small handwritten ledger book with forms. Browseable images on FamilySearch.org.
Ohio, Trumbull County Records, 1795-2010, images, FamilySearch (https://familysearch.org/pal:/MM9.3.1/TH-1942-46264-38528-21?cc=2065327 : accessed 27 September 2015), Cemetery records & Burial records (indigent soldiers) vol 1 1909-1917; images 113; Trumbull County Courthouse, Warren.
The form reads as follows:
(Under Act Amended April 22, 1902)
To the Honorable Board of County Commisioners of Trumbull County, Ohio:
We, the undersigned, appointed by you for ___________________________
in said County, under and in pursuance of the laws of Ohio, authorizing the burial of the body of any
honorably discharged Soldier, Sailor or Marine, their wives or widows, etc., who die without leaving
means sufficient to defray funeral expenses, have had under consideration the case of:
an honorably discharged soldier _________________________________________
in Company ________________________________ Regiment, Ohio Volunteer Infantry
and after a careful inquiry into and examination of all the circumstances in the case, do find and report that the said ___________________________________________________ died on the
______________________ day of _________________ A.D., 19_____ that we have caused ______
to be buried in a decent and respectable manner in _________________________ Cemetery;
that the occupation of said decedent while living was ______________________________
that the said decedent died in indigent circumstances,
that his family is unable to pay the expenses of the burial,
and that the expenses of burial amount to the sum of ______ Dollars
an itemized account of which is hereto attached.
_____________________________________, Ohio __________________ 19_____
*If he has no family state it here, drawing the pen across the succeeding clause.
We, the undersigned, residents of ____________________________________
in Trumbull County, Ohio, it being the ________________________________ in which
the said decedent _____________________________________________ lived, do hereby
certify that we knew the deceased in life and are well acquainted with the family of said deceased, and they are
in indigent circumstances, and umable to defray said funeral expenses.
[ITEMIZED STATEMENT OF EXPENSES]
[APPROVAL BY COMMISSIONERS]
There are only two entries from Farmington.
FARMINGTON BURIAL COMMITTEE
|43||Peter Thayer||20-Feb-11||Civil War, Co G, 41st Regiment, Ohio Volunteer Infantry||Farmer||West Farmington||O. C. Osmer||D. F. Huntley|
|44||Agnes Elwell||31-Jan-11||Widow of Amasa Elwell, Co. E, 5th NY, Heavy Artillery||Housekeeping||West Farmington||O. C. Osmer||D. F. Huntley|