| 1. Place of Death | 3808 Park Ave, Nashville, Davidson County, Tennessee |
| 2. Full Name | Adolph Robert Gasser |
| 3. Sex | Male |
| 4. Race | White |
| 5. Marital Status | Single |
| 6. Date of Birth | [16 Apr 1914] |
| 7. Age | 3 years, 9 months, 4 days |
| 8. Occupation | None |
| 9. Birthplace | Tennessee |
| 10. Name of Father | Fred Gasser Jr. |
| 11. Birthplace of Father | Tenn [Tennessee] |
| 12. Maiden Name of Mother | Emma S Hess |
| 13. Birthplace of Mother | Tennessee |
| 14. Informant | Fred Gasser, 3808 Park Ave |
| 15. Filed | [31 Jan 1918] |
| 16. Date of Death | [20 Jan 1918] |
| 17. Certification & Cause | Acute Double Pneumonia |
| 18. Length of Residence | [blank] |
| 19. Place of Burial | Spring Hill [Cemetery] [Nashville, TN] |
| 19. Date of Burial | [22 Jan 1918] |
| 20. Undertaker | Gupton-Sweeney |
| 20. Address | Nashville, Tenn. |
Author’s notes in ‘[ ]‘
