CERTIFICATE OF DEATH
STATE OF TENNESSEE
DEPARTMENT OF PUBLIC HEALTH
DIVISION OF VITAL STATISTICS
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Jane Lewallen
Reg. Number: 52; Reg. District:
030
Certificate Number: 4282
Name: Jane Lewallen
Residence: Boone County, WV
Sex: Female
Race: White
Date of Birth: 30 Jun 1874
Place of Birth: Elk Valley, Campbell
Co, TN
Date of Death: 07 Apr 1952
Place of Death: Madison General Hospital,
Uneeda, Boone Co, WV
Age: 77 years, 9 months, 7 days
Marital Status: Married
Spouse, if living: (no place on death
cert. for this)
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number: none
Occupation: Housewife
Industry or Business: (left blank)
Father's Full Name: H. C. Blankenship
Father's Birthplace: (no place on death
cert. for this)
Mother's Full Maiden Name: Oneta Thompson
Mother's Birthplace: (no place on death
cert. for this)
Cause of Death: Cerebral hemorrhage
- Due to: Arterior scleratic xxxxx
xxxxxxxx
- Other conditions: (left blank)
- Operation?: (left blank)
- Autopsy?: No
If death was due to external causes, fill
in the following:
- Accident, Suicide, or Homicide: (left
blank)
- Date of Occurrence:
- Where did the injury occur: (left
blank)
- Did injury occur in or about home,
on farm, in industrial place, in public place?: (left
blank)
- While at work: (left blank)
- Means of Injury: (left blank)
Informant: Thelma Lay
Informant Address: (no place on death
cert. for this)
Burial, Removal, or Cremation: Beard
(Baird) Cemetery, Elk Valley, TN
Date: 10 Apr 1952
Undertaker: Fred B. Vance
Address: (no place on death cert. for
this)
By: (no place on death cert. for this)
Date Filed: 30 Apr 1952
Registrar: Mrs. Lonnie C. Meadows
Signature: (no place on death cert.
for this)
Address: (no place on death cert. for
this)
Submitter's Name: John C. Carter
Submitter's Email: spiff@atlantic.net
Relationship to the Deceased: Great-Grandson
Comments: Census records have indicated
her birth year may have been 1878 or 1879, not 1874. Her full
name was Malinda Jane Blankenship Lewallen. Her husband's full
name was Filetus "F.L." Lewallen. Her father's full name was
Henderson "Henry" C. Blankenship. Her mother's full name was
Perneta "Nita" / "Neatie" Jane Thompson Blankenship.
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