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

No. 90
Date: April 22, 1912
Name of Deceased: Annie Sewell
Charge to: John Ward
Order Given by: Mrs. Ward
How Secured:
Date of Funeral: April 22, 1912
Place of Death: Ward Farm
Funeral Services at:
Time of Funeral Service:
Clergyman:
Certifying Physician: Dr. Hunter
His Residence:
Number of Burial Certificate:
Cause of Death: Meningitis
Date of Death: April 21, 1912   9:30 p.m.
Occupation of the Deceased:
Single or Married:
Religion:
Aged: 14 years
Body to be shipped to:
Size and Style of Casket or Coffin: # a - 5-9
Manufactured by:
Metallic Lining:
Outside Box:
Number of Handles:
Interment at: Marlin Cemetery
Lot or Grave No. 84475 (note: also has number written below this number as 94475 –kc)
Section No. 430130
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 names of those buried in Lot.
Price of Casket or Coffin: $18.50
Price of Metallic Lining:
Price of Outside Box:
Price of Grave Vault:
Price of Burial Robe: $3.00
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:
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: $21.50
By Amount Paid in Advance:
Balance:
Entered into Ledger, page or below:

To Funeral Charges Total:
By Cash: Oct. 19, 1912 $19.80
PAID


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