WHITE COUNTY, TN - VITALS - Rachel Selby Death Certificate
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STATE OF TENNESSEE
STATE BOARD OF HEALTH
Bureau of Vital Statistics
CERTIFICATE OF DEATH

1. Place of Death: Tennessee
 County: White
 Civil Dist.: 12  
 Registration District No. 941
 File No. 80
 Village or city: Sparta #1
 Primary Registration District no. 12th
 Registered No. 25
 City: _________________

2. Full Name: RACHEL SELBY
3. Sex: Female
4. Color or Race: White
5. Single, married, widowed, or divorced: Widow
6. Date of Birth: Feby 25 1841
7. Age: 80 yrs, 3 mos, 24 days
8. Occupation
 Trade, profession, or particular kind of work: On Farm
 General nature of Industry: Housework
9. Birthplace: Tennessee
10. Name of Father: William Daniel
11. Birthplace of Father: Tennessee
12. Maiden name of Mother: Casey Pennington
13. Birhtplace of Mother: Tennessee
14. The above is true to the best of my knowledge
 Informant: W N Selby
 Address: Cookeville, Tn
15. Filed: 6-20 1921 Alta Richards, Registrar
16. Date of Death: June 19 1921
17. I hereby certify that I attended deceased from JUNE 3 to 19, 1921 
 that I last saw him alive on JUNE 12, 1921, and that the death occurred 
 on the date stated above, at 8:30 am
 The cause of death was as follows: (Difficult to read)
 Duration: 8 days
 Contributory: ?Imonity (difficult to read)
 Duration: 9 months
 Signed: W.M. Jibssion(?) M.D. 
 6-20-1921
 Address: W.M. Johnsier(?)
18. Length of Residence (for hospitals, institutions, transients, or 
 recent residents): _______
19. Place of Burial or removal: Board Valley Cemetery
 Date of Burial: 6/20, 1921
20. Undertaker: H.B. Hunter
 Address: Sparta