Name: Norville Nelson
Residence: LaFollette Rt. 1
Sex: Male
Race: White
Date of Birth:
Place of Birth: Union TN
Date of Death: 02 Mar 1911
Place of Death: LaFollette, Rt. 1
Age: 46 years
Marital Status: Married
Spouse, if living:
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: Farmer
Industry or Business: (left blank)
Father's Full Name:
Father's Birthplace:
Mother's Full Maiden Name:
Mother's Birthplace:
Cause of Death: Tuberculosis

• 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: Dr. W.B. Sargent
Informant Address:
Burial, Removal, or Cremation:
Date: 19
Undertaker:
Address:
By:
Date Filed: 11 Aug 1911
Registrar: Jno. E. Brown
Signature:
Address:

Submitter's Name: Suzanne Pratt
Submitter's Email: swmpratt@swmpratt.com
Relationship to the Deceased: none

Comments: source: Copy of Campbell County Death Certificate