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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
4 : RECORD OF FUNERAL.
No.. Y.7. LS.. wpe usm Date. . ou, Geet Ahiiasseuaniidons 1942
Zi Number)
[yA
Name of. Deceased. Ao At ZQAMsr. KANAE LL occ cc ccc cece eee ALLA, cess cece ceeeeees OSE lent
:
Yel Race) (Where Born)
—Ww wow fcnukone a See eo CHALZe £0. oo cecie sciecieiss c csnsivion o sess o4 ve eis os cere sense
Address 2.. ciccics cowigiews eee cesses cscccvegeeccss sees
Order Given ww litede fl, Ke ttr~ ty
How Seeuted 5 ¢ feiss. ig siguas s capinls oqatas saenes scmmcine P rice of fat afin mibiond & BiRiatee. aR SIA TE/SS § Bist $ KS. ao
fc Lining .....2 see cece eens ——
Date of Funeral. . Left, ate sssisistasdinin's + Siaiehe aacietion mee a (State kind) in py
“ A
Residence ... Guan. Y EP Sistine vacvesceneces Outside Box ... ‘gucka eh: . amen
Place of Death..... US ccppamsingls 'aiwane vp vwcn’s vtec “Grave Vault ... ‘aides Sergi te patcee
Funeral Services at..-f./%. ‘ “ Burial Robe ..,..ccccccccccreccesece shepslatel
“ 4 69
Time of Funeral Service. . / 2 3 7. Z : _ Burial Slippers and Hose...-.-++++. al eg
Engraving Plate .....+s000% s ecereiere © warp dii cine oi .
Clergyman ... LT A sete eeeeens Embalming Body (with......2000005 Fluid) 3) a.
Certifying Physician Ald. Ge. Lt. SACLE. cc ce cnees Washing and Dressing. ....0.0eeeee eee ee ee [lessee wenteren . sneneeune
His Résidence ..:; i Aan = Me Shaving Caiere-g ReralSiaze 5 viesevwie Sersiareieie erseee & o wese8 bs wrsoetieanes nda
Keeping Body on Ice. ....0.eeeeeee cece eens ,
Number of Burial Certificate. .....seeeeeeeeeees +++++ . Disinfecting Rooms ....scececeaeeeeeeeenes Qo
Cause of Death......0.e0ee0e ps seiartis, Magda Sasvesere « Use of Catafalque and Drapery......e+e005 ee (ae
Folding Chairs 00.0.6 02b00piiscosesenceeees F
Date of Death... “ Candelabrum and Candles......020000 lees
Date of Birth... Qn, Gloves $.....0ee00% Crape $.....e00eee
Occupation of the Deceased. 2 besa Crape $....+.4.Canopy $.....+ owe
CBRE: 0 Coiscascra Karate Bea denies & eaieIES 6 6 ye
Single or Married Ua irre Religion Carriages to Cemnétery..,3.:-@ $ 6
ges oe nphors HQ Bie Phasinns Saves atic
Aged. Se.. F Automobiles to Cemetery...@ $...eseeeeee
Date of Birth.. g, Weagtin Deliveries yi ai.c 5 weicasy gaiee’s « wasewie s ore flee wnonter aualls ™
LN f Fatt City Calls (Coaches)....scceeeeceeeeceeees stclassccltl sem
habe dieu Death Notices in..... Newspapers.....besa
His Birthplace (0.. AULA LELOCGY. cc ceccceceneneee . e cccccceueeuceaees eee ae ceeeeeeseeesesseeeneee ones
Name of Mother. . Flowers ... nae : pant ‘ll " sia vnowslbon v0 Gist si
Her Birthplace ....; {8 a Outlay for Lots series s sveincies sce os sueiee c geisieies andi ien el dogs
Mother’s Maiden Nam Opening Grave or Vault.....cee ee eeee eens annua JD
. TAG GAVE 6 4 vedtcinie « seecniacg’s saisinss 0:8 slealhweoinene scsi
Body to be shipped to. ... ccc sce ccecccseeesecwoeecenes Walt BOHOL 5 < cecde'c cslerwre bo-domaeermmmate ou c's
Size and Style of Casket or Coffin. .. 0.. cc ccc cece eee e eee Shipping Charges, prepaid.....eeeeeeeeeeee iis
saibins: Binvajete’ 0 & avasaya.g « wcerecere & u Starouarel's & wreratay # x Svaverere a.siayerwiary’s oak Removal Charges
Cremation Charges .....ccceceeceeeeeeeeeens cvewiljaetved eacinsy
Manufactured by 2.0.0.. 6c, cec ye gece gpee ee eese een eeeeeees ™
? ia POFEELS:): aleiered Shinde os visseien ds einer 6 6 marae glee we eens) ene
Interment at. (itn. ledledlace Palas Ws Cemetery. . Watcliens:s « . ssicais ss sieine.e saaalvgsd’ssieieises siege «ox snares . Masia
Lot or Grave No......005. Section No. ...aceeeees Personal Services . sesneannssene . cnantnn
a Music
1.
2.
3.
4,
a secession
= Total Footing of Bill.....cscceeeees eens $ LY 92.
Diagram of Loy or Vault. By Amount Paid in Advance...... fw va siwiniere sccagee eae . cere ,
Designate all Graves in Lot with Numbers (1, 2, 8, 4, ete.), and é
mark space for this Funeral with a cross (+). Balance.. ioc os ccieide othe cies cece 4 [fosnsessnadbosIBeil laces
esignate place for Monument with a small square (fJ). . ;
in spay eee Bo Ea igs OF Eieepraen tne Vee ape ee renee heeled! rentered ‘into Ledger, page........00 below. . l swws..-O
Lhd 7 Ahh !
4 Gly..
lat _2Z.. To Funeral Charges... Total, $ Lhe: Q. ¥ GslLfg.\ By Cash...c.cceceeeeeeees $ mh bled LA .