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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
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RECORD OF FUNERAL.
No LY cco..
(Total F..
No. AG. cece
‘Name of aa % Mace “Death. dds sejheb dip gses MOMs 8 iy
~ileaeaneoa fee ges ae
Wite-Widow oe See eee eee eee eee eee ee ee ee ee
Son-Daughter of
Address .~4 lackey, vag Siprewes » wumbididie 6 BMSMEM € RRRIOS
Order Given A. Poa. a widiors wCtovs t
How Secured .... 0.. cece ec eeeeeeeeeceeeeceeneeenees Fine of Pre wen 68 RISTO RS Ba RGIS A Go athe $
Date of Funeral.. 2.0.0.. cece cece cece ee eee eee eeeeioes et a oe ee
“ Outside Box ..... cece gece eee eeee
Res dehCl canes. ewesoinete serglaie chye gwd St bP ened wreceeiein's wieseee ae (Stave kind)
“ Grave Vitale: 5.5 caitiss s asicisee asst ss — Place of ay la. hs Aa > ne ave Va ata rae :
Funeral Services at.... 0.0.0 c cee ee eee cee sence ce eeaes “Burial Robe ....5 ccc e eee coe fauboess
Time of Funeral Service......0cceececceceececeeces Burial Slippers and Hose. feeds oe eeesies ”
C1 ; Engraving Plate 2.0.. cc cece cece cece eeen ence lf
ETZYMAN oes eee e eee ee ee sete eaten agree y et eg gence ++ . Embalming Body (with.... epege : . -Fluid)
Certifying Physicign Lar Aa. hh. rt Hawise «a Washing and Dressing..... iis bw BEB ee pre ove
His Residence . (rwnhde. os EOE eT Shaving SfSieisisg # Bg i 5 WiRTeRG SSRIR EWR asieioere © se
Keeping Body on Ice......+.+++ tania e Bsa
Number of Baril Beis supceisty F Eoigeiele « weiwalewd F tres cw 9 § Disinfecting Rooms .... * cuaveis ea wmmucets be wid
Cause of Death.C.<<4¢x-44. . Bluddler seine busrenew oe Use of Catafalque and Drapery. :....02 0060 Wi cesceeeeee acest
my jecondary] “ Folding Chairs .....ccceeeceeeeeeees seoversnsivecea . ie
Date of Death bade OL Gh “ Candelabrum and Candles.......0.005 _
Date of Birth. .. 0.. cc cece epee cee ag cece eee eeeeeeees Gloves $..5...00.00:
Occupation of the Deceased. .9 y, eee Crape $.
< Le oe foe amt
Single or Married....>. sexuat Religion en fac sia Carriages to Cemetery a.. s@ $.csscceevecee en
Aged uh § Avears,. 2: as wastes shee Days. . Automobiles to’ Cemetery...@ $.....05: ~g. Date of Birth.. cree cece cece eee cece eee eee eeeee Wagon Deliveries ..... essen ees dete eee soon cee
City Calls (Coaches)
Name of ed bee mediating wwcereare « 9 wesaiarne 9 aimeree Fowlers e's s ‘I Death Notices in.....
His Birthplace ..00.i.scseeeeeeeeeeceeneeeeeteneees re De seth se tetea al hea’ a Ts whee Bu ve Pend a
Name of Mother.. 0.. cee ece cece eee ceeeeeeseenneees Pigwets o<. bivesscu ten obi ee ee .
Her Birthplace 20.03 0. c cece cece cece ence eee e eee e ene eens Outlay for Lot.. .. ce. cece eee eee teen eee sessspeassrnsttasl Sop sced
Mother’s Maiden Name ee Grave or Vault + ses soSeais
woe ; Teining ‘Grave ~. gives s0:aieiginda s siviote o's a waions esas eee
Body to be shipped to.. . Vault Rental ... MDSTEEE 5 abso tr rer) ae i eee
Size and Style of Casket or Coffin. . Shipping Charges, prepaid. ..:....0.-0e0ee a hi:
SIM yaSLOrew.& 6 & BGA TIE MW SSRIS 8 2 BIGeaLe 4 ¥.9BITER 8 LBiaaidie,f's Soctieee 305 Removal .Charges sscerescneas’
ra : Cremation Charges ......0.eceeeeeee v3 88410 a ll agouen tere woes
Manufactured by .-++ss+eeeerseeegreerersreeee aeons * WPorters ..c.ccccecenscesecccucccencnctevsseuss eSeeosseeatf ie
Interment ats.. .ceccceesceeces SAAB ET piprecsinice 6 Comins Watchersice.cchiseddestecesed le acdie de eee e'e's 4 [fevencomanen . Sai
Lot or Grave No....2.... Section No......005 Personal Services ....++.00sceseeeesee see eeees
CRYPER CHAPEER 5:00 6 baw + seoserem os esewie os oie
Diagram of Lotor Vault..
Designate all Graves in Lot with Numbers (1, 2, 3, 4, etc.), and
mark : ace for ol Funeral with a cross (+).
Designate place for Monument with a small square (J).
re, Use space zg the right of Diagram for the names of those buried
ee ce ee ery
i ey
er i ee a ers
..ot below. Entered into Ledger, page......
Ralance....... eae ney 2 Seats ikea
7
a
ude. oeZ. To Funeral Charges... Total,$ . _ 5 774