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Certificate of
Death 464
1. Full name of deceased: D. T. Dye
2. Date
of death: Month: Apl.; day: 12;
1918;
3. Place of death (county)
Talladega
4. City or town: ; ward ; street and
No ;
5. Place of birth of deceased (state or country)
6.
White or colored? Male or female?
Occupation [strikethrough text are the words
colored and female]
7. How long did deceased reside at place of
death?
8. Where was disease contracted?
9. Principal disease
causing death: old age D. K.
10. Contributory
disease causing death:
11. If homicidal, suicidal, or
accidental, state definitely how accomplished:
12. Did
deceased undergo a surgical operation and if so when and of what
nature?
13. Age: Years: 67 months ; days ;
single, married or widowed?
14. Full name of father of
deceased:
15. Birthplace of father (state or
country):
16. Full name of mother of
deceased:
17. Birthplace of mother (state or
country):
18. Place of interment:
19:
Remarks:
Reporter: B. B. S. [written direclty above is:
J. H. & W. C. Wilson]
Date of
Report:
191_ Post
Office:
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