|Following is a transcription of the above
person's (TN) death certificate:
Place of Death: County: Robertson, Civil Dist.: 9, Primary Reg. Dist.: 27509
Village or City: Springfield, Reg. Dist.: 752, Reg. No.: 495
Full Name: Thomas FORT
Sex: Male Race: Col Marital Status: Widowed
Date of Birth: Don't know
Age: about 85 yrs.
Name of Father: Geo Metcalf FORT
Birthplace of Father: Tenn.
Maiden Name of Mother: Su?kye CARR
Birthplace of Mother: Tenn.
Informant: Mary PALMER Address: Clarksville, Tenn.
Filed: 11/24/1917 Frank Bell, Registrar
Date of Death: 11/24/1917
The physician attended him from 11/17/1917 to 11/24/1917
and last saw him alive on 11/23/1917
Death occurred on date above at 3:30 am
Cause of Death: Hemorrhage at the lungs Duration: 6 ds.
Contributory: Bronchitis & nephritis
Signed: T. Howard Bullard, M. D. Date: 11/25/1917
Address: Springfield, Tenn.
Place of Burial: Lendahand Date of Burial: 11/25/1917
Undertaker: Henry & Bell Address: Springfield, Tenn.