
- Operation?: (left blank)
- Autopsy?: No
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: Ruth McNeely
Informant Address: LaFollette, Tennesse
Burial, Removal, or Cremation: Burial
Date: 05 Oct 1962
Undertaker: Mars-Roach
Address: LaFollette Tennessee
By: Margaret H. Ayers, Dep. Reg.
Date Filed: 26 Nov 1962
Registrar: Paula Taylor
Signature: Margaret H. Ayers, Dep. Reg.
Address:
Submitter's Name: Walter H. Goins
Submitter's Email: barbra@chartermi.net
Relationship to the Deceased: Grandson
Comments: The informant Ruth McNeely
was James Alvis Goins' daughter. While she stated his wife's
name was Nell Vina Large, on James' application for Social Sercurity
he writes his wife's name is Martha Jane Large.
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