Texas Department of Health
		      Bureau of Vital Statistics
			1100 West 49th Street
		       Austin, Texas 78756-3199

Certificate Number: 15005

 1. Place: County of Hill Precint No 5 Mt. Calm 
    Length of Residence: 50 years
 2. Name of Deceased: J. W. Wallace
    Residence:Mt. Calm TX
 3. Sex: Male
 4. Color or Race: White
 5. Marital Status: Married.  
    Spouse: Mrs. John Wallace
 6  Date of Birth: March 15, 1871
 7. Age: 68 years, 11 months, 19 days
 8. Trade: Farmer
 9: Industry:
12: Birth place: Ark. Erni
13: Name of Father: Don't Know
14: Birth place of Father: Don't Know
15: Maiden name of Mother: Don't Know
16: Birthplace of Mother: Don't Know
17: Informant: Hugh Wallace
18: Address of Informant: Prarie Hill TX
18. Burial: Hubbard TX, 3-5 1940
19: Undertaker: BC [..]obson
21. Date of Death: 3-4
22: Cause of Death: Influenze.  Date of onset: 2-28-1940
    Other contributory causes: cardic vascular - renal [...] short duration.