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.

Updated December 7, 2007