CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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Elizabeth Green
Reg. Number: 13; Reg. District:
40701
Certificate Number: 408
Name: Elizabeth Green
Residence: LaFollette, TN
Sex: Female
Race: White
Date of Birth: 16 Aug 1857
Place of Birth: Campbell County, TN
Date of Death: 05 Aug 1917
Place of Death: LaFollette, TN
Age: 60
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: Mike Green
Father's Birthplace: Campbell County,
TN
Mother's Full Maiden Name: Rebecca Drake
Mother's Birthplace: Campbell County,
TN
Cause of Death: Tuberulosis of bowels
- 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: Dr. Chas Rogers
Informant Address: LaFollette, TN
Burial, Removal, or Cremation: Wells
Springs, TN
Date: 06 Aug 1917
Undertaker: none
Address:
By: Dr Chas Rogers
Date Filed: 08 Sep 1917
Registrar: W. G. Meador
Signature:
Address:
Submitter's Name: Bob Leach
Submitter's Email: bleach@rose.net
Relationship to the Deceased: Great
Grandson
Comments: Death certificate for Elizabeth:
Info on the certificate was provided by a Dr. Chas. Rogers.
It is strange that one of her six kids did not provide the info.
The death certificate lists birth place for her, her father
and mother as Campbell Cty, TN but according to the census records
she was born in VA, Michael (certificate list him as Mike) in
KY and Rebecca in NC. She was buried the day after she died
and there was no attending undertaker. The certificate also
listed her as single (not married, divorced, or widowed) so
I assume she was never married. Her children, according to the
census, using the surname of Green were John E., Rebecca J.,
William, James, Eliza, James F. Green.
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