Date: 07 June 1952
Cert: 12857
Place of Death: County: Knott City or
Town: Rural
Street Number or Location: On Bear Fork at home
Length of stay in hospital or community: Hospital 14 days In
Community all life
Usual Residence of Deceased: State: Kentucky County:
Knott
City or Town: Rural If rural give
precinct: Ball Branch
Full Name: Cicero WALLEN
If Veteran Name War: (blank)
Social Security No.: 403-14-6867
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Martha
Age of husband or wife if alive: 63 years
Birth date of deceased: 21 May 1879
Age: 73 years, 17 days
Birthplace: Mousie, Ky., Knott Co.
Occupation: Farming
Industry or business: Self
Father Name: (blank)
Father Birthplace: (blank)
Mother Maiden Name: Nancy WALLEN
Mother Birthplace: Kentucky
Informant: Woots WALLEN, Glo, Ky.
Burial Place: Ball Branch
Date: 08 June 1952
Signature of funeral director: Woots Wallen, Glo, Ky.
Date received by local registrar: 28 June 1952
Registrar's Signature: Mrs. Rose B. Craft
Date of Death: 07 June 1952
I hereby certify that I attended deceased from 23 January 1952
to 23 January 1952, that I last saw him alive on 23 January
1952, and that death occurred on the date stated above at 3
a.m.
Immediate cause of death: Paralysis
Duration: 04 months, 14 days
Due to: Clot on brain
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Mark Dempsey, Garrett, Ky.
Date signed: 07 June 1952
Transcribed by Debbie Tamborski, 28 January 2011 |