Death No: 49-06684
1. Name: MINNESOTA SELBY
2. Date of Death (month, day, year): 3-2-49
3. Color or Race: W
4. Sex: Female
5. Single, married, widowed, or divorced: Married
6. Date of Birth (month, day, year): 3-7-1882
7. Age (in years last birthday): 66
8. Place of Death:
County: White
Civil District: 1
City or town: Sparta
Length of stay in this place: 20 yrs.
Name of Instition or Hospital: ------
9. Usual Residence of Deceased:
State: Tenn
County: White
Civil District: 1
City or Town: Sparta
Street Address: -----
10. Usual Occupation: Housewife
11. Social Security Number: -----
12. Was deceased ever in armed forces: No
13. Birthplace: White, Tenn
14. Citizen of What Country? U.S.A.
15. Father's name: John Milligan
16. Mother's maiden name: Myra Clouse
17. Informant: Nathan Selby
Address: Sparta, Tenn
18. Cause of Death: Chronic Myocarditis
19. Date of operation: -----
20. Autopsy: -----
21. Accident, Suicide, Homicide: -----
22. I hereby certify that the deceased died on the date and
from the cause stated above.
Signature: J.C Blauburlup M.D.
Address: Sparta 10
Date: 4-1-49
23. Burial, cremation, removal: Burial
Date of Burial: 3-4-1949
Name of Cemetery: Board Valley
Location: White County, Tenn
24. Funeral Director: Hunter Funeral House
Address: Sparta, Tenn
25. Registrarion Dist. No: 39301
26. Date signed by local Reg: 4-1-49
27. Registrar's signature: Tina B Camp
1. Name: MINNESOTA SELBY
2. Date of Death (month, day, year): 3-2-49
3. Color or Race: W
4. Sex: Female
5. Single, married, widowed, or divorced: Married
6. Date of Birth (month, day, year): 3-7-1882
7. Age (in years last birthday): 66
8. Place of Death:
County: White
Civil District: 1
City or town: Sparta
Length of stay in this place: 20 yrs.
Name of Instition or Hospital: ------
9. Usual Residence of Deceased:
State: Tenn
County: White
Civil District: 1
City or Town: Sparta
Street Address: -----
10. Usual Occupation: Housewife
11. Social Security Number: -----
12. Was deceased ever in armed forces: No
13. Birthplace: White, Tenn
14. Citizen of What Country? U.S.A.
15. Father's name: John Milligan
16. Mother's maiden name: Myra Clouse
17. Informant: Nathan Selby
Address: Sparta, Tenn
18. Cause of Death: Chronic Myocarditis
19. Date of operation: -----
20. Autopsy: -----
21. Accident, Suicide, Homicide: -----
22. I hereby certify that the deceased died on the date and
from the cause stated above.
Signature: J.C Blauburlup M.D.
Address: Sparta 10
Date: 4-1-49
23. Burial, cremation, removal: Burial
Date of Burial: 3-4-1949
Name of Cemetery: Board Valley
Location: White County, Tenn
24. Funeral Director: Hunter Funeral House
Address: Sparta, Tenn
25. Registrarion Dist. No: 39301
26. Date signed by local Reg: 4-1-49
27. Registrar's signature: Tina B Camp
Death No: 49-06684
1. Name: MINNESOTA SELBY
2. Date of Death (month, day, year): 3-2-49
3. Color or Race: W
4. Sex: Female
5. Single, married, widowed, or divorced: Married
6. Date of Birth (month, day, year): 3-7-1882
7. Age (in years last birthday): 66
8. Place of Death:
County: White
Civil District: 1
City or town: Sparta
Length of stay in this place: 20 yrs.
Name of Instition or Hospital: ------
9. Usual Residence of Deceased:
State: Tenn
County: White
Civil District: 1
City or Town: Sparta
Street Address: -----
10. Usual Occupation: Housewife
11. Social Security Number: -----
12. Was deceased ever in armed forces: No
13. Birthplace: White, Tenn
14. Citizen of What Country? U.S.A.
15. Father's name: John Milligan
16. Mother's maiden name: Myra Clouse
17. Informant: Nathan Selby
Address: Sparta, Tenn
18. Cause of Death: Chronic Myocarditis
19. Date of operation: -----
20. Autopsy: -----
21. Accident, Suicide, Homicide: -----
22. I hereby certify that the deceased died on the date and
from the cause stated above.
Signature: J.C Blauburlup M.D.
Address: Sparta 10
Date: 4-1-49
23. Burial, cremation, removal: Burial
Date of Burial: 3-4-1949
Name of Cemetery: Board Valley
Location: White County, Tenn
24. Funeral Director: Hunter Funeral House
Address: Sparta, Tenn
25. Registrarion Dist. No: 39301
26. Date signed by local Reg: 4-1-49
27. Registrar's signature: Tina B Camp
1. Name: MINNESOTA SELBY
2. Date of Death (month, day, year): 3-2-49
3. Color or Race: W
4. Sex: Female
5. Single, married, widowed, or divorced: Married
6. Date of Birth (month, day, year): 3-7-1882
7. Age (in years last birthday): 66
8. Place of Death:
County: White
Civil District: 1
City or town: Sparta
Length of stay in this place: 20 yrs.
Name of Instition or Hospital: ------
9. Usual Residence of Deceased:
State: Tenn
County: White
Civil District: 1
City or Town: Sparta
Street Address: -----
10. Usual Occupation: Housewife
11. Social Security Number: -----
12. Was deceased ever in armed forces: No
13. Birthplace: White, Tenn
14. Citizen of What Country? U.S.A.
15. Father's name: John Milligan
16. Mother's maiden name: Myra Clouse
17. Informant: Nathan Selby
Address: Sparta, Tenn
18. Cause of Death: Chronic Myocarditis
19. Date of operation: -----
20. Autopsy: -----
21. Accident, Suicide, Homicide: -----
22. I hereby certify that the deceased died on the date and
from the cause stated above.
Signature: J.C Blauburlup M.D.
Address: Sparta 10
Date: 4-1-49
23. Burial, cremation, removal: Burial
Date of Burial: 3-4-1949
Name of Cemetery: Board Valley
Location: White County, Tenn
24. Funeral Director: Hunter Funeral House
Address: Sparta, Tenn
25. Registrarion Dist. No: 39301
26. Date signed by local Reg: 4-1-49
27. Registrar's signature: Tina B Camp
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