Registered Number: 40
Registration District Number: 231

1. Full name: Billie Bivens
2. Date of Death:   Feb     22  1941
                   MONTH   DAY  YEAR

3 Place of Death
a) County: Dyer    Civil District: 13
b) City or Town: Halls Route #1
c) Name of Hospital: 
d) Length of stay in Hospital:  In community:

4. Legal residence
a) State: Tenn
b) County: Dyer   Civil District: 13
c) City or town: Halls Route #1

5.  Race or Color: White
6.  Sex: Male
7.  Single, Married, Widowed, Divorced: Married
8.  Age: 71 years  3 months  7 days
9.  Date of birth: Month: Nov  Day: 15   Year: 1869
10. Place of birth:  State: Ark
11. Husband of: Nannie Bivens
    Age of husband or wife, if living: 60
12. If veteran name of war:
    Social Security Number:
13. Usual occupation: Farmer
14. Industry or business:
15. Father: Full Name: unknown
    Birthplace: unknown
16. Mother: Full Name: unknown
    Birthplace: unknown
17. Informant: Mrs. Nannie Bivens
    Address: Halls Tenn. Route #1
18. Burial, Removal or Cremation: Burial  Date: Feb 23, 1941
    Cemetery: Fairview     Place: Dyersburg, Tenn
19: Undertaker: J. W. Curry & Son
    Address: Dyersburg Tenn   By: F. C. Denton

Medical Certification
20. I hereby Certify, that I attended the deceased from Feb. 13  1941 to Feb. 22  1941
    and that i last saw him alive on Feb 22 1941 and that death occurred on
    the date stated at 2 40 AM.
    
    Immediate Cause of death:
    Auricular Fibrulation

    Due to: posibly hereditary

Signature: Dr. Wm Hall (signed)
Address: Halls Tenn   Date signed: 2/24-41

Date Filed: 2-23 1941    Mrs. G.W. Chambers    
                              Registrar