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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
190
G4.. wp Adf.
Total Number) (Yearly Numb:
Name of deceacet, £2 A <a Sp, Ew ses eaieeleets LZ. vcgcews bab S53 Swikie Oe oS. es
“Bad
seeee Charge to . A heck, uf. def. EA Wife—Wido
Son-Daughter of
Order Given by Ao “tHow Secured ...
Date of Funeral. $§
Time of Funeral ya 4 eet
Clergyman ... Oe a
Certifying Physician .
His Residence .... GARTH UIT. S
Number of Burial Certificate......-ee een aie
Cause of Death......-++ 205 qe neemes TF idiaje dias do seane :
ry) . [Secondaty]> ©
Date of Death. Lopeee 2 es aa bale baae 3
Date of Birth...Ketm.: FFD. 5 cvidecaging as one
Occupation of the Deceased.. 4.0. ATS ee
Single or Married.. 4y. .. Religion. CG. EOE.
Aged.. 44D. Years,.. a wee Months,;.osc.00e Days.
Date of Birth..... te ee eee KDBigs ie tin w00ikt
Name of Father. 7 Ader eteG i. CO tf.. eee ee
His Birthplace Pree 4 ee EE Ce
Name of Mother.. Ca. Meer fog: eased
Wer Birthplace ...... dre. ne
roe Are ee ee
Mother’s Maiden Name.....eecer cece ee enee sawn’ 6 wie’
@F Pi SiVis
Diagram of Lot or Vault.
Designate all Graves in Lot with Numbers (1, 2, 3, 4, ete.), and
mark space for this Funeral with a cross (+).
wwe www eer asecresesesassssesesssssessesesere
Date
Address ....++A
PIOWOEE i ccectiers Saidwwie dere vi0ied 2 oie
Vault Rental ....----seee eters
Shipping Charges, prepaid.....
Removal Charges ....+s++e+++
Cremation Charges .....--+++:
Porters ..cceeeee cece cence cece
Outlay for Lot....seeeeeeeees sedpeenseebega t seers “pit scenic
Opening Grave or Vault.....--sseeeeereeers _& 282
Lining Grave ....eeeerseeere eee ones 4.
Watchers .... 0. cece cece ee eeeee
Personal Services ....nec eeecee cece ce eee ceeee
Mastec agiiecess os creleiars a eeerece $s oe
Price of Casket or Coffin.. ..ceeeeeeeeeeees $ Ax 2 O
e Metallic Lining ....-.--0+2-eeeeree
(State kind)
“ Outside Box 22. .ce sees cee eeeeeeeeeees hal 3.2
(Btate kind)
by Grave Vault ... aba tbgcse bakin sents . nen
& Bitte Robe Cigisees copwesecernege ers —~4AG 2°
“Burial Slippers and Hose...---++++ ionnomassisde Lictacstaoe
Engraving Plate’ .....seseeee+ “455 b 5 cecgtaig & 4 ia [tomopeemermpelagatanesede
Embalming. Body (with....seseeseeees Fluid) . ].. . 2S
Washing and Dressing...--++++seeeseeseeree sc apcbemonee I as
Shaving ....scceee cence eect nent eeeee recess :
Keeping Body on Ice.....-e+eeerreeereerecee
Disinfecting Rooms ....-+ Vad eeeld coaateina 6
Use of Catafalque and Drapery
“s Bolding Chairs ....sseeeeeeeeeeerceees
“ *Candelabrum and Candles
Gloves $, siciinikeccses ees Crape $
Door Crape $...-.-+-Canopy $. 22.. 00 c eee elie cpenccsee . caeetes
Hearse ..ccc cece cc cee eens cece ec eeeecseneces weA ao
Carriages to Cemetery. + eZ.. .@ $..eeereceees Ate 22
Automobiles to Cemetery... @ $..-. ee ee cers caninnaislasaigill nvsimione
Wagon Deliveries .....eeeeee erence ence eres we saaitteced . ebb
City Calls (Coaches)....seesseerereeeererees 1c nial 5G [neato
Death Notices in....-+ Newspapers.. -.-+++ ied meron
ssecanconessoeses . seecssenses
meee ee me wee eee Jos evvenen ssesneceenew
eee c ee wee eee steneeeesen: seceeeeener
Pe aves ecsenneees: . cacensaneee
scoccessoes cocee . sevsccsscen
ee
esignate pee for Monument sbi a pant square (9). ‘
in poe space to the right of Diagram for the names of those buried) ritered into Ledger, page.-------.-.--.or below. . ! =) Te
1£4%. : LOLI . ' )
ee f Lr Sl
Sf.. 19.. To Funeral Charges. ... Total, $ . / 7 2.\
seneeene aeeewene Pp noeseenens on: saenvenen . -neneeenees nee ceeenens sseeeeennen
—
ed
ees