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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.
GAG..
No.. 29.. 6.0.05
Date.
ior Auteap... A
Name of Deceased..
Wite—Witow
F Saud Penton.
Son-Daugkter
ot
LOL vececens a
ade
Boe
Caf,
Charge to A. a 4,
_ Address
Order Given. byes
ne
.sadins ss ciccditle s siiesca becsnde ccgsineelsies
ete,
:
LI
t
‘
. bela.. ‘
4
JA
Hows Setured . isis siginisie os visa isiaa semsie.s os aawiecsceaaaine
« vdie Price of nig rn tteteeee beaten eeeeees $ £20
Date
of Funeral. ,.¢
Residence ..
/ (Abi e obsli'salncy suman oae
pcidiaiiiniel “isos
Place of Death.. Diao, EZ.aig tamed st Recseran qgeaie
hdd,
cotiene covets
Burial: Robe ‘v.06. ecceeves
2. eg Schade
*f ;
Burial Slippers and Hose.......rneen fl ‘
Bngraviing Plate..
Zz.
.
:
“Grave Vault ...ie
Lp stains
j werner seecainal
Funeral Services at. Re: /. Ulu,fare. pea PNB
Time of Funeral: Service.’: Jes
a,
t's aise ois o & ciara . ) asssoced
siegeASN
Onttside: Box .s:sieiegeri 4sreel
WARP.. Sou
ldighias Se vsjeicisa > Lelwaiwls says
escces asics so seseis « osicisigia se . . scherees stein
Clergyman .. Mga ft
Embalming Body (with...... mE seta Fluid) . . <2,
Certifying Physician . A¥-K.
His Residence
...% (22 Le 4. :
ia .
.
Number of Burial Certificate
Cause of Death........0.4. ge y siaverasae
0 8 sheriheise momwisye
Washing and Dressing......s0eeeeeeeeeees aa eons
having);
« Skuisiis « sedge 5 cimping 0s Sireiewe 6 a wiaionn as [lrahiostleacsos ,
Keeping Body on Ice.....
ccc cesee ee eeeneee
Disinfecting Rooms ......Ge ceeceeeeeees a
Use of Catafalque and Drapery. ..... 065000 Wess csseeceeen
Primary)
[Secondary]
Date of Death.. Mifae: : +%y OLA.oye. * eters meee
Date of Birth.. et
SWYGL PD.. cccevecsee
Occupation of the Deceased. Gf.SZ
“ Folding Chairs ....... “aid
“
d Y sslelid & § BAheaonrenaie
Candelabrum and Candles........45 see ote}
pie b piace tale’
Single or Married. Liege. Religion. litle,. Carriages to Cemetery.. eae
GP.. Ahead
/; can Years,/..3. . Months,..Af ..Days. . Automobiles to Cemetery
Aged..
Date of Birth. ....200ecepeccegecceceseeeseetssesens Wagon Ap esiar Peete ee ee eee etna een ee ee ees
Name of Father. EM.
hissed 5 5 sree
His Birthplace ....
City Calls (Coaches)
Beth Notives-in. .:.2.. P
4
Name of Mother.....
:
Flowers 0.0.00.. ccc ccc ec ee cee eeeesteeeeueeaes
a
Her Birthplace ... A
Outlay for Lot
Mother’s Maiden Name.
Opening Grave or Vault.......cceeeeeeees Pare3
Body to be shipped to....foecccscecreefrvecsccaceres
Lining Grave .....0csce
ee eeesPreys
4 9 atereee
view a
&
Vault Rental ...cccccceccccccsccecicecenees ae
wut Lira,
en
foldUae..” \Removal Charges
Size and Style of Casket or Coffin
Shipping Charges, prepaid......06
0.00000 . ccccsssnseen
;
Manufactured
Cremation Charges
Pee
ce 5 ohn good ihe oie ores oes wnench ade ae
by ..,..-.eeeee0wince
6 « ajeceints a seers
Interment at..
a
;
Watchers ...sceceeceeeee Kpcaro ny » {bbe
¥ sieietbs esas tabeseaes
Lot
or Grave No........ Section No:.... rit Personal Services cis de igitleng qreinisicies « as pigitieey oswise'Tl tips
Wet
gnc tS Tees, MRM RSG ggg baicats pm mtesied piped depos
2
3.
4.
6.
$
Diagram of Lot or Vault.
Designate all Graves in Lot with Numbers (1, 2, 8, 4, etc.), and
mark space for this Funeral with a cross (#
ignate place for Monument with a small square
Use Hoece
the right of Diagram for the names of ee, buried
ads
77
Mpa. 2.. (To Funeral Charges... Total,$ . 27ANZ.PA
Vanes of) Pal? Roaron
=
Total Footing of Bill....2..00e.005 See AIA
By Amount Paid in Advance.......0s0006 a
‘
i
Balance... He anaidiaiie:
a BAe ee are thes sé ore Hansbivace
;
t