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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
Sh
‘Mother’s Maiden Name
“0 (xumber)
Name of. Deceased..
Wite—Widew
‘Son-Daughter of
Order Given by.
How Secured
Date of aT died
Residence .
Funeral Services at. .st.44.-.66Time of Funeral Service
Clergyman . . AM: Lhitloes.
Certifying Physician Aha.
His Residence ...4
Number of Burial Certificate.
Cause of Death
[Secondary]
dss ws ass wicatig 4 wie Date of Death..
Date of Birth..
Occupation of tife D ased
Single or Married Ba Sek
Name of Father. /
His Birthplace.. “ ;
Name of Mother.....+++eeseese: use pigveisiere e'ebipigsese 6 97
Her Birthplace .
Body to be shipped to.
Size and Style of Casket or Coffin
Cee e weer e ewer eereeseree Pewee eee wee neem eer aweeeeeneeee
Diagram of Lot or Vault.
Designate all Graves in Lot with Numbers (1, 2, 8, 4, etc.), and
mark space ira this dy rej with a cross (+).
esignate cade ‘or Monument with a small square (f}).
Use space to the right of Diagram for the names of those buried
ee ween weewe
(What Race)
Charge to ..
Address .
‘Price of Casifet or Coffin
Metallic Lining
Outside Box
Grave Vault
Burial Slippers and Hose
Engraving Plate
Embalming Body (with
Washing and. Dressing
Shaving .
Keeping Body on Tce. ...
Disinfecting Rooms
Use of Catafalque and Drapery
“ Folding Chairs
“ Candelabrum and’ Candles
Carriages fo Cemetcry....+
Automobiles to-Cemetery :
Wagon Deliveries ....+.6+ ceigioute's a baie sap 1
City Calls (Coaches)
Death Notices ‘in..
Outlay for Lot
_'. Opening Grave or Vault
Lining Grave
Shipping Charges, prepaid...... iets oY 5.0
Removal Charges :
Cremation Charges
Porters 5.ci.c 5 veg sk st cvices oReieinng oe eee ees eneeee
isi Services ....
Church Charges Te alas bu staves SL pcigareoirs #4 Ae il
Total Footing of Bill....5.. eee eee eens «Sl.
By Amount Paid in Advance .
Balance
.. To Funeral Charges Total, $
a peneesean guetaeneens teeeesananes manenqeceas eummamenmmms sersseers gees
By Cashes .scess scvapa ts deep
Vault Rental :.. siete’s edule imere'e Sareidhé,s 6s Peer ees bat
Watchers ole cece ect cei n ee de de dletete ete 'e 4 0% Hien ‘
Entered into Ledger, page........or' below, . ! 2. 32).