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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.
” (rotal Number)
Name of Deceased. We..
Wite—Witew tt
eur Daugtrteret
Order Given by. piste, Plated eS
How’ Seesvedl oh. sccieicc sade cis} fo Sedbas Rewowis fe meas es siebes
Date of Funeral. !
Residence . 4% “O.
. Place of Death. GZ:L.
‘Funeral Services at.. / OV
“Time of Funeral Seryice...
Clergyman ... Pian ee!
Certifying Physician Av. L.
‘His Residence ..
“Number of Burial Certificate.....ccccceceeeceeeeeeeee
; Catise of Death.......0ee eee f Sadia Rbewagiss « sesset hss
3 [Secondary]
_Date of Death... \e. d hb, Vlei Exeese ne
“Date of Birth.. 80) & een ee
Occupation of the Deceased. x40
Single or Marrie( 44a Y.
eG..
Date of Buthhes 5 oiscice s pp qees jitie Lope Rhiewiee cones eeenuparep
Name of Father.. OU Pork iiSpiowidle-s Hgibe
His Birthplace ... Rulihenns
Name of Mother... Covtartin YY whl, dueidlecere
Her Birthplace ..... om WVIAEAE cc iclecseeseas
Mother’s Maiden Name... 2.2.0.0.. Qeccceeee ee eceeees
Body to be. shipped to...... cece feressceene Be wie oes OH
Size and et. Cagket or os ai b D.
No.. 4.7 y Sores ee
~ Religion Disidiese # Midieveisre © &s
Aged.. VCR oi eiec's owt Months,..... Days.
er ee) oeee Cree eee ee eee Cr ee
Manufactured by .
Interment at... Grn . us jo emt
Lot or Grave No......005 Section No......-51.
2.
3.
4.
6.
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 (+).
esignate peas for Monument with a small square (
Pedy
).
the right of Diagram for the names of P. buried
Date. lu
Removal Charges .....2.eceeeen cece eeese ees
Cremation Charges ....0. 0c eee eee seen eeeees
Porters Tee ee eee eee eee ee
Personal Services .... cc eeececee ence dete ee
Serre rere eee ere ee, Corer
Watchers ... cece eee e cece eee eee pier, g 0 ete Lease
CIE. Satins anes 1946,
ie 54 Race) liathattie s Bork)
Charge to . ‘ante flag ica 5:5. wsignds
Address . ~A9GQual SAL Cui bet >
io
Price of Casket or Coffin....seeeeeeeeenes $ hod S. eo.
bad Metallic Lining . Hasan gobi tv nas ees! eee
© Qpthalde BO. ois ssccee ass sadens oecade one 22.
: (State kind’
~ Grave Vault .. ae aa desasroie gg aie:
— Burlal Robe 2.0.0. cccneeseceeaeeeses Amd) 22.
« Burial Slippers and Hose....++++++ aaemansopsssce f wicesses
Engraving Plate ..... S ahve orerb-ere iw wieieieieis ae oi essere eeinags paste’
Embatraing Body (with:...6.« ee ten Fluid) . . _._2. 22’
Washing and Dressing.....se+eeee0+ gnelgas I scaninisbiltes . wanes
Shaving ...ceccceee eee e et eee eee e een en oneness secsvotsschoiae . daa
Keeping Body on Ice.....0seceeeeeeeeceees
Disinfecting Rooms ....-seeeeepeeeceserees ee eens,
Use of Catafalque and Drapery....aid 3 6 cimverane ar PAC eee
“ Folding Chairs ....seceeceeeeeeeeeeees couclitess via scancrens
“ “Candelabrum and Candles.......erie] . ae ee (eres
Gloves $..... so bee Crape $.. 00.0 cee ewes muy A974
Door Crape $....0665 Canopy $....-206 sta esedhcbiced coe
PeRre ore aes jis vacbaon cone wie qesios gpg 9 ote A Phe. OO.
Carriages to Cemetery. an .@ $ = ge . J.tee. OO
Automobiles to Cemetery... @ $. 0.. cece eee =o p
Wagon Deliveries .... dards & srwmseare dpeceng obo —
City Calls (Coaches) ....c cee ee ee ee eee e ene
Death Notices in..... Newspapers....-.
seg betteneneee estas aoe oa susescsscestee rent cnentess
PIQWETS <. v:d.s:000.0j0ie oo cisien tole eaeine song cies seen
Outlay for Lot... cece cece eee center eee wees
Opening Grave or Vault aitins Pewimaias 0 Saws « essere
Lining Grave ...c.5ecceee cece eee e nee n a teeeeet
Vault Rental 2.0.0.0. cccccetcerceeeeteeeeeecs sccsasseel omc
Shipping Charges, prepaid......2+-eeeeeee sew eneesanen
‘Total Footing of Bill
By Amount Paid in Advance... bowie baasiew 8 ae
in cal a Entered into Ledger, page 2000 DeLOW. . f eesccsosee see] cee
4 Li
v4 xX
77 :
Guay..\.dz\To Funeral Charges. ...Total,$ . _2/4. 52 By Cash. ..cesceeeeseeees $32..
ee cevsencana: . ossseatennes spensenenes senseseoens seserannenes aememeenamnasnensenese. games ee ae 2 Mf 312..
SET eT Doct, A (a wait sasosscsane . ovesvcnsse Wf LAL Goose . Losereen. coven hh whe ae . a ie
ama! Se bho Ei #. . ) 2 dam
ei