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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
os
Ne LOLY he
». . (Total Number)
, .
Nidke of: Deasel PMR yd Bi ae
. Sae-Danghter ot Ey eRe ene Stemetcgeay Severs Ly eames to. Cass wets
>
“How Secured steeeed
‘Place of Death..
Wite—Widow
Date of Funeral..
Residence ...
Funeral “Services ati
rvice. ahh Time of Funeral
Clergyman ..¢.¢
’ Certifying Physician 1 peo. wie ove wits kt ies
His Residence,...! Mee ewaEe Phe
Number of Burial Cantfcatecsssvier stip sasiaseteles ne
Cause of Death. «2. rifles eas URE apne odie sat oie 2 1
(BAmary 7 Game
Date of Death.. 6.6.8 6) COV eaaia baie» s'bsiaia'a’s
Date of Birth. Ming AES wading evid elie. ah 0-0
es} of ¢ thes 1 fSAe GAPrcacies sss
Single or Married. aaetiig O Athen Ak Ase s
Aged. .82.77.. acaiiel Montissi7 5» dens, Dage.
Date of Birth.. 60s ssseveseeeeeeeeteretebeceteeetergens
Name of Father: «/srilesyaaniatueieh:
His Birthplace 5 wHyelb. any eles Wis og 344 a 0 pele elarait'e eWeia.si pig dd of ie
1 Nase of Motleet st: Secs Cesiav'id yhebeusweducece ns
Hep. Hirthplioy::sies pice iyi ctewse'es evaheny dela os
vs) Mother's Maiden Name. .. 0000.0.. ccpcceeseteeeeveecs
"Body to be shipped Hei 8 ca vee AU SUBIE es ge cscs
‘Size and Style of Casket or Colne sevens tecqeadieh esse
Manufactiired by . pasta caieghrret anaes tae oeeee
a : Lot or Grave No. Hive sh dseise Section ‘No’ Hy Aatie ta
Gadi takin
Designs ahr ito Nanibers (t, 2, 8,4
tk space Stor this Funeral with a cross (+).esignate place for Monument with a emall square ({J). «:
pg Wee space to the right of Diagram for the names of those buried
" £bLE
(4
ne Death Notices i Me iiey ae
‘. Total one of Billets
Address ....
(Where Born)
tee OLY Dedede tht bio)
Price of Casket or Coffin......ss0000ss Metallic Lining 2.0.00.. ce eue eee e eee
(State kind) .
4 Outside Box ......-+ adisepaiew eats
. Grave Vault TRRET EAE RES Fe
Burial Slippers and Hose.,..+.+-5++
Engraving Plater sis’. ecissine ddd ngs
Embalming Body ‘(with.,....04
Shaving ...+++++++ pie Bebe baie ew ealyeyw'e Mavelhied
Disintectiag Rodin’ o2h0s-.02. bee, son
Use of Catafalque and Drapery: .:...3..-006%
* + Folding. Chairs o's: sis sie vic cio device.’ aie
“ Candelabrum and Candles: .......5
Gloves $, 0 oii.. cesses Craps $. o2ytaecc deed ky
Hearse ... sible 's DUip Aw Rearwielde 6 8.9 ie ais!
Carriages to Cemetery.....@ $..055eee
Automobiles to Centetery . 25S : Z oe Erreeins
Wagon Deliveries.. cee vane cena ees
City Calls (Coaches) 4+. Gig Shataiats obslbia,aty
eee eee ry ripe eee eee ee ee
‘(Nemes of: Newspapers) ;
Outlay ‘for LS A iat Gin Lng ee
Lining Grave ..... to ipk ge getheeeinnens ge
Shipping Charges, prepaid: ..
Removal .Charges ....
Cremation Charges ......6esseeeeseeee
Porters itthsnembecerdtgeecte years esas
Paice ees Po
Church Ch hiies
i ee ee arid
r q t
By Amount Paid i in Advance. ... ao
Washing and Dressing.....2%: vised sveipie' hed
Fee ae eT a seen Disktre’s 74 .
Flowers \..4...0000. tf abore sis gf cee te ae mee faeg
Opening Grave or Vault.....ccccsnereese tee {lin
Ron Seat a
V: ault Rettal <...+.,eseees Wile sae eisie-esseeula WROTE
To Funeral Charges. ...:. Total, $
epneon ho hicadseseese ‘. Ootneaa abies
Mag Sanelecl.
tt tne flee
Puke / pom A
RT Gas at hol Pa
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