Smith County TN Archives History .....B.S. Highers, Application For Insurance Policy April 14, 1919 ************************************************ Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm http://www.usgwarchives.net/tn/tnfiles.htm ************************************************ File contributed for use in USGenWeb Archives by: Fran Cutrell Rutkovsky prutkov@garnet.acns.fsu.edu November 7, 2006, 6:38 pm Banks Samuel Highers (b. Nov. 28, 1868 d. March 22, 1933) Smith County, Tennessee To the Missouri State Life Insurance Company, St. Louis, Missouri I hereby apply for a policy on my life for $5000.00 on the Ordinary Life Economic Protection Non-Participating plan at an annual premium of $176.65. The policy is to be for the benefit of Farmers Implement Co. of Dixon Springs, Tenn., a firm. My full name is Banks S. Highers (member of firm). My occupation is Dealer in Farm Implements, Vehicles, & work in Carriage Shop. I was born at Smith County, Tenn. on the 28th day of Nov. 1868. My age nearest birthday is 50 years. My place of business is Dixon Springs, Smith County, Tenn. Send premium notices to residence. I have resided at above address 15 years. During the past two years I have also resided at same. I hereby request alternate 5000 Ordinary Life Non- Participating With Disability Rider 1779. The amount of insurance now in force on my life is $500.00. Name of company--Equity of N.Y. Kind--Govmt Bond When taken--1918 Amount $500.00 I have no application pending in any other company except $5000.00 with _ Life of Iowa. First premium C.O.D. Dated at Dixon Springs, Tenn. this 14 day of April 1919. signature Banks Samuel Highers Witnesses --W. B. Wooten, A.B. Timberlake Application Part II--Statements to Medical Examiner 1. A. Date of Birth - Nov. 28, 1868 B. Are you a Caucasian? (If not, what race) - Yes C. Married, Single, or Widowed? - Married 2. A. What is the amount of insurance now in force on your life? - $500.00 B. Has any life insurance organization ever declined or failed to issue a policy on your life, or offered one different than applied for? - No 3. A. What is your present occupation? - Merchant B. Have you any other occupation? - No C. What have been your occupations in the past? - Same & work in Carriage Shop D. Have you ever been engaged in any way in the manufacture or sale of any alcoholic beverage? - No E. What, if any, change in occupation or residence do you contemplate? - None F. Have you ever changed residence or traveled to improve your health? - No 4. A. Family Record {questions asked are: age if living, health good or bad, age at death, cause of death, how long ill, and year of death} Father (d) 76 congestion of lungs 2 days 1905 Mother (d) 66 Bronchitis Chronic 6 months 1902 Brothers 5 - (l) 60 good (l) 48 good (d) 58 killed in coal mine 2 days 1919 (d) 27 acute consumption 4 mos. 1891 (d) 8 Dysentery acute 2 wks. 1878 Sisters 4 - (l) 56 good (d) 30 Bronchitis acute 1 mo. 1892 (d) 2 months Infant 3 days 1875 (d) 3 years 1862 B. Age attained by father's father? - 80 father's mother? - 92 mother's father? - 66 mother's mother? - 50 C. Have any of your grandparents, parents, brothers or sisters had cancer, tuberculosis, or been insane? - Only as stated above 5. What illness, disease, accidents or injuries have you had since childhood? {questions asked are: Affliction, Date/yr/mo, Duration, Complications, Results, Name of medical attendant} Whooping cough 1891 June 3 wks. none good none Measles 1879 Feb. 2 wks. none good Dr. Robt. Johnson Fistula 1901 Jan. 5 wks. none good Dr. Charles Briggs, Nashville, Tenn. 6. A. Have you ever had a surgical operation? - Yes, for Fistula B. Have you ever coughed or spit up blood? - No C. Have you any disease of impairment of eyes or ears? - No D. Are you now in good health? If not what is the cause? - Yes 7. A. Have you in the last year gained or lost weight? - No, same B. Has any person in your home suffered from or died of consumption in the past year? - No C. Has any physician ever expressed an opinion that your urine contained sugar, or albumin, or casts? - No 8. A. Have you state in answering questions 5, 6, and 7, all illnesses, diseases, accidents, injuries, and surgical operations you have had since childhood? - Yes 9. A. To what extent do you use alcoholic drinks? - Very little. B. Have you been intoxicated in the last five years? - No C. Have you ever taken treatment for the alcoholic or any drug habit? - No Dated at Dixon Springs, Tenn. the 14th day of April, 1919 Signature - Banks Samuel Highers Witness - I. H. Beasley, M.D. ------------------------------------------------------ NOTE: I transcribed this from a handwritten copy that my father, Homer Cutrell, made from the original policy belonging to Lula Ross Highers, widow of Banks S. Highers. From the "Family Record" part of this application, I believe that the living brothers were: Henry, age 60, and Simon, age 48 (my grandfather). The living sister was Pherbia Armpster Highers Warman. The "father" was Jacob Highers, and the "mother" was Eleanor Wilson Highers. "Father's father" was Henry Highers; "father's mother" was Celia Williams Highers. I do not know the names of Eleanor' Wilson's father and mother. 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