Jerry Bryan's Web Pages
Certificate of Death
Dept. of Public Health
State of Tennessee Div. of Vital Statistics
Cooperating with Dept. of Commerce
Bureau of the Census
1. Full name SALLIE JANE PETERS
2. Date of death 7/22/42
3. Place of death ANDERSON COUNTY, Civil
District 8, EDGEMOORE, TENN., R.F.D. #1
4. Legal residence state TENN. county ANDERSON,
city EDGEMOORE, TENN., street R.F.D.#1
5. Race W
6. Sex F
7. Single, married, widowed, divorced
W
8. Age 72 years 0 months 23 days
9. Date of birth JUNE 29 1870
10. Place of birth TENN.
11. Husband or wife of MR. A. E. PETERS
12. If veteran name of war
13. Usual occupation
14. Industry or business HOUSEKEEPER
15. father WILLIAM COLE born in TENN.
16. mother VESTA CLAY ENGLAND
17. Informant MR. LESTER PETERS, address
EDGEMOORE, TENN. R. I
18. Burial 7/23/42 cemetery MT. VERNON CEM.
ANDERSON CO.
19. Undertaker MARTIN FUNERAL HOME, LAKE
CITY, TENN. PAUL MARTIN
20. I hereby certify that I attended the
deceased from May 28, 1942 to July 22, 1942 and that I last saw her alive
on July 19, 1942 and that death occurred on the date stated at 8:15 A.M.
Immediate cause of death Carcinoma of Stomach. Signature: O.E. Ballou,
M.D. Address: Clinton, Tenn. Date signed 7/24/42.
