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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

Name of , Deceased. .
“Number of Burial Certificate. ... eeenit gH
Name of Mother...
» Intermient at. / 4
‘Lot or Grave Now. .veisas tee
(Total Number) ly Nu ber) ‘
Wite—Widow
Perr rt tert eee ee ee eee kl
‘ ‘Bon-Daughter of
*
‘Orde Gived ty: tadary Sok A Rents ah eae:
Perrriere tit Re kk
AM
i einele'g-are else «6
sadese
Residence .
Place of Death. .:
Funeral: Services at.. .i6ee ese
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weeeee
meee eee ee eee ee ee Here eene
Time of Fimeral Service. . wiveegededesedtepeeecrtetrerees
&
M4 Certifying Phiyaheiaal wins (Lee
See ew eee ee
His Residence ‘s/s Deo
eee e ee geeene
ts
Cause of. Tenth dd isis stisiel deslet yal SoM Nu babons ls «
(Primary) Seco :
hygey Pr
(Dh vi LIAM ca cviss Date of Birthss. cs
Occupation of the: Deceased.
Single or Married
Aged.. 4. &.,,., Years
Date of Birth. ++
Name of Father..
His Birthplace’. .4..
L. . sna. Months,.. 4--Days.,
Sve we vee eevee
+
Her Birthplace’...
Mother's Maiden Name.
"Body to be shipped . finial ge a dee Von eons Roig dea et
"Size and Style of Casket or Collin beahs Pion goes
vedydbyierecenstevddysevnteeddessseedeged HBA teyees
eee sere rnte,
i) Washing. and. Dressing...-.+2 +++
Gate yy iy PHearse ... gedit shige
,. Religion \Earriages to Cemetery..
.
:. Death’ Notices in.,...-eee tee ete we rer ae ly fy See eee eee dee lee
wee. Charge to.4 LU. 40M..
Address Pee dS Sie erode H 0 FS ew oe es 0 068. bee +O ame Hee Se
Price Of Casket or Coffin 26 eT Ss or aah
s Metallic Lining .....; Riven ogaisibie
ed ‘ (State kind) 4
“t Outside Boxe....--» aislececorgyeiees
“(tate kind) ne
“Grave Vault ..-+:.s1:05: Sasbcrraseees
(tate kind)
«Burial. Robe...5--.:Hs Burial Slippers and Hose. . seete gerne
sein eae eee ens te
‘. Embalming Body (with.:...:6
iseie-d apres
Shaving ...-eseeessees
Keeping Body on Ice...
Disinfecting Roorhs NEL cess bob . anata coe shecw's
De Cattle ithe serra
“ Folding Chairs ...--eeeeeee ee eereresets
Come eer eveseosiavies se oe
Serer ee eee
» Candelabrim and Candles: HK
Gloves $. ORR Snes rts
Door Cfape 28 be
eee eee nee eene
Automobiles: to Cemetery. eo . ; N jroiterepies
Wagon Deliveries ,..-. fence sevedip oe cists Sees
City Calls (Conababyats c sveon sey seer eeasees
au aORY Sexe E EB
Newspapers. be
‘ikemes ‘of Rewspapers)
. Blowers) sees. eee eee eee eee a ole gees
Outlay. for Lot.. .. eee eee ee eee pe neta rs
Opening Grave or. Vault..+-sssserree serge:
seeeee
[etag’ Grave vs ssaevoneseetecetensteie et Weeks
‘Vault Rental ..c.e cece eee eee eee ee ee ee rete
Shipping Charges, prepaid..
Removal Charges ...+.+eenseenennenneneneenert
Cremation Charges «...++re+reeterserue ee eres
Porters esis icant aac
ba Selene enerwrwraer
§diecedd, erdsetOloltters'a.herety vee eee tenes
Music «2s -++++
Church Cabra
ae
sh,
fey Designate all Graven tw Lot)
space for this Funeral. with a cross (+). :
esignate ane for Monument with a small squa si
“Use space to the right of Diagram! for the names meact t
‘with Numbers a, 2,8, 4 ote) ing)
buried] 5
By Amount Paid j in fa avarice
A Lay a 2,3) alt
_ Balance iN Ni “ 2
~
To Faneral Charge, ai. /Total, $ sa
j
pe bane as,
5 .
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