Mitt Douglas
Reg. Number:  ;
Reg. District: 40704
Certificate Number: 57-10681

Name: Mitt Douglas
Residence: Newcomb, Campbell, Tennessee
Sex: Male
Race: White
Date of Birth: 09 Aug 1905
Place of Birth: Tennessee
Date of Death: 02 May 1957
Place of Death: Newcomb
Age: 51
Marital Status: Married
Spouse, if living: Mrs. Nannie Douglas
Age of Spouse, if living:
If Veteran, Name of War: No
Social Security Number:
Occupation: Miner
Industry or Business: (left blank)
Father's Full Name: Zebb Douglas
Father's Birthplace:
Mother's Full Maiden Name: Mandy Hensley Douglas
Mother's Birthplace:
Cause of Death: Died of Natural Causes

• 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: Mrs. Nannie Douglas
Informant Address: Newcomb, Tenn
Burial, Removal, or Cremation: Burial
Date: 04 May 1957
Undertaker: Ray Ellington, Jr
Address: Jellico, Tenn
By:
Date Filed: 22 May 1957
Registrar:
Signature: Mr Les Alexander
Address:

Submitter's Name: Troy Mitchell
Relationship to the Deceased:

Comments: