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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
Funeral Services ne a kes Giste'g date alee
i Her: Birthplace iyi si icie feed. d go ceeds Genie oie GeV uae
< Mother's’ Maiden Names ii see sey Sebald Seg ee oe
Ie pt ae “Noi LID coco
(Total Number)
(Yearly Number)‘Name of Deceased. felon Li fn. Ge ps os VA Fe:
Wite—Widow
Son-Danughter of
Sede eee eS secede eG eee ewes cece eeeeecscecsteeveces Charge tO v...eees
ee rs
(What Race).
oa es
Address. ..... bie tin ovinais Gad lety Coens gd Sea
How Secured ¥ 0 SH Pay oe Pe ye ya 'ew Geis eieth gece 0.4 6 SuieE Rye seh e
Date of Funeral.. s Add
Place'Gt Degthi.. 0 eich (oi ein on Pana were Bioko o oisk bs ccavebe
Time of Funeral Se buds note
Certifying Physician Bea. L 3
His Residence sng CAL DT He oo oe aati de inistes 4
Number of Burial Coctificate: cvs kh oer ee ee
ae ey ii gum
(P; iy ondary)
Date of Death...
Date of Birth...-:.Z. cay oa wa ies
Occupation of the ae dee SURE oak
Single or Married. Laer Religion. Kid bec
Aged.. 29.. Years,...... Months,..... Davy
Date of Warp: asc. a
Name of Father, .cis anjeathans boty
His. Birthplace. ..0.0.656.600% eic'yG dec ta wee sepneeessy es
Name of Moths. co. soggetren, die
SNe 88 tiple ee gw ew)
ee ry
~ Body to be shipped POSER SELES Ee ence tte eee anes
Size and sh of Casket or # Cotas j
. Manufactured Dy isd. s hbase dc Gucds gees cs
“Interment ate.s. ‘Lh a tec _ Cemetery
~ Lotor Grave Nov. -+y +034 4004 Section nor arta a
Seed ee ved en seetenes
<> Designate all ot with Numbers 8
ena All Graves ts Loe wih Ne ). ‘ x
esignate place for Monument with a small equare (f}).
‘Use ng ‘the esi of agian for the names of those buried
=
Price of Casket or Coffin.....ccsesuesee$
“ Metallic Lining ..... 0.00 e eee
(State kind)
“ Outside Box ......55. sjarenerh sleie ws
(Btate kind) .
sr Grave Vault ....... avgigtidlesede 0
« Burial Robe ..5.5.... ree ete
(Whe
ee ee ee ee roe it
“Burial Slippers and Hose..,....+5
Engraving Plate ......eeceeeeee wih eeip lateree [ooereier
Embalming Body (with....1.... ,.+Fluid)
Washing and Dressing.... $die 8 Ba gdreneuaae»
Shaving ...seseseeeKeeping Body on Ice.... sins
Disinfecting Rooms ..%...
ee acy
Use of Catafalque and Drapery...:....5
“Folding Chairs .....
“
ec is
Gloves $....0.00006 Crape $.c.c00s
Door Crape $......5 CHORE Pent nie
Alearse ..... 29 vores vasbielie « s¢aleamie's dis 66 Seo aes
Carriages to Cemetcry.... ior $.
Automobiles to Cemetery...@ $... einesreyed ve
Wagon Deliveries ......
City Calls (Coaches)....ccccccceeveeves waves
Death Notices i in.. .... Newspapers.
"isames' of Newspapers)
Flowers ....... iene
Outlay for Lot...4..
Opening Grave or Vault.. tteeeeeebeseaneae en . .
Vault Rental 2.0.. ..ce cece es
Shipping Charges, prepaid......c00.esee 0%
Removal Charges ......0.0005 Paeciey SWasines
ee ee ry
Candelabrum and Candles.... ig'pre oid eet ose Phos
ee ey Oe . ore
ee ae . ree
creas . ee
Cremation Charges .......5. pe
Porters . s05 gaya veinlse boris vais the cath-sgin taints
Watchers’ Pete e detec eee eee tee game b ees ee ele
To Funer4l Charges. “i :Vs Total, $ AZAL2.
alendedadet . pedtoseates ableesbedine Katite,
eeeeeen eeeeeees te os
seteseennes maven
,
mwotnes seteononeet: . cpeneasene . setenstnsen seeeeewee, sebeeeeeaes ceeeneneee
es oe iabeeseeeen ceespets cnebsaesnaas teenees secre teestrves Senne: teense caeeees,
‘ A
saneneweee: seveasnnnne . cctnsue exarsneee:. soednnses
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aoe teeaeooee
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Seanad seewee: srretnaetion snag conresreie . ieests sepneonen [teminnerees DE cceen cessceenes [oveseseenee . oveese
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