Riley Corley Death Certificate

Source Type: Other
Date of publication: 7/20/1913 0:00
Source URL: View Source

Certificate of Death

1. Full name of deceased: “Riley Corley”
2. Date of death: Month: “July”; Day: “6”; “1913”; Hour: “AM”
3. Place of death (county): “Tuscaloosa County”
4. City or Town: “Near Brookwood”
5. Place of birth of deceased (town or county): “Do not know”
6. White or colored: “Col” Male or Female: “M” Occupation: “Laborer Turpentine Farm”
7. How long did deceased reside at place of death: “1 year”
8. Where was disease contracted: “—-” Duration of illness: “——”
9. Principal disease causing death: “Shot through right eye”
10. Contributory disease causing death: “Killed immediately”
11. If homicidal, suicidal, or accidental, state how accomplished: “Shot with a shot gun”
12. Did deceased undergo a surgical operation and if so when and of what nature: “—-”
13. Age: Years: “33” Months: “X” Days: “X”; single, married, or widowed: “?”
14. Full name of father of deceased: “Do not know”
15. Birthplace of father (state or country): ” ” ” ”
16. Full name of mother of deceased: ” ” ” ”
17. Birthplace of mother(state or country): ” ” ” ”
18. Place of interment: “Brookwood, Ala”
19. Remarks: ” ”

Reporter: *indecipherable as of yet*
Date of Report: “July 20, 1913”
Post Office: *indecipherable as of yet*, Alabama