Jerry Bryan's Web Pages
State of Tennessee
State Board of Health
Bureau of Vital Statistics
Certificate of Death
1. Place of death -- County: Anderson,
Civil Dist.: 9, Registration District: 40109, File number: 8, Village:
Edgemoor, Tenn.; Primary Registration District No.: 40109, Registered
no.: 8. R.F.D. #1
2. Full name -- Hulda Asberine Peters
3. Sex - female
4. Color or race - w
5. Singe, married, widowed, or divorced -- widowed
6. Date of birth -- Month Dec, Day 22, Year 1845
7. Age -- 70 yrs 3 mos. 17 ds.
8. Occupation -- housewife
9. Birthplace -- Tenn
10. Name of father -- Alfred Carter Cross
11. Birthplace of father -- Tenn
12. Maiden name of mother -- Zipporah Peters
13. Birthplace of mother -- Tenn
14. The above is true to the best
of my knowledge (Informant) signed Hutsel Peters, Edgemoor RFD#1
15. Filed 4/9, 1916 J.M. Cox
16. Date of death -- month Apr day 9, year 1916
17. I hereby certify that I attended from
Sept 19, 1915 to Apr 9, 1916, and that I last saw her alive on month Feby
22, 1916 and that death occurred on the date stated above at 1:20 P.M.
The cause of death was as follows: Chronic Valvular Heart Disease
Signed A.T. Stevens M.D., Apr 10, 1916 (Address) RFD#2
18. Length of residence
19. Place of burial or removal -- Scarbrough;
Date of burial -- Apr 10, 1916
20. Undertaker
The informant Hutsel Peters was
Asberine's son
Henry Hutsel (Hutsel) Peters.