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Collection: Original Records > Death Records
Mortuary Records 1914 to 1919 - Book 13 & 14 (310 pages)
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Page: of 310
: RECORD OF FUNERAL.
Le No. a ore
(Total Number)
Name of Deceasedt(/??
Wife—Widow
Son-Daughter of
Se TBE Nhe
ee ee ee ee er ee ee!
Faas censivess braceVilly ,
ewe ween
J Lb A. _ Address {eawewe Beaiemes
Order Given by /A¥%cy. CHAE, oo ec c eect eee eeeee
PAHbw SebuUred odie Soyenncchs ssa ve nesnen suns se canes Price of Pewee ee serecececreasnsonsees s. . a0.
Date of Funeral. C444 5+. Oe ao L042 sacra Seaceibe ee te ening) —
“Residence Cece CE Fe Outside Box, .+-+e.s-scssivesseeerees
‘ : €. .1G Vault ccc cece eee e cece ee eeeeee siaLacsacie . entaooege . Place of Death. “A UNatly iedices «beige 64 bbe bas & rave ve ‘alae bina
. Funeral Services at. Tre eresssepegerseresagees ere ce eens “Burial Robe «12.2.. ssereeeeeereceeces sseneenee
Time of Funeral Service. . A _ Burial Slippers and Hose...-++++++++ adeassccs . sntanng
nS Engraving Plate .....seeeeneeeeeceer nsec es [femme meee .
Clergyman .'.66+ Embalming Body (with. ....ceseeeee+ + ¢E tid) [mmnen ene] mmene
Certifying Physician %*4 ct er Washing and Dressing.... eceaeeeeeeneenees en .
“His Residerice Y. DP v4 a wl Sry gs Bata ss ok heurdies Shaving ree . ccsteactaal om
j ‘ ‘ Keeping Body on Ice....+.seeeeseeeeeereecee
Number of Burial Certificate. ....++++seseeeeeeereeees Disinfecting Rooms ....sesesseeeneeeeesees case
/Cartse of Death. .--...2-++seers jet Neh Se pawn seedhoied 6 Use of Catafalque and Drapery... éSijbisiane T's asia OE ical ec
‘ (Primar. 4 [Secondary) “ Folding Chairs .....ese0+0+ Rormigie 0 0 Poe . eureka) ORNs
; Date of Death. Caee 0 BIL ILE oes fale “ Candelabrum and Candles..... Prd . peeeennrnen bere
Date’ of Birth. Gere§s Bite WOO seuss ioieneeseies Gloves $osscceassoedess Crepe $.so0ss pvasiet. ee:
Occupation of the Deceased.....++4. w 4 bajeiore oo aacord > oor Crape $...+.+.00s Canopy $....++00++ iecosivbns ancnsenen
; ‘ x «fo fe cee a BAPSE: oc acigiedie s veuulone deoe-oiad 5 bisibinw wmeereien aoe en
Single or Married. .rbsoegdec. . ReligionhaeQeateort.. Carriages to Cemetery... vad HY Ginn sasamasaee cite Ie.
Aged...-. +++ Years,....5+Months, £/4ae@. Bays. Automobiles to Cemetery... On Se anaemia . santa
Date of Birth. ...,c0ccpecpeeegeccecceeeeeeeeeeusseeees Wagon Deliveries .... cciaad’s aoeceerdie & serene 2 se i
Name of Father. Of. i deaaart Fs we qisreteise 8 emia aay Cells’ (Cosches) iF nee ce ala
Death Notices in.:....Newspapers...+.+‘His Birthplace .@° eb her ayiwiege ¥ 0 sisieivlees Sadiewers eebinwes . cca os cegadcecshe
cera ey J ii
Her Birthplace BPS io olin cmap oe sinigionee sins iia ¥ 69 Outlay for Lot ensene sa
Mother’s Maiden Name. Mhecr. ink ” Bo paws ore Opening Grave or Vault.....e cece eee eee [fone wad . FD
. Lining Grave ...ceceeeee een cece e en eencerenees issadsscnas-'
Body to be shipped to.. . sec. ce cece cece deren enon ere ee ees Vault Riatal coiisacsee Gices De ceeseesseeeeaees a
Size and Style of Casket or Coffin.. ..seceeeeeeeeeeeeees Shipping Charges, prepaid....+ssseeeeeeeees scomwaclaases eas
Lobe weds pened ecdecceebeeseascndovceeees sete eeeesionnceds Removal Charges ..+++seserersertrercncetee ses [lummammens . amen
Cremation Charges .....sseeeee eer eeeeeeeee sen ae sass
Manufactured by . RL enn nee eae Pp het oon xian kan dd aataaes . ownene Fassete
Interment at.0. CAC. wo cece eee cence eens Cemetery. . Watchers .....eeeeeeee eee eee e tegen enna.
Lot or Grave No.....-0005Section No.....eeeee Personal Services ...++++severnnnnsseee . aennreane
Music ...seseeeeereeeeneee eraser sere ceeeees ceecmees . ceseceue
i. Church Charges .....eeeeeeeeeeeeeeneeeeees eee
2.
3. sbennntssabas oGittiight tain abaiegg v evens + onl ma wars
4. Seishin Devas bctaieg sen endow blicenatA banitells « eka a
6.
sonsseece . coonven —
= Total Footing of Bill..... unas wba agen $
Diagram of Lot or Vault, By Amount Paid in Advance. ...+++seseeeeeee en
Designate all Graves in Lot with Numbers (1, 2, 3, 4, ete.), and
mark space for this Funeral with a cross (+). Balance... Say ode Sema ee bereits g Sis cata vapsanctanw . raileiosees
esignate Logs for Monument with a — epee (). as
wer space to the right of Diagram for the names of those buried . ts tered into Ledger, page....+.-.+.-0r below. . ---. ee ee
v
meas meee To Funeral Charges... pone creee seve) eetneee . cceem omen . r. By Cale. ccc sececeeeeeences $ codcustcalll seoteabes