Genealogy Pages for Northern Middle TN
Death Certificate for Sam Wilson POLLARD
| Following is a transcription of the above
person's (TN) death certificate: Place of Death: County: Houston, Civil Dist.: 4th, Village or City: Erin Reg. Dist.: 421, Primary Reg. Dist.: 4, Registered No.: 12 Full Name: Sam Wilson POLLARD Sex: male Race: white american Marital Status: single Date of Birth: 12/14/1884 Age: 32 yrs. 8 mos. 14 ds. Occupation: Carpenter Birthplace: Houston Co., Tenn. Name of Father: W. T. POLLARD Birthplace of Father: Houston Co., Tenn. Maiden Name of Mother: Rebecca Jane PARISH Birthplace of Mother: Houston Co. Informant: Geo. POLLARD Address: Erin, Tenn. Filed: 04/28/1917 J. W. Reynolds, Registrar Date of Death: 04/28/1917 The physician attended him from 09/14/1916 to 04/28/1917 and last saw him alive on 04/26/1917 Death occurred on date stated above at: 11:45 AM Cause of Death: Pulmonary Tuberculosis with mixed Infection Duration: 1 yr. Contributory: Chronic LaGrippe Duration: 2 yrs. Signed: J. S. Edwards, M. D. 04/28/1917 Address: Erin, Tenn. Length of Residence at place of death: 2 yrs. Where was disease contracted, if not at place of death? at or near place of death. Former or Usual Residence: 5th Dist. Houston County Place of Burial or Removal: Erin Cemetery Date of Burial: 04/29/1917 Undertaker: J. C. Burwell? Address: Erin, Tenn. |