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DEATH
CERTIFICATE
LOUCINDA SLONE WALLACE
Date 17 May 1933
Cert: 22206
Place of Death: Voting Pct.: #23, Freeburn, Pike Co.,
Ky.
Full Name: Loucinda SLONE WALLACE
Sex, Color or Race, Marital Status: Female, White,
Widowed
Date of Birth: 29 January 1847
Age: 86 years, 03 months, 20 days
Occupation: Home
Birthplace: Knott Co., Ky.
Name of Father: J. C. SLONE
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: Sarah JOHNSON
Birthplace Mother: Knott Co., Ky.
Informant/Address: L. B. HUGHES, Edgarton, W. Va.
Filed: 10 September 1933
Registrar: Gus Schaffer
Death Date: 17 May 1933
I hereby certify that I attended deceased from 18 April 1933,
to 17 May 1933, that I last saw her alive on 16 May 1933, and
that death occurred, on the date stated above at (blank)
Cause of Death: Aortic regurgitation, chronic nephritis,
(illegible)
Duration: (blank)
Contributory: Infirmities of age
Signed/Address: W. A. Dotson, MD, 19 May 1933, Edgarton
Length of residence at place of death:
Where was disease contracted if not at place of death?:
(blank)
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 02 April 2010 |
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