Name: James Henry Wallace
Residence: LaFollette, Tennessee
Sex: Male
Race: White
Date of Birth: 11 May 1898
Place of Birth: Tennessee
Date of Death: 30 Jul 1968
Place of Death: LaFollette, Tennessee
Age: 70
Marital Status: Married
Spouse, if living: Helen Wallace
Age of Spouse, if living:
If Veteran, Name of War:
Social Security Number:
Occupation: Miner
Industry or Business: Industry
Father's Full Name: Harrison Wallace
Father's Birthplace: Tennessee
Mother's Full Maiden Name: Aletha Rutherford
Mother's Birthplace: Tennessee
Cause of Death: Coronary Occlusion

• Due to: (left blank)
• 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: Ethel Daugherty
Informant Address: Detroit, Michigan
Burial, Removal, or Cremation: Burial
Date: 04 Aug 1968
Undertaker: Martin's
Address: 618 W. Central Ave. LaFollette, TN
By:
Date Filed: 13 Aug 1968
Registrar: Dr. P. M. Dings
Signature:
Address:

Submitter's Name: Rick Chambers
Submitter's Email: RLChambers@fuse.net
Relationship to the Deceased: Grandson

Comments: