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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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SIRES TTTITTT BRE a
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Name of Deceased. .
Wite—Widow
Son-Daughter of
Place of Death..
Funeral ‘Services at
Time of Funeral §
Certifying Physician od
His Residence .... ee
Number of Burial Certificate
Cause of Death.:.... ae oes queers o Meh art « od Wneg ace ard
Date of Death.. AAA
Date of Birth......
Occupation of the Deceased. .
Single or Married.. AE.
Aged..%.
Date of Birth. ... 00. e ec cecece eee ee ee nee e ees
Name ‘of Father
His Birthplace. .... 0. cee eee eee e eset enone eeneeeee
Name of Mother
«. Vears,....06. Months,..... Days.
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Her Birthplace. :
Mother’s Maiden Name sinib bie a ete bcobtieg orergcazy a ye taiglagg « epee’ s
Cremation Charges ......00eceeseeee eee eees :
Manufactured by, .. POMCEB AS 00s ceie itis no oie Sale fs Siassioreis ¥ 3 eee Rial» SaeTonTe Tsanasinims is
Interment at... «4. SALA . Watchers -.
Lot or Grave No.... eee eees VSection No......04
1.
2
3.
4. ee ae
5.
£ Total Footing of Bill
Diagram of Lot or Vault. , a
Designate all Graves in Lot with Numbers (1, 2, 8, 4, ete.), and
mark space for this Funeral with a cross (@).
esignate place for Monument with a small square (f).
Bs space fo the right of Diagram for the names of those buried
they ger
ee eee ee ee ee a
Agrees 1s acai
_ Burial Slippers and Hose
Engraving Plate ;
Embalming Body (with...... aes Fluid)
Washing: and Brressing:
Keeping Body on fee wdiare: a 6 © sioyeuer 9 4 pacers crqe ¢ stereo
Carriages to Cemetery.....
Automobiles to Cemetery. .
Wagon Deliveries ....... fsergie ¥ v Skauoxace « wigye
City Calls (Coaches).. ...cc ccc ee eee eee ee
Death Notices in
Flowers): oisss 645) oR hes eh ewans eas Re ewe alanviend § «suave
Lanta Grane s «5 cies uavicas's te seas 64 weiees exes
Vault Rental .....00.ce cede Je Uistaygie ow 9 gare
Remoyal Charges .... rece 2 argceie « wnrgeenelalada wee
By Amount Paid in Advance ay
Balance
Entered into Ledger, page.. Sicclips «fant
Shaving ......5-% iinet pcecacginp os Srqnale « mailed
Price of Casket or Coffin....... 2 eee eee $ mye) rao
Metallic Lining .......-eeeeeees L pcacomrensil td na a
(State kind) a
“ Outside Box .. ccc cece ee cece ee ee cee . . cscs —. Q2O
(State kind) :
Ft, NBVO: VOR ices sags Ge 6} screws age ew ode socnshsieeis Ow ts
(Btate kina)
ute Burial Robe cc. sce sedse sc ateieee c oecitiee Nyisnayy
Outlay for Lot. ... 1c ec ee ee eect eee cee . . Mee
Opening Grave or Vault......020ce eee eee oes
Shipping Charges, prepaid: .::.....0.0s0008 ;
Disinfecting Rooms ......2e0eee seen eeeees ae ae
Use of Catafalque and Drapery.....0.i-0005 scan cscanpons pl ascend
“: Belding Chairs’ oa.. ods eciewee cancion obs aes Le 5,
“ Candelabrum and Candles.. 0.0.0. .6 0620 ee + Were wemeaeee
Gloves $......4005
Door Crape $...... aes albnbaeak
Hearse .. Freie sles \Gineegnee esis cam be Peuseonpe eee_. To Funeral Charges.. .. Total, $
Names of Pall Bearers.. 2.2.2.. 00 ccc ee cee eee eee tees tebe cnet ents teneeeeeeaseeveeeuveescdnueers tsar sus vee 3 wie ts