Tennessee Death Records 1908-1912 > Sample Death Certificate

The image below is a sample of the death certificate form used in Tennessee from 1908 through 1912. Each death certificate has thirteen fields of information; however, fields were sometimes left blank.

The fields are as follows:


  1. Name of deceased
  2. Date of death
  3. Sex
  4. Color or race
  5. Age
  6. Marital status
  7. Place of death
  8. Cause of death
  9. Place of birth
  10. Occupation
  11. Name of physician
  12. Name of coroner holding inquest
  13. Date recorded

Death certificates are stamped with an identification number near the upper right-hand corner.

Sample Tennessee death certificate for 1908 - 1912