Date: 03 January 1955
Cert: #03215
Place of Death: County: Knott City or Town:
Smithsboro - Rural
Length of stay (in this place): (blank)
Name of Hospital or Institution: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Smithsboro - Rural Street Address: (blank)
Full Name: Nancy Jane ASHLEY
Date of Death: 03 January 1955
Sex, Color or Race, Marital Status: Female, White,
Married
Date of Birth: 01 October 1878
Age: 76 years
Usual Occupation: Housewife
Kind of Industry or business: (blank)
Birthplace: Knott Co., Ky.
Father's Name: Daniel D. MULLINS
Mother's Maiden Name: Susan MULLINS
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant: Lewis DAY
Disease or condition directly leading to death:
Congestive Heart Disease
Interval between onset and death: 02 years
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
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 October 1954 to
03 January 1955, that I last saw the deceased alive on 02
January 1955, and
that death occurred at 6 a.m., from the causes and on the
date stated above.
Date signed: 09 February 1955
Address: Allock
Signature: A. B. Pigman, M.D.
Burial, Cremation or Removal: Burial
Date: 05 January 1954 (transcribed as written)
Name of Cemetery or Crematory: Cornett Hill
Location: Sassafras, Ky.
Date received by local registrar: 16 February 1955
Registrar's Signature: Myrtle Slone
Funeral director & address: John Everage, Hindman,
Ky.
Transcribed by Debbie Tamborski, 14 May 2011 |