Date:    11 October 1946
Cert:    20411 
Place of Death: County: Knott  City or Town: Lackey, Ky. Rural 
Name of Hospital or Institution: Lackey Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.     County:  Knott
City or Town:  Lackey 
Full Name:  Lillie Mae COLLINS 
If Veteran Name War: (blank)
Social Security No.:  (blank)
Sex, Color or Race, Marital Status:  Female, White, Single
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  20 July 1934 
Age:  12 years, 03 months, 21 days
Birthplace:  Soft Shell, Ky. 
Occupation:  (blank) 
Industry or business:  (blank)
Father Name:  Madison COLLINS 
Father Birthplace:  Yellow Mt., Ky. 
Mother Maiden Name:  Nancy TERRY 
Mother Birthplace:   Elmrock 
Informant:  Chester COLLINS, Garrett, Ky. 
Burial Place:   Soft Shell 
Date:  12 October 1946 
Signature of funeral director:  W. J. Ryan, Martin, Ky.
Date received by local registrar:  10 December 1946 
Registrar's Signature: Rose B. Craft
Date of Death:  11 October 1946 
I hereby certify that I attended deceased from 05 August 1946 to 11 October 1946, that I last saw her alive on 11 October 1946, and that death occurred on the date stated above at 9:25 a.m.
Immediate cause of death:  Otitis Media acute otitis interna 
Duration: (blank)
Due to:  Possibly due to medications with hexylresorcinol
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:  J. Williams, M.D., Nicholasville, Ky.
Date signed:  25 September (illegible)
Transcribed by Debbie Tamborski, 04 December 2010