|Following is a transcription of the above
person's (TN) death certificate:
Place of Death: County: Rob., Civil Dist.: 9th, Village or City: Springfield
Reg. Dist.: 752, Primary Reg. Dist.: 27509, Reg. No.: 358
Full Name: Daniel Webster COUTS
Sex: Male Race: Negro Marital Status: Married
Date of Birth: 11/03/1882
Age: 34 yrs. 8 mos. 5 ds.
Occupation: Tobacco Nature of Industry: Laborer
Name of Father: Joe COUTS
Birthplace of Father: Tennessee
Maiden Name of Mother: Clara WATKINS
Birthplace of Mother: Ky.
Informant: Clara Bell COUTS Address: Springfield, Tenn.
Filed: 07/09/1917 Frank Bell, Registrar
Date of Death: 07/08/1917
The physician attended him from 06/25/1917 to 07/08/1917
and last saw him alive on 07/05/1917
Cause of Death: Carcinoma of Stomach Duration: 15 ds.
Signed: S. R. Backell?, M. D. Date: 07/09/1917
Address: Springfield, Tn
Place of Burial: Couts B. G. 9th Dist. Date of Burial: 07/09/1917
Undertaker: Henry & Bell Address: Springfield, Tenn.