APPLICATION FOR MORTUARY WARRANT

THE STATE OF TEXAS,

County of Dallas,	I, Mrs. M. J. Queen

do hearby certify that I am the person ti whom is entrusted the paying of the accounts and indebtedness of the late Mrs. Icie Dyer, who was aa pensioner of the State of Texas, and whose file number was 39287 and whose original county was Dallas, Texas.

The said pensioner Mrs. Icie Dyer, died on the 5th day of July, 1940, in the town of Dallas, County of Dallas, Texas.

The pensioner died in the home of Daughter, Mrs. M. J. Queen who was related to the pensioner as Daughter.

That the warrant, which application is hereby made for, shall be applied to paying all or part of the funeral expenses incurred by the said pensioner Mrs. Icie Dyer.

I further certify that the warrant for the current month has not been cashed by the pensioner, to the best of my knowledge and belief.

I am related to the pensioner as Daughter , that my postoffice address is 5512 East Side St., Dallas, TX

Signed: Mrs. M. J. Queen

Sworn before me this 11 day of July , 1940.

Signed: A. J. Urbish

Notary Public in and for Dallas State of Texas.

CERTIFICATE OF UNDERTAKER

I, J. H. Kitching of Guardian Funeral Home, do certify that I am undertaker in the town of Dallas, County of Dallas, State of Texas. That I had charge of the body of Mrs. Icie Nola Dyer Dyer, who died in the town of Dallas, County of Dallas, State of Texas on the 5th day of July, 1940. That said body was prepared for burial by me on the 5th day of July, 1940 and that I am of the opinion that warrant herin applied for should be issued to the said Mrs. M. J. Queen

Signed: J. H. Kitching of Guardian Funeral	Home, Dallas, Texas. (Undertaker)

(The certificate of the physician was left blank so no cause of death was listed. It was stamped received in the comptroller's office on July 15, 1940.)