Date of ledger entry: DEC. 30 1929.
Single or Married: MARRIED.
What Race: COLORED.
Residence: PALMYRA MO..
Charge To: TAYLOR COOK.
Address: PALMYRA MO..
Order Given By: .
How Secured: PHONE.
Veteran State War: .
Occupation of the Deceased: HOUSEWIFE.
Age: 75 YEARS.
Date of Funeral: JAN. 2 1930.
Time of Funeral Service: 2:30.
Funeral Services At: A. M. E. CHURCH.
Clergyman: REV. LEALS.
Clergyman's address: .
Religion: METHODIST.
Resided in the state: .
Cause of Death: .
Certifying Physician: DR. HAMLIN.
Certifying Physician's address: PALMYRA MO..
Body to be shipped to: .
Interment At: COLORED CEMETERY.
