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DEATH
CERTIFICATE
POLLY COMBS
Date 15 January 1942
Cert: 00751
Place of Death: County: Floyd City or Town:
Martin, Ky.
Name of Hospital or Institution: Beaver Valley Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Bypro
Full Name: Polly COMBS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: James COMBS
Age of husband or wife if alive: (blank)
Birth date of deceased: 04 July 1886
Age: 56 years, 06 months, 11 days
Birthplace: Knott Co.
Occupation: Domestic
Industry or business: (blank)
Father Name: Brice HANSHOE
Father Birthplace: Knott Co.
Mother Maiden Name: Elizabeth SHEPARD
Mother Birthplace: Hanshoe
Informant: John (?Clabo? illigible) Bypro, Ky.
Burial Place: Hanshoe, Ky.
Date: 18 January 1942
Signature of funeral director: O. T. Lemaster, Martin,
Ky.
Date received by local registrar: 30 January 1942
Registrar's Signature: Mrs. Ben Norris
Date of Death: 15 January 1942
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at 2:10 p.m.
Immediate cause of death: Hypertensive cardio Vascular Disease
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Erwood R. Corder, M.D., Martin
Date signed: (blank)
Transcribed by Debbie Tamborski, 25 May 2010 |
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