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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
!
H RECORD OF FUNERAL.
NoGLF sBars o Thee . No. 2. Ro edhe bs wares Date. ch $L0..7. ed wa eestece sees 4.
(Botal Number) J (Yearly Nymber) ot
¢
Name of Deoenei,. read hats. gh.. llL, V Nibles, Mb.. je asany BU Yu ore aie
Cheek ° (Where Born)
Wite—W
der balersl ag bUDNt Tete ewenyeeastie sedan gaa aeeseeneee ees Charge to Gecf&-0O"4 fh ol
as . ey x Address .“(2404@4c€. VA
Order Given by..ssseeeeeeeseeeer treet ereeteeseeeenaees
How Sedured -..0segseipvgzsrseoeopferensnecrecsecsnee Price of panier = Coffin.. .seseeeeerereeers —_
; } AS ooo cece gnewes te cwionses
Date of Funeral. Afehs. lyfi2 siauwiene aa simorere SMe Crane eS ** atave kind) ie
Residence ..s.ecegeeecteeresteeet gisbas «cree elehoe Outside Box .-..waaay Te ae
Place of Death. .,4 A Like, W/ P72, Set « Grave Vault ... esawagree 3
Ny Funeral Services at...csceeeeeeeeneeees catay #4 2 bosvee « “Burial Robe...+++-serereeeererere es “
Time of Funeral Service.....-+seeeeeeceeeeeeeeneeeee wh Burial Slippers and HoseEngraving Plate ....eseeeeseeeeeeeeesrseres “
Clergyman .. cece cece eee e eee eh agesec cn sceceseee Embalming Body (with....:. wt date
Certifying Physician Le.. CP OP4R EE. ccc enes Washing and Dressing
. g His Residence .Y.t64 BO.. ccc cccceccvsssenenseees SO
i. i ; . , Keeping Body on Ice
. Number of Burial Certificate. .....0sseeeeeereeeeee es Disinfecting Rooms ;.:....seeceeeeeeeeeeees
. Cause of Death.. DLS 6c Use of Catafalque and-Drapery —
rigpary) Me [Secondary] “ Folding’Chaira:. oo.. 00+ eee To ,
Date of pais gf 4 Le, (hi “ Candelabrum and Candles
Date of Birth..< Fe a Mee eres) . ee
Occupation of the Deceased.....++seeeereeeeeeeeeeees Door Crape $..---+++++
. . Zs — Hearse ... cece cece cee eee eee eee e rene ee enesSingle or Married.... aeesDeee Religion. ...-+++00+++5 Carriages to Cemetery
Aged..7... Years,..77.. Months,.. 77...Days. . Automobiles to Cemetery...
Date of Birth....gecegeeecap gee cece sees eeeeeeneeees Wagon Lima senneeeeeeeenseereeenaee enna se ne
Name-ot Pathos és, Dog @teey oo sscssssssscsvee City Cals (Coates) oosecson oe sneer
His Birthplace ... FA PACER eee eee Lie cence eet e ees
Name of Mother. FIOWETS oc ccc ccc cece sce ce eee seeeereneceneres
Her Birthplace .. Outlay for Lot os
Mother’s Maiden Name& . Opening Grave or Vault.....e cece ener ee eee Ly
: . Lining Grave ...eee cece eee ere tebe eee ere sees
t Body to be shipped to...-ssseeeeeee rece eteer teen eeeers Vaile FEeCtaE . «ovis ua cacsregng watee's + pewine eon :
Size and Style of Casket or Coffin.....+sseeeereeerrers Shipping Charges, prepaid
ri ' Mb cence cece enee cee e sees eeenet esse sees eeeeeeseteetee Removal Charges ..-. eC ATaTR 88 eprom mae SiS BARES Posen eninnr
. . Cc tion Charges .....cce cee ereeeceeeeees .
Manufactured by ..... edie peldiGince » onelfiga h@iaiea 6 4 sisiey e Porters “— ‘
Interment at..sseeeceeeeeee reece ee eees yom «gnu Cemetery. . Watchers 6.2. 6066. edd e cece eee eee’ fitex Edda TY . ee
Lot or Grave No...-----+-0Section No....-----e0 Personal Services.. +++ ++cpee screeners ecee certs Hl cnutnensen
. Music ..0eee cece cere cess Na diacsce 6 8 aabidle,o Hiete . agate
1. Church Charges
2
4. @ 2 6.0: 8:0 C8 0 6.088 Co HEPES ¢ HH OCC Oe Oe C06 F oO O:0'S1e & FKeree Sets . aptnnnennne ev quips tens cvovene se ngees his fee
o: Total Footing of Bill......0-0+5 . . eee
Disarm ef Lot or Vault ; By Amount Paid in Advance.. ..esee erence ees seve
Designate all Graves in Lot with Numbers (1, 2, 8, 4, etc.), and ’ ,
mark space for this Funeral with a cross (+). : Balance.. 3. ide cg seis gare 8 eis M6 a8
Lbesigbete lace for Monument with a small square ({}). : i *
Leto” aphoe te the right-of PAGE fae Chip amen Of tone Senries Entered into Ledger, PALES saisisies sacig oaesOFr below.. ! .....-.-cosatmuusee,. ammeeee {LO Funeral Charges...Total, S. fees Pee eee [omnes . By Cash. cee et sees ee ee rece 9 . eee as