Genealogy Pages for Northern Middle TN
Death Certificate for David Clayton WALLACE
| Following is a transcription of the above
person's (TN) death certificate: Place of Death: County: Houston, Civil Dist.: 4, Reg. Dist.: 421 Primary Reg. Dist.: 4, Registered No.: 10 Full Name: David Clayton WALLACE Sex: Male Race: White Marital Status: Single Date of Birth: 06/15/1868 Age: 48 yrs. 9 mos. 25 ds. Occupation: Fireman General Nature of Industry: Meal Factory, Retired 7 years Birthplace: Dickson Co., Tenn. Name of Father: David WALLACE Birthplace of Father: Dickson Co., Tenn. Maiden Name of Mother: Susan PATTERSON Birthplace of Mother: Dickson Co., Tenn. Informant: Harris WALLACE Address: Erin, Tenn. Filed: 04/11/1917 J. W. Reynolds, Registrar Date of Death: 04/10/1917 The physician attended deceased from 03/15/1917 to 04/10/1917 and last saw him alive on 04/10/1917 Death occurred on date stated above at: 10 PM Cause of Death: Pellagra Duration: 3 yrs. Signed: W. H. McMillan, M. D. 04/11/1917 Address: Erin, Tenn. Place of Burial or Removal: Arlington, Tenn. Date of Burial: 04/11/1917 Undertaker: J. C. Burwell? Address: Erin, Tenn. |