Date:   21 September 1956
Cert: # 56-27592
Place of Death: County: Knott  City or Town:  Amburgey - Rural
Length of stay (in this place): (blank)
Full Name of Hospital or Institution:  (blank)
Usual Residence of Deceased: State: Ky.     County: Knott
City or Town: Amburgey           Residence on a Farm?:   Yes
Street Address: (blank)     Residence inside City Limits?:  No
Full Name:    Adaline MULLINS
Date of Death:  21 September 1956 
Sex, Color/Race, Marital Status: Female, White, Never Married
Date of Birth:   20 August 1901
Age:  55 years
Usual Occupation:  none
Kind of Industry or business: (blank)
Birthplace:   Knott Co., Ky.
Father's Name:  Riley MULLINS 
Mother's Maiden Name:   Dicie EVERAGE
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:   Jasper MULLINS
Disease/condition directly leading to death: Coronary occlusion
Interval between onset and death:  (blank)
Due to: (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: (blank)
Describe how injury occurred:  (blank)
Time of injury:  (blank)
Injury occurred at work: (blank)
Place of injury: (blank)
City, Town or Location, County, State: (blank)
I hereby certify that I attended deceased from 19 August 1956 to 20 August 1956, that I last saw the deceased alive on 19 August 1956, and that death occurred at 7 a.m., from the causes and on the date stated above.
Date signed:   03 December 1956
Address:  Allock 
Signature:  A. B. Pigman, M.D. 
Burial, Cremation or Removal: Burial
Date:   23 September 1956
Name of Cemetery or Crematory:   Franklin Cem.
Location:    Amburgey, Ky.
Date received by local registrar:   27 February 1957
Registrar's Signature: Myrtle Slone
Funeral director & address:  John Everage, Hindman, Ky. 
Transcribed by Debbie Tamborski, 25 April 2012