State of Tennessee
State Board of Health
Bureau of Vital Statistics
Certificate of Death
 

1. Place of death -- County: Jefferson, Civil Dist.: 1, Registration District: 44601, File number: 406, Village: Dandridge, Tenn.; Primary Registration District No.:  , Registered no.: 14.
2. Full name -- Susan Harrison
3. Sex -- Female
4. Color or race -- w
5. Single, married, widowed, or divorced -- widowed
6. Date of birth -- July 31, 1846
7. Age -- 74 yrs..... mos., 4 ds.
8. Occupation -- a) Trade, profession, or particular kinds of work .... Housework  b) General nature of business, or establishment in which employed.... Housekeeping
9. Birthplace -- N C
10. Name of father -- Thomas Slaton
11. Birthplace of father -- Virginia
12. Maiden name of mother -- Rebecca George
13. Birthplace of mother -- N C
14. The above is true to the best of my knowledge signed Daniel Harrison (address) Dandridge, R.3
15. Filed Oct 9, 1920  Daniel Harrison
16. Date of death -- Aug 4, 1920
17. I hereby certify that I attended from July 31 1920 to Aug 3, 1920 and that I last saw her alive on Aug 3, 1920 and that death occurred on the date stated above at 11 A.M.  The cause of death was as follows:  Peralysis (sic)  Signed T.R. French, M.D. (Address) Dandridge
18. Length of residence --
19. Place of burial or removal -- Shady Grove ; Date of burial -- Aug 5, 1920
20. Undertaker -- Mack Fry ; Address -- Dandridge