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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
: RECORD OF FUNERAL. 199 .
Nov LO Zee cvvse Nov aBrrconee Sa 2a SEY 24
(Total Number) (Year Number .
Name of. Deceased. nie: oe
.Wife—Widow Oe eo ; eet birieettteeteeewewaeaeacsreweses read scasesseneaes 5
é/ . Address.. << EOL.. —, LA (ae 3
Order Given by....cecccccecccccsceeenerecseeeeeeces {
How Secured ...cccccccccccccesceccceticcsssegeegeece Price of Casket oF Coffin, 2 Siig ¢ 2 massmg > emeee Ye s. .%A. 2.0
“ Metallic Lining .....0eeee eee eee
Date of Funeral. WA By. fA ) i a ee Seals eee (State kind) bea VA lag
WeeRRe * Seudic ds + oS weinn Coes plea «'s ejaran's's sarmehiaduedl Oetale Bian 0 0 0 f6 3 wo cases Ss Le
Place of Death. ad. Beaten 5 6 aidigrays 6 antioiee ie wales “ Grave Vault ... 1 ca pane menos
Funeral Services at.../4.. ethan « nance oii wedles Cuaasseea @ Byrlal Robe.. .. cesses: seessset oe eeg.s whe 2B) 2.D
: i e Burial Slippers and Hose....-.+++++ ae AN (eee
Time of Funeral Service......0ssseeeneeeeeeseeeees PP ¥
ime of Funeral Service Engraving Plate ..... ees ceee eee e eee eee es ffssnnee « 4 F-Y3
Clergyman ..4 Embalming Body “(with....:.ode fsa : Fluid) . me] QO
Certifying Physician . 4% Washing and Dressing.....+.eeeeeeeeeeees i aan ea
Lis: Redidence 2. 4 Shaving . 6.. cece cence cece eee eee eee ee ee tet Ul censceenntsne enosteeuen
5 *, E Keeping Body on Ice. ... es cece eee ee ee eee eee [lee seseersee-. eesseeen 7
Number of Burial Certificate.....-.:.eceeee ee eeee eee Disinfecting Rooms
CSanse: of Destht ss oc.sleisiox dione sees ag teesiec eM reeissoseajedsp.ee Use of Catafalque and Drapery..... i aisles © 02 aoe endive eieaeug
(Prima [Secondary] “Folding Chairs’.. . 0.. c cece cece ee cee eee . f caenseee ete . aneenee G
Date of Death... Cre? Shs “a ANCL, ee a foo “ Candelabrum and Candles......-.000+ —
Date of Birth... TMiretin 28. ALS. Ades hei Gloves $.....00008 2 Crape $.... veces owes
Occupation of the Deceased. / pes Crape $2).. eee. conte Canopy $....0.06A cade
earse ..-.65 Slee & aes tade bo Biecess's ¥ o Wlessiele © a Sigiare « swweethe Sree:
Singleor Married Lhathss.. Religion YZ, . 7 “eS \ Carriages to Cemetery....-@ $.. 0.0 e eee sete Seely fanaa
Aged seine aS Years,... we . Months,...%.. Days. . Automobiles to Cemetery... @ Giececeeceeees
Date of Birth.. .c.0,.ccececccesecee eee eeee bene eee eens Wagon Deliveries .....0sseeeeeee reer erens
City Calls (Coaches)
Name of Father. Haagen OS kay se Death Notices‘in'c. te
His Birthplace ...<Cf flan Kocees snsce see ee gu nt SB sBGE ose ators cans ibscenvdegopen
(Names of ihewspepers)
Name of Mother..... 400. 00 c epee eee ye cere re veeeeee epee ok cs go lcen's Sete owen € ellen Le cyceass _
Her Birthplace .... 4% Zp EE see eee ee tenes Outlay Aor ‘LGtis oc seen) setae darceweeenes pel Snead! oy eee as
Mother’s Maiden Name.. ZZZ&ty%. Jt. _, . Opening Grave or Vault.....-.5++. 8 cimbregre gle may 4 LQ.
rae ; Lining Grave ....-..e.eee ee eee sinpdan 00 aE £.\2L2.
Body to be shipped to.... F258. Vee Se sdee dace sacs cies Vault Rental ....0seseeeeeeee es re ce ee a
Size and Style of Casket or Coffin. 9 syocoreserll « SSsedibere !enatone «Ferd Shipping. Charges, prepaid ae
ee semrererele eavedlay Wee ee Tlee Cy o Milles od beanies Removal Charges ... Lgeeine sew umeneses cae e174 [hae
Cremation Charges ...c0..eceeecceseceeecees ceneeseee wicuis
Manufactured by ...0eseeeeeseeee cence teeeeeeeeereees F . SRR are Powers 18d cence cll
Trbermg ht. Obs« o oejeee ciweietere » oiebioin’s siaueicie's ec emeitiors Cemetery. . Watchers .. See ee
Lot or Grave No.. /...ecsees Section No....0.00%6 Personal Services ».+++++++eeeeeetenee eee cee ress sete eon
Music ...cc cc ceceece tere neces asec cee wete wee
‘ 1. ‘
2
3.
é 4.
= merece Bf
$: Total Footing of Bill.o..c.s.cseeeceeceeck oto C2 L)2.0 +3
Diagram ef Lot or Vault. . By Amount Paid in Advance. .....ee eee e tes ssc .
Designate all Graves ‘is Lot with Numbers (1, 2, 3, 4, etc.), and ‘ :
mark space for this Funeral with a cross (4). Balatie... os cdec ed asia o's sodaee ee selunssencenneees . suceateeds
esignate pese for Monsien® — a ae square ({}).
a in ta apace to the right of Diagram for the names of those buried! Fs ntereid into Ledger, page........or below. . I....._.. ate 4
7 = Ah. L.
7 Bh, 7 PtP: am
lta. $e Funeral Charges... Total, $ LEE a. Cte ‘ay By Cash. ... Sa hveae te teal $§ WEE
10
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