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File Number: 109 Registered Number: 41 Place of Death: Dyer Civil District: 4 City: Dyersburg Registration District Number: 231 Primary Registration District No: 4 2. Full Name: Mrs. Elizabeth Forrest Personal and Statistical Particulars 3. Sex : Female 4. Color or Race: White 5. Marital Status: Married 6. Date of Birth: 3-1, 1864 7. Age: 52 years, 25 days 8. Occupation: Housework 9. Birthplace: Tenn 10. Name of Father: Don't know 11. Birthplace of Father: Don't know 12. Maiden Name of Mother: Don't know 13. Birthplace of Mother: Don't know 14. Informant: C. W. Max??, Dyersburg 15. Filed: Mar 26, 1916 Registrar W.H. Ward Medical Certificate of Death 16. Date of Death: 3-26, 1916 17. I hereby Certify, that I attended deceased from 3/20, 1916 to 3-26, 1916, that I last saw her alive on the 3-26, 19166, and that death occurred on the date above at 2 P.M. The Cause of death was as follows: Pneumonia (Signed) W. P. Watson, M.D. 3-26, 1916 Dyersburg 19. Place of Burial: Hurricane Hill Date of Burial: 3-27, 1916 20. Undertaker: J. W. Curry & Son Address: Dyersburg |