Place of Death: County: Dickson, Civil Dist. 5, Village or City: (blank)
Reg. Dist. No. 221, Primary Reg. Dist. No. 5, Reg. No. 68, File No. 68
Full Name: Thos. Burton ADCOX
Sex: M Race: W Marital Status: Married
Date of Birth: 11/20/1841
Age: 75 yrs. 10 mos. 26 ds.
Occupation: Farmer Nature of Industry: Farmer
Birthplace: Tenn.
Name of Father: Davis ? ADCOX
Birthplace of Father: S. C.
Maiden Name of Mother: Martha C???
Birthplace of Mother: Tenn.
Informant: Flint? ADCOX Address: Nashville
Filed: 10/16/1917 by: (blank)
Date of Death: 10/15/1917
The physician attended him from 7/1/1917 to 10/14/1917
andlast saw him alive on 10/14/1917
Death occurred at: 6 PM
Cause of Death: Peri Carditis?
Signed by: B. F. Walker, M. D. Date: 10/16/1917 Address: Dickson
Place of Burial: Richardson Date of Burial: 10/16/1917
Undertaker: Taylor Bros. & Davis Address: Dickson
Place of Death: County: Dickson, Civil Dist. 5, Village or City: (blank)
Reg. Dist. No. 221, Primary Reg. Dist. No. 5, Reg. No. 68, File No. 68
Full Name: Thos. Burton ADCOX
Sex: M Race: W Marital Status: Married
Date of Birth: 11/20/1841
Age: 75 yrs. 10 mos. 26 ds.
Occupation: Farmer Nature of Industry: Farmer
Birthplace: Tenn.
Name of Father: Davis ? ADCOX
Birthplace of Father: S. C.
Maiden Name of Mother: Martha C???
Birthplace of Mother: Tenn.
Informant: Flint? ADCOX Address: Nashville
Filed: 10/16/1917 by: (blank)
Date of Death: 10/15/1917
The physician attended him from 7/1/1917 to 10/14/1917
andlast saw him alive on 10/14/1917
Death occurred at: 6 PM
Cause of Death: Peri Carditis?
Signed by: B. F. Walker, M. D. Date: 10/16/1917 Address: Dickson
Place of Burial: Richardson Date of Burial: 10/16/1917
Undertaker: Taylor Bros. & Davis Address: Dickson
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