RECORD OF FUNERAL
~~~~~~~~~~
No. 66
Date: March 21, 1912
Name of Deceased: Nettie Roberts
Charge to: Frank Ward, Hiram Roberts
Order Given by:
How Secured:
Date of Funeral: March 22, 1912
Place of Death: Ward Farm
Funeral Services at:
Time of Funeral Service:
Clergyman:
Certifying Physician: Dr. Ward
His Residence:
Number of Burial Certificate:
Cause of Death: Tuberculosis
Date of Death: March 21, 1912 4 am
Occupation of the Deceased:
Single or Married: Married
Religion:
Aged: 38 Years
Body to be shipped to:
Size and Style of Casket or Coffin: # B - 5 - 9
Manufactured by:
Metallic Lining:
Outside Box:
Number of Handles:
Interment at: West of River Cemetery
Lot or Grave No.
Section No.
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: $28.00
Price of Metallic Lining:
Price of Outside Box:
Price of Grave Vault:
Price of Burial Robe: $3.50
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:
Total Footing of Bill: $23.50
By Amount Paid in Advance:
Balance:
Entered into Ledger, page or below:
To Funeral Charges Total:
By Cash: November 30, 1912 Hiram Roberts $20.00
June 30, 1912 By Cash $ 3.50
$23.50
Transcribed by: Lena Stone Criswell & Kay Cunningham
Note: I added the year to all except for the date at top. kc
