Date: 23 November 1943
Cert: 07535
Place of Death: County: Knott City or
Town: Mousie, Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Mousie, Ky.
Full Name: Lawrence WALLEN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Edna SPARKMAN
Age of husband or wife if alive: 21 years
Birth date of deceased: 03 November 1919
Age: 24 years, 00 months, 20 days
Birthplace: Mousie, Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: Cicero WALLEN
Father Birthplace: Mousie, Ky.
Mother Maiden Name: Martha SMITH
Mother Birthplace: Elmrock, Ky.
Informant: Cicero WALLEN, Mousie, Ky.
Burial Place: Campbell Cem.
Date: 24 November 1943
Signature of funeral director: (blank)
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 23 November 1943
I hereby certify that I attended deceased from 01 November
1943 to 23 November 1943, that I last saw h-- alive on 20
November 1943, and that death
occurred on the date stated above at 10 a.m.
Immediate cause of death: Pulmonary T. B.
Duration: (blank)
Due to: (blank)
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: J. W. Duke, M.D., Hindman, Ky.
Date signed: 27 November 1943
Transcribed by Debbie Tamborski, 29 October 2010 |