Date:  19 May 1954
Cert:  26473 
Place of Death: County: Knott      City or Town: Bolyn  Rural
Length of stay (in this place): All of Life
Street address or location:  Bolyn, Ky. 
Usual Residence of Deceased: State: Ky.     County: Knott
City or Town:  Rural     If rural give location: Bolyn, Ky.
Full Name:  Martha Ann CHAFFINS 
Date of Death:  19 May 1954 
Sex, Color or Race, Marital Status: Female, White, Married
Date of Birth:  18 February 1866 
Age:  85 years
Usual Occupation:  Housewife
Kind of Industry or business: (blank)
Birthplace:  Knott Co., Ky. 
Father's Name:  Fielding COMBS 
Mother's Maiden Name:  Sally Ann COMBS 
Was deceased ever in armed forces: no
Social Security No.:  none
Informant:  Alec CHAFFINS 
Disease or condition directly leading to death: Blood poisoning on right leg
Interval between onset and death:  (blank)
Due to (b):  Senility
Due to (c): Note:  This person never had a doctor in her life.
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from (blank) to (blank), that I last saw the deceased alive on (blank), and that death occurred at (blank), from the causes and on the date stated above.
Date signed:  19 May 1954
Address:  Hindman, Ky.
Signature:  Jno. N. Taul (Funeral Director)
Burial, Cremation or Removal: Burial
Date:  21 May 1954
Name of Cemetery or Crematory: Chaffins Cemetery
Location:  Knott Co., Ky.
Date received by local registrar: 24 February 1955
Registrar's Signature: Myrtle Slone
Funeral director & address:  John N. Taul, Hindman Funeral Home, Hindman, Ky.
Transcribed by Debbie Tamborski, 24 February 2011