Date:   08 May 1941
Cert:   15461 
Place of Death: County: Knott   City or Town: Hindman - Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: All life in community, 04 days in hospital
Usual Residence of Deceased: State: Kentucky   County: Knott
City or Town:  Rural    If rural, give precinct:  Hindman
Full Name:  Mary Alice POLLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, (blank)
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  03 February 1939
Age: 02 years, 03 months, 05 days
Birthplace:  Hindman, Ky.
Occupation:  (blank)
Industry or business: (blank)
Father Name:  Champ Clark POLLEY
Father Birthplace:  Hindman, Ky.
Mother Maiden Name:  Nannie AMBURGEY
Mother Birthplace:  Pinetop, Ky., Knott Co.
Informant:  Nannie POLLEY, Hindman, Ky.
Burial Place:  Hindman, Ky.
Date:  10 May 1941
Signature of funeral director: (blank)
Date received by local registrar:  20 June 1941
Registrar's Signature:  Macie Miller
Date of Death:  08 May 1941
I hereby certify that I attended deceased from 03 May 1941 to 03 May 1941, that I last saw her alive on 03 May 1941, and that death occurred on the date stated above at 5 p.m.
Immediate cause of death:  appendicitis
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: Mark Dempsey, M.D., Hindman, Ky.
Date signed:  16 June (illegible)
Transcribed by Debbie Tamborski, 14 October 2010