Date:  18 April 1964
Cert:   07364
Place of Death: County: Clay     City or Town: Manchester
Length of stay (in this place): 07 months
Street Address or Location:  Home of daughter
Usual Residence of Deceased: State: Ky.     County: Perry
City or Town: Hazard     Street Address:  Rural
Full Name:  Polly JENT
Date of Death:  18 April 1964
Sex, Color or Race, Marital Status: Female, White, Widowed
Date of Birth:  28 March 1886
Age: 78 years, 00 months, 20 days
Usual Occupation: Housewife
Kind of Industry or business: (blank)
Birthplace:  Ky., Knott Co.
Father's Name:  Ben STACY
Mother's Maiden Name:  Lucill HURT
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:  Nora CALTON (Daughter)
Disease or condition directly leading to death:  Carcinoma of intestines
Interval between onset and death:  03 years
Due to:  Nephritis
Interval between onset and death:  06 months
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 01 October 1963 to 17 April 1964, 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:  18 April 1964
Address:  (blank)
Signature:  J. C. Coldiron, M.D.
Burial, Cremation or Removal:  Burial
Date:  20 April 1964
Name of Cemetery or Crematory:  Hurt Cem.
Location:  R. R., Hazard, Ky.
Date received by local registrar: 22 April 1964
Registrar's Signature:  Daisy W. Ribetts
Funeral director & address:  Paul Brashear (FD) Viper, Ky.
Transcribed by Debbie Tamborski, 20 November 2010
Death Certificate Provided by Frank Taylor