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1.	PLACE OF DEATH
County:  BRECKINRIDGE
Vot. Pol.:  12
Inc Town:  IRVINGTON
City:  
No.  
St.  
Ward:  
Registration District No.:  5312
Primary Registration District No:  
File No.  28699
Registered No: 5312 
2.	FULL NAME: WAGGONER, HERSCHEL 
PERSONAL AND STATICAL PARTICULARS
3.	SEX:  MALE
4.	COLOR OR RACE:  WHITE
5.	SINGLE, MARRIED, WIDOWED, OR DIVORCED:  SINGLE
6.	DATE OF BIRTH:  SEP 8, 1903
7.	AGE  (yr. mo. da) (If less than 1 day, hours or min?):  10 / 2 / 12
8.	OCCUPATION (a.) Trade, profession or particular kind of work:  AT SCHOOL
(b.)  General nature of industry business or establishment which employed:  
9.	BIRTHPLACE:  McKENZIE, TENNESSEE
10.	NAME OF FATHER:  J.B. WAGGONER
11.	BIRTHPLACE OF FATHER:  ROELLEN, TENNESSEE
12.	MAIDEN NAME OF MOTHER:  ALICE TATE
13.	BIRTHPLACE OF MOTHER:  MT. JULIET, TENNESSEE
14.	THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  J.B. WAGGONER
(Address)  IRVINGTON
15.	Filed  DEC 1, 1913
REGISTAR:  
MEDICAL CERTIFICATE OF DEATH
16.	DATE OF DEATH:  NOV 20, 1913
17.	I HEREBY CERTIFY, That I attended deceased from (date):  NOV 13, 1913 to NOV 20, 1913
That I last saw him/her alive on (date):  NOV 20, 1913
And that death occurred on the date stated above at (time AM/PM):  1 PM
THE CAUSE OF DEATH was as follows:  DIPTHERIA
(Duration)   Years:            Months:            Days:    7 DAYS
Contributory:  

(Duration)   Years:            Months:            Days:  
Signed (M.D.):  S.P. PARKS
Date:  NOV 21, 1913
Address:  IRVINGTON
18.	LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19.	PLACE OF BURIAL OR REMOVAL:  LEBANON, TENNESSEE
DATE OF BURIAL:  NOV 22, 1913
20.	UNDERTAKER:  M.HAMMON & SONS
ADDRESS:  CLOVERPORT


ADDITIONAL COMMENTS/NOTES:




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Dana Brown http://www.genrecords.net/emailregistry/vols/00005.html#0001067
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