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DEATH
CERTIFICATE
POLLY ANN ENGLE COMBS
Date: 26 April 1947
Cert: 14300
Place of Death: County: Perry City or Town:
Dwarf
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Dwarf
Full Name: Polly Ann ENGLE COMBS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 15 April 1867
Age: 80 years, 00 months, 11 days
Birthplace: Knott
Occupation: Housewife
Industry or business: (blank)
Father Name: Jack COMBS
Father Birthplace: Knott
Mother Maiden Name: Mary YOUNG
Mother Birthplace: Knott
Informant: Mrs. J. T. BEAVENS, Hazard, Ky.
Burial Place: Engle Cem.
Date: 29 April 1947
Signature of funeral director: Engle's, Hazard, Ky.
Date received by local registrar: 31 April 1947
Registrar's Signature: Pearl G. Combs
Date of Death: 26 April 1947
I hereby certify that I attended deceased from 10 March 1947 to
20 April 1947, that I last saw him alive on 20 April 1947, and
that death occurred on the date stated above at 8 p.m.
Immediate cause of death: Gastric Carcinoma
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: S. M. Richie, M.D., Hazard, Ky.
Date signed: 30 April 1947
Transcribed by Debbie Tamborski, 22 June 2010 |
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