Date of ledger entry:
Single or Married: WIDOWED
What Race: COLORED
Residence:
Charge To: COUNTY
Address:
Order Given By: S. DRAKE
How Secured:
Veteran State War:
Occupation of the Deceased: RETIRED LABORER
Age: NOT KNOWN
Date of Funeral: 10-5-48
Time of Funeral Service:
Funeral Services At: CHAPPEL
Clergyman: REV. ANNA CONYERS
Clergyman's address:
Religion: METHODIST
Resided in the state:
Cause of Death:
Certifying Physician: LUKEY
Certifying Physician's address: HANNIBAL MO.
Body to be shipped to:
Interment At:
