RECORD OF FUNERAL
~~~~~~~~~~

No. 15
Date: January 30, 1912  
Name of Deceased: Susan Smith
Charge to: Excelsor No. 261
Order Given by:
How Secured: Cal Calvert
Date of Funeral: January 30, 1912  4 p.m.
Place of Death: Marlin
Funeral Services at:
Time of Funeral Service:
Clergyman:
Certifying Physician: Dr. Hunter   
His Residence: Marlin
Number of Burial Certificate:
Cause of Death: Meningitis  
Date of Death: January 30, 1912    2:30 a.m.
Occupation of the Deceased:
Single or Married: Married
Religion:
Aged:  
Body to be shipped to:
Size and Style of Casket or Coffin:
Manufactured by:
Metallic Lining:
Outside Box:
Number of Handles:
Interment at:
Lot or Grave No.
Section No. 1166.45
1.
2.
3.
4.
5.
6.
Designate all Graves in Lot with Numbers (1,2,3,4,etc),and mark space for this Funeral with a cross (+).  Designate place for Monument with a small square.  Use space to the right of Diagram for namesof those buried in Lot.
Price of Casket or Coffin: $45.00
Price of Metallic Lining:
Price of Outside Box:
Price of Grave Vault:
Price of Burial Robe: $5.00
Price of Burial Slippers and Hose:
Engraving Plate:
Embalming Body:
Washing and Dressing:
Shaving:
Keeping Body on Ice:
Disinfecting Rooms:
Use of Catafalque and Drapery:
Use of Folding Chairs:
Use of Candelabrum:
Candles:
Gloves & Hose: $.60
Crape:
Number of Carriages:
Carriages:
Hearse: $10.00
Wagon Deliveries:
Death Notices in Newspapers:
Name of Newspapers:
Flowers: $1.25
Outlay for Lot:
Opening Grave:
Lining Grave:
Shipping Charges, prepaid:
Removal Charges:
Cremation Charges:


Total Footing of Bill: $60.60
By Amount Paid in Advance:
Balance:
Entered into Ledger, page     or below:

To Funeral Charges Total:           $61.85
Hacks
Grave                                              $  5.00                     
                                                       $66.85
                                     
By Cash: February 17, 1912       $66.50
                                                        PAID


Transcribed by: Lena Stone Criswell & Kay Cunningham
Note: I added the year to all except for the date at top. kc