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

No. 27
Date: February 13, 1912  
Name of Deceased: Henry
Charge to: Falls County -- By: C. M. Briggs
Order Given by: Judge W. E. Hunnicutt
How Secured:
Date of Funeral: February 13, 1912
Place of Death:  Co.
Funeral Services at:
Time of Funeral Service:
Clergyman:
Certifying Physician: None
His Residence:
Number of Burial Certificate:
Cause of Death: Old Age
Date of Death: February 12, 1912
Occupation of the Deceased:
Single or Married:
Religion:
Aged: 90 Years
Body to be shipped to:
Size and Style of Casket or Coffin: Pauper
Manufactured by:
Metallic Lining:
Outside Box:
Number of Handles:
Interment at:
Lot or Grave No.
Section No.
1. 35730
2.
3. 163525
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: $6.00
Price of Metallic Lining:
Price of Outside Box:
Price of Grave Vault:
Price of Burial Robe:
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:
Crape:
Number of Carriages:
Carriages:
Hearse:  
Wagon Deliveries:
Death Notices in Newspapers:
Name of Newspapers:
Flowers:
Outlay for Lot:
Opening Grave:
Lining Grave:
Shipping Charges, prepaid:
Removal Charges:
Cremation Charges:
see ledger page 127

Total Footing of Bill: $6.00
By Amount Paid in Advance:
Balance:
Entered into Ledger, page     or below:

To Funeral Charges Total:   
By Cash: May 17, 1912  Falls Co.   $6.00

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