RECORD OF FUNERAL
~~~~~~~~~~
No. 67
Date: March 22, 1912
Name of Deceased: T. Henderson
Charge to:
Order Given by:
How Secured:
Date of Funeral: March 23, 1912
Place of Death: Levy Farm
Funeral Services at:
Time of Funeral Service:
Clergyman:
Certifying Physician: Dr. Allen
His Residence:
Number of Burial Certificate:
Cause of Death:
Date of Death: March 22, 1912
Occupation of the Deceased: Farmer
Single or Married:
Religion:
Aged: 40 Years
Body to be shipped to:
Size and Style of Casket or Coffin: 6 - 3 # B
Manufactured by:
Metallic Lining:
Outside Box:
Number of Handles:
Interment at: Levy Farm Cemetery
Lot or Grave No. 105630
Section No. 308290
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: $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:
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: $20.00
By Amount Paid in Advance:
Balance:
Entered into Ledger, page or below:
To Funeral Charges Total:
By Cash: March 25, 1912 $20.00
Transcribed by: Lena Stone Criswell & Kay Cunningham
Note: I added the year to all except for the date at top. kc
