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DEATH
CERTIFICATE
KEEF WALLACE
Date: 13 March 1931
Cert: 17580
Place of Death: Voting Pct.: Thacker Mines, Mingo Co., West
Virginia
Full Name: Keef WALLACE
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Lucinda SLOAN
Date of Birth: (blank)
Age: 57 years
Occupation: Miner
Birthplace: Russia
Father Name: (blank)
Birthplace Father: (blank)
Mother Maiden Name: (blank)
Birthplace Mother: (blank)
Informant/Address: (blank)
Burial Cremation Removal Place: (blank)
Date: (blank)
Undertaker/Address: (blank)
Filed: (blank)
Registrar: (blank)
Death of Date: 13 March 1931
I hereby certify, That I attended deceased from killed
instantly to (blank), that I last saw h-- alive on (blank),
death is said to have occurred on the date stated above, at
(blank)
Cause of Death: Slate fall in mine
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: (blank)
Accident, suicide, homicide: Accident
Date of Injury: 13 March 1931
Where did injury occur: Thacker Mines, W. Va.
Specify whether injury occurred industry, home, public place:
in coal mine
Manner of injury: Slate fall
Nature of injury: Mashed through chest & abdomen
Related to occupation: Yes
Signed/Address: F. A. Lawton, M.D.
Transcribed by Debbie Tamborski, 02 April 2010 |
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