CA1369

Death Records v. 55, Tipton Co., Tennessee
(C. Avis Catalog entry #1369)


"Tipton, Tennessee, United States records," images, FamilySearch (https://www.familysearch.org/ark:/61903/3:1:S3HY-DR8C-NK?view=index : Mar 25, 2025), image 9 of 359; Tennessee State Library and Archives (Nashville, Tennessee),Tennessee. County Court (Davidson County).


STATE OF TENNESSEE
STATE BOARD OF HEALTH
Bureau of Vital Statistics

CERTIFICATE OF DEATH

1. PLACE OF DEATH
County  Tipton
Civil Dist.  9
City  Mason

Registration District No.  833
Primary Registration District No.  9 & 10
Registered No. 3

2. FULL NAME  Charlotte Elizabeth Bailey

3. Female   4. White   5. Widow

6. DATE OF BIRTH  Jan 18 1825

7. AGE  89 yrs. 11 mos.  25 da.

8. OCCUPATION  Nil

9. BIRTHPLACE  N.C.

10. NAME OF FATHER    John Mooring

11. BIRTHPLACE OF FATHER  --

12. Maiden Name of Mother    Susan Staten

13. BIRTHPLACE OF MOTHER  --

14. (Informant)   P. H. Taylor    Mason #1  Tenn

15. Filed  1-13-1915    P. H. Taylor

16. DATE OF DEATH   Jan 13, 1915

17. I HEREBY CERTIFY, That I attended deceased from
        Jan 12, 1915, to Jan 13, 1915 that I last saw her alive on Jan 12, 1915, and that death occurred,
        on the date stated above, at 1210 a.m.
        The cause of death was as follows:  Burn and Shock    Duration  1/2 da.

        W. A. Gibsonett, M. D. Covington, Tenn   Jan 13, 1915

18. LENGTH OF RESIDENCE   --

19. PLACE OF BURIAL  Roberson Grave Yard  DATE OF BURIAL Jan 13, 1915

20. UNDERTAKER  J. T. Carney   Mason Tenn.