Date 19 March 1935
Cert: 10272
Place of Death: Voting Pct.: Smoot Creek, Letcher Co., Ky.
Full Name: Polly ADAMS
Residence: Van, Ky.
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Clint ADAMS
Date of Birth: 30 March 1878
Age: 56 years, 11 months, 19 days
Occupation: Housewife
Birthplace: Redfox, Ky.
Father Name: James BREEDING
Birthplace Father: Redfox, Ky.
Mother Maiden Name: Polly CODY
Birthplace Mother: Redfox, Ky.
Informant/Address: Boone FRAZIER, Hot Spot, Ky.
Burial Cremation Removal Place: Van, Ky.
Date: 20 March 1935
Undertaker/Address: (blank)
Filed: 21 March 1935
Registrar: Marion Frazier
Death of Date: 19 March 1935
I hereby certify, That I attended deceased from (blank) to (blank), that I last saw h-- alive on (blank), death is said to have occurred on the date stated above, at (blank)
Cause of Death: Heart attack
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: T. R. Collier, Whitesburg
Transcribed by Debbie Tamborski, 16 April 2010