Tennessee Death Records 1914 - 1933 >Sample Death Certificate

The image below is a sample death certificate from Tennessee. Each death certificate has twenty fields of information; however, some fields were left blank if the requested information was not readily available.

The fields are as follows:


  1. Place of death: County, civil district OR village OR city
  2. Full name
  3. Sex
  4. Color or race
  5. Marital status
  6. Date of birth
  7. Age
  8. Occupation
  9. Birthplace (state or country)
  10. Name of father
  11. Birthplace of father (state or county)
  12. Maiden name of mother
  13. Birthplace of mother (state or county)
  14. Name and address of individual who provided information for death certificate
  15. Name of registrar
  16. Date of death
  17. Cause of death
  18. Length of residence
  19. Place of burial or removal and date of burial
  20. Name and address of undertaker

Death certificates are stamped with an identification number in the upper right-hand corner (marked in yellow on the image).

sample Tennessee death certificate