RECORD OF FUNERAL
~~~~~~~~~~
No. 3
Date:
Name of Deceased: Annie Willis
Charge to: J. Washington
Order Given by:
How Secured:
Date of Funeral: January 21, 1912
Place of Death: 2 miles S of Marlin
Funeral Services at: Big Creek
Time of Funeral Service:
Clergyman:
Certifying Physician: Hunter
His Residence:
Number of Burial Certificate:
Cause of Death: Heart Failure
Date of Death: January 20, 1912 6:30 a.m.
Occupation of the Deceased:
Single or Married:
Religion:
Aged: 21 years
Body to be shipped to:
Size and Style of Casket or Coffin:
Manufactured by:
Metallic Lining:
Outside Box:
Number of Handles:
Interment at: Big Hill Cemetery
Lot or Grave No.
Section No.
1.
2.
3.
4. 814.20
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: $20.00
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 & Hose: $.60
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:
Bill Rendered
Total Footing of Bill: $ 20.60
By Amount Paid in Advance:
Balance:
Entered into Ledger, page or below:
To Funeral Charges Total:
By Cash: August 3, 1912 $10.00
December 18, 1912 $10.60
$20.60
Transcribed by:
Lena Stone Criswell & Kay Cunningham
Note: I added the year to all except for the date at top. kc
