Name: Sarah Ellen Scott
Residence: Loudon county
Sex: Female
Race: White
Date of Birth: 1861
Place of Birth: Roane county
Date of Death: 29 Aug 1944
Place of Death: Loudon county
Age: 87
Marital Status: Single
Spouse, if living:
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number: none
Occupation: none
Industry or Business: (left blank)
Father's Full Name: John Scott
Father's Birthplace: unknown
Mother's Full Maiden Name: Betty Sweatt
Mother's Birthplace: unknown
Cause of Death: broncho-pneumonia and myocarditis

• 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:
Informant Address:
Burial, Removal, or Cremation: Burial
Date:
Undertaker:
Address:
By:
Date Filed: 19
Registrar:
Signature:
Address:

Submitter's Name: Anna Anderson
Submitter's Email: anna@nashville.net
Relationship to the Deceased: great grand-daughter in law

Comments: