WHITE COUNTY, TN - VITALS - Mary Frances Selby Death Certificate
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CERTIFICATE OF DEATH

STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
Division of Vital Statistics

Reg No. 11
Reg Dist No. 941

1. Full Name: MARY FRANCES SELBY
2. Date of Death (month, day, year): Jan 21, 1940
3. Place of Death:
 County: White
 Civil District: 1st
 City or town: Sparta Tenn.
 Name of Instition or Hospital: ------
 Length of stay in hospital: ------
4. Legal Residence:
 County: White
 Civil District: 1st
 City or Town: ------
5. Color or Race: W
6. Sex: F
7. Single, married, widowed, or divorced: W
8. Age: 86 years, 8 months, 21 days
9. Date of Birth: Month: April, Day: 30, Year: 1853
10. Place of Birth: White County, Tenn.
11. Husband or wife of: John Selby
 Age of Husband or wife, if living: -----
12. If veteran name of war: -----
 Social Security Number: -----
13. Usual Occupation: Housework
14. Industry or Business: ------
15. Father's full name: Jimmie Kinnaird
 Birthplace: VA.
16. Mother's maiden name: Pollie Hill
 Birthplace: White Co., Tenn
17. Informant: Mrs. Staley Selby
 Address: Sparta, Tenn
18. Burial, Removal, or cremation: Burial
 Date: Jan 22, 1940
 Cemetery: Board Valley
 Place: White Co.
19. Undertaker: Hunter Thurman
 Address: Sparta
 By: BB Hunter
 Date Filed: Jan 4, 1940
 Tina B Camp, Registrar
20. I hereby certify that I attended the deceased from 
 ______ to _____ and that I last saw her alive on ________.  
 And the death occurred on the date stated at 7:15 pm
 Immediate cause of death: Chronic Myocarditis, Influenza
 Signature: J.C.Blankinship M.D.
 Address: Sparta, Tenn