Certificate of Death

John W. McCartney
submitted by

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.