| Place of Death: County, City, Length of stay |
Tom Green, San Angelo, one month |
| Full Name of Hospital or Institution |
Shannon Hospital |
| Usual Residence: State, County, City |
Texas, Coke, Robert Lee |
| Usual Residence: Street Address |
Box 71 |
| Name of Deceased |
Wallace Bruce Clift |
| Date of Death |
November 30, 1963 |
| Sex |
Male |
| Color or Race |
White |
| Married, Never married, Widowed, Divorced |
Married |
| Date of Birth |
October 15, 1891 |
| Age |
72 |
| Usual Occupation |
Funeral Director |
| Kind of Business or Industry |
Funeral |
| Birthplace |
Tennessee |
| Father's Name and Birthplace |
William Clift |
| Mother's Maiden Name and Birthplace |
Martha Jane Wallace |
| Was Deceased Ever in U. S. Armed Forces? |
No |
| Social Security No. |
Unknown |
| Informant |
Mrs. Allen Davis |
| Immediate Cause of Death & duration |
Probable cerebral metastasis of carcinoma of left lung |
| Interval between onset and death |
about 2 mo. |
| Other significant conditions |
|
| Autopsy? |
No |
| Accident Suicide Homicide |
|
| Attended |
Feb. 1963 to Nov 30 1963 |
| Last Saw Alive |
Nov. 30 1963 |
| Death occurred at |
8:24 p.m. |
| Physician |
G. Cuesosta MD |
| Burial, Cremation, Removal |
Removal |
| Date |
November 30, 1963 |
| Cemetery or Crematory, Location |
Robert Lee Cemetery, Robert Lee Texas |
| Funeral Director |
Merl R. Steele |
| Registrar File No. |
558 |
| Date rec'd by Registrar |
12-9-63 |
| Registrar |
O. L. Miller |