Certificate of Death – Thomas J. Koger
Title
Certificate of Death – Thomas J. Koger
Creator
Tennessee Department of Health and Environment
Identifier
T100097
Date
1986 June 12
Description
The Tennessee Department of Health and Environment Certificate of Death for Thomas J. Koger.
Source
John W. Swartzwelder Jr. and Nancy Joyce (Koger) Swartzwelder
Publisher
Woodrow Wilson Presidential Library & Museum
Language
English
Text
CERTIFICATE OF DEATH
TENNESSEE DEPARTMENT OF HEALTH AND ENVIRONMENT
VITAL RECORDS
DECEASED - NAME
Thomas J. Koger
DATE OF DEATH
June 12, 1986
AGE
90
DATE OF BIRTH
8-29-1895
RACE
White
ORIGIN OR DESCENT
American
SEX
Male
COUNTY OF DEATH
Shelby
CITY, TOWN, OR LOCATION
Memphis
INSIDE CITY LIMITS
Yes
HOSPITAL OR OTHER INSTITUTION - NAME
Oakville Health Care Ctr.
IF HOSPITAL OR INSTITUTION INDICATION [unintelligible]
inpatient
STATE OF BIRTH
Ms.
CITIZEN OF WHAT COUNTRY
USA
MARRIED, NEVER MARRIED, WIDOWED, DIVORCED
Married
SURVIVING SPOUSE
Francis Hamond
SOCIAL SECURITY NUMBER
411-12-1182
SERVICE IN ARMED FORCES
No
USUAL OCCUPATION
Retired
KIND OF BUSINESS OR INDUSTRY
Civil Service
RESIDENCE - STATE
Tn.
COUNTY
Shelby
CITY, TOWN, OR LOCATION
Memphis
STREET AND NUMBER
1105 Robin Hood
INSIDE CITY LIMITS
Yes
CENSUS TRACT NO.
080
FATHER - NAME
Walter M. Koger
MOTHER - MAIDEN NAME
Ada Lou Howell
INFORMANT - NAME MAILING ADDRESS
R. L. Koger 1232 S. Early Dr. Knoxville Tn.
BURIAL, CREMATION, REMOVAL, OTHER
Burial
DATE
6-16-86
CEMETERY OR CREMATORY - NAME
National
LOCATION
Memphis, Tn.
FUNERAL DIRECTOR
Maurice W. Chisholm
LICENSE NO.
859
EMBALMER
Paul Howard
LICENSE NO.
2506
FUNERAL HOME - NAME AND ADDRESS
Memphis Funeral Home 5599 Poplar Ave.
REGISTRAR SIGNATURE
[signature]
DATE RECEIVED BY LOCAL REGISTRAR
6-19-86
PHYSICIAN
[signature] MD
DATE SIGNED
6-12-86
CERTIFIER - NAME
George P. Jones, MD
MAILING ADDRESS
3391 Old Getwell Rd., Memphis, TN 38118
DEATH WAS CAUSED BY
IMMEDIATE CAUSE: cardio-respiratory failure
DUE TO OR AS A CONSEQUENCE OF: [unintelligible] heart disease
DUE TO OR AS A CONSEQUENCE OF: Diabetes [unintelligible]
TENNESSEE DEPARTMENT OF HEALTH AND ENVIRONMENT
VITAL RECORDS
DECEASED - NAME
Thomas J. Koger
DATE OF DEATH
June 12, 1986
AGE
90
DATE OF BIRTH
8-29-1895
RACE
White
ORIGIN OR DESCENT
American
SEX
Male
COUNTY OF DEATH
Shelby
CITY, TOWN, OR LOCATION
Memphis
INSIDE CITY LIMITS
Yes
HOSPITAL OR OTHER INSTITUTION - NAME
Oakville Health Care Ctr.
IF HOSPITAL OR INSTITUTION INDICATION [unintelligible]
inpatient
STATE OF BIRTH
Ms.
CITIZEN OF WHAT COUNTRY
USA
MARRIED, NEVER MARRIED, WIDOWED, DIVORCED
Married
SURVIVING SPOUSE
Francis Hamond
SOCIAL SECURITY NUMBER
411-12-1182
SERVICE IN ARMED FORCES
No
USUAL OCCUPATION
Retired
KIND OF BUSINESS OR INDUSTRY
Civil Service
RESIDENCE - STATE
Tn.
COUNTY
Shelby
CITY, TOWN, OR LOCATION
Memphis
STREET AND NUMBER
1105 Robin Hood
INSIDE CITY LIMITS
Yes
CENSUS TRACT NO.
080
FATHER - NAME
Walter M. Koger
MOTHER - MAIDEN NAME
Ada Lou Howell
INFORMANT - NAME MAILING ADDRESS
R. L. Koger 1232 S. Early Dr. Knoxville Tn.
BURIAL, CREMATION, REMOVAL, OTHER
Burial
DATE
6-16-86
CEMETERY OR CREMATORY - NAME
National
LOCATION
Memphis, Tn.
FUNERAL DIRECTOR
Maurice W. Chisholm
LICENSE NO.
859
EMBALMER
Paul Howard
LICENSE NO.
2506
FUNERAL HOME - NAME AND ADDRESS
Memphis Funeral Home 5599 Poplar Ave.
REGISTRAR SIGNATURE
[signature]
DATE RECEIVED BY LOCAL REGISTRAR
6-19-86
PHYSICIAN
[signature] MD
DATE SIGNED
6-12-86
CERTIFIER - NAME
George P. Jones, MD
MAILING ADDRESS
3391 Old Getwell Rd., Memphis, TN 38118
DEATH WAS CAUSED BY
IMMEDIATE CAUSE: cardio-respiratory failure
DUE TO OR AS A CONSEQUENCE OF: [unintelligible] heart disease
DUE TO OR AS A CONSEQUENCE OF: Diabetes [unintelligible]
MEMPHIS & SHELBY HEALTH DEPARTMENT - 814 JEFFERSON AVENUE, MEMPHIS, TENNESSEE
THIS IS TO CERTIFY that this is a true and correct copy of the record filed with the Division of Vital REcords, Tennessee Department of Public Health by the Memphis and Shelby County Health Department.
Date Issued: SEP 2 9 1989
BY [signature]
Robert E. Burke, Director
Division of Vital Records
THIS IS TO CERTIFY that this is a true and correct copy of the record filed with the Division of Vital REcords, Tennessee Department of Public Health by the Memphis and Shelby County Health Department.
Date Issued: SEP 2 9 1989
BY [signature]
Robert E. Burke, Director
Division of Vital Records
Original Format
Certificate
To
Koger, Thomas J.
Files
Collection
Citation
Tennessee Department of Health and Environment, “Certificate of Death – Thomas J. Koger,” 1986 June 12, T100097, Thomas J. Koger Collection, Woodrow Wilson Presidential Library & Museum, Staunton, Virginia.