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DEATH
CERTIFICATE
CRITTENDEN WALLEN
Date 31 October 1930
Cert: 24409
Place of Death: Voting Pct: 8 mi. Winchester Rd.,
Lexington, Fayette Co., Ky.
Full Name: Crittenden WALLEN
Residence: Hindman, Ky.
Length of Residence in city where death occurred:
(blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 25 September 1903
Age: 27 years, 01 months, 06 days
Occupation: Teacher
Birthplace: Knott Co., Ky.
Father Name: David W. WALLEN
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Girlie HAYS
Birthplace Mother: Floyd Co., Ky.
Informant/Address: D. W. Wallen, Hindman, Ky.
Filed: 04 November 1930
Registrar: D. A. Furlong
Death of Date: 31 October 1930
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw h-- alive on (blank), and that death
occurred on the date stated above at 5 p.m.
Cause of Death: Broken neck & Internal Injuries
sustained in an accidental Auto Accident
Duration: (blank)
Contributory: Auto Accident 8 miles on
Winchester Rd. (Fayette Co.)
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: (blank) Date: (blank)
Was there an autopsy: (blank)
What test confirmed diagnosis: (blank)
Signed/Address: J. H. Kerr, Coroner, 03
November 1930, Lexington, Ky.
Place of Burial or Removal: Hindman, Kentucky
Date of Burial: 02 November 1930
Undertaker/Address: Kerr Bros., Lex., Ky.
Transcribed by Debbie Tamborski, 29 March 2010 |
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