John W. McCartney

Certificate of Death

John W. McCartney

STATE OF TENNESSEE

STATE BOARD OF HEALTH

Bureau of Vital Statistics

CERTIFICATE OF DEATH

1. Place of Death - Gibson County, Civil District 15, Registration Dist. 278

2. Full Name - John W. McCartney

PERSONAL AND STATISTICAL PARTICULARS

3. Sex - Male

4. Color or Race - White

5. Single, Married, Widowed, or Divorced - Married

6. Date of Birth - (left blank)

7. Age - 68 years

8. Occupation - Farmer

9. Birthplace - Tenn.

10. Name of Father - Billie McCartney

11. Birthplace of father - Tenn.

12. Name of Mother - Caroline Beard

13. Birthplace of Mother - Tenn.

14. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE - E. A. McCartney, Informant, Milan, Tenn.

15. Filed Dec. 10, 1916, J.H. Browning, Registrar

MEDICAL CERTIFICATE OF DEATH

16. Date of Death - December 9, 1916

17. I HEREBY CERTIFY, That I attended deceased from Nov. 15, 1916, to Dec. 4, 1916, that I last saw him alive on Dec. 4, 1916, and that death occurred, on the date stated above, at 12 p.m. The CAUSE OF DEATH was as follows: Appoplexy. Signed - Sid L. Mackey, M.D., Dec. 10, 1916, Bradford, Tenn.

18. Length of Residence - (left blank)

19. Place of Burial or Removal - Poplar Springs; Date of Burial Dec. 10, 1916;

20. Undertaker - ?? Fields (cut off); Address: Milan, Tenn.