Date:    15 February 1947
Cert:    03936 
Place of Death: County: Knott   City or Town:  Emmalena
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.     County:  Knott
City or Town:  Emmalena 
Full Name:  Polly Ann SMITH 
If Veteran Name War: (blank)
Social Security No.:  (blank)
Sex, Color or Race, Marital Status:  Female, White, Widowed
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  03 January 1852 
Age:  95 years, 01 months, 12 days
Birthplace:  Perry 
Occupation:  Housewife 
Industry or business:  (blank)
Father Name:  Nathanal CORNETT 
Father Birthplace:  Perry 
Mother Maiden Name:   (blank)  
Mother Birthplace:   (blank) 
Informant:  Oscar MORGAN, Emmalena, Ky. 
Burial Place:   Home (Cem.) Knott
Date:  17 February 1947 
Signature of funeral director:  Engle's, Hazard, Ky.
Date received by local registrar:  23 February 1947 
Registrar's Signature:  Rose B. Craft
Date of Death:  15 February 1947 
I hereby certify that I attended deceased from 10 February 1947 to 15 February 1947, that I last saw him alive on 15 February 1947, and that death occurred on the date stated above at 8 p.m.
Immediate cause of death:  Senility 
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:  M. F. Kelley, M.D., Hindman, Ky.
Date signed:  23 February 1947 
Transcribed by Debbie Tamborski, 15 December 2010