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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

ae fo viyeiane ‘eee wa
No. ISG.. hy a bias
cresapdegenesteCeaudit
(Total Number)
Name of Deceased.
(Where Born)
arte, Oh, sec clsnena ened é
mainte
Race)
Wife—Widow _
Bon-Daughter of
PrOrrrer err errr ree ee ee eee
Charge to . Nez
eee eee
Address
‘Order Given GPa ccciia'snsunas viernes yaitunte sen in 6 Swielere
How Secured ....
wee Seco
eee reser seeearesseeoessaseorescseeeese
Price of Casket e Coffin..
Metallic Lining
Date of Funeral.
«
Residence ..
cc ccc cee eee eeeeeee $
Outside Box
“Grave Vault i a ee
“
Funeral Services at..
Time of Funeral Service. .
Clergyman Met.
ee
Burial Robe
Burial Slippers and Hose. seeeergeeeeee dl:
Engraving Plate weer eer eee
e ew eeeeeeerersseree
ELLE.. Bidiogewns Embalming Body <(with..:+. 4 igcderredegFluid)
Ja
++reee++ Rei + st
Certifying Physician. ...!ASA UA.....Je 6 8 slags Washing and Dressing..,.-.+++
Shaving
His Residence ..... WS. Ghee sein oMtacetere
+5
8 Batwiainnd
on Ice....+++++ wSuie's
Keeping Body
Number of Burial Certificate. seen eeneceeeenees swing « shlowens
Cause of Death. .....c cece eee ny cece ee ce crete eseaeees
Date of Death..
es
Disinfecting Rooms’ ee
Use of Catafalque and.Drapery....--+-++++++
Date of Birth bee & odieSlaig
Peace9 Rafigion....++-++++++
Yearsy. cicgeve cee Months,....-+ Days.
Single or Married. wisleiore «
9 sracorecwig’s s-ncpcereie « 5 SleisTb ES S16
3 4 8 Bisnre
Date of Birth... Bie
Hearse ..ccccccccecessecegeeeeenceceeereceees
Carriages to Cemétery.....
Automobiles to Cemetery... @ $. «. wieewnes hes
Wagon Deliveries
City Calls (Coaches) bp. reyesere: 9 wen wsniie e 9 9 Bivisis 6H .
ass
cancetye weaed¥s
sie
ae cicseiee
Name of Father: osc osccec
sense
His Birthplace .0..¢-cceseccccvevnccedenaseeeneebe
Death Notices in...0.. Newspapers....+a
sy eT enatasies
Name of Mother. .....0+eeeeeeeeeeeees oy gaisicas
BIOWELS 1.. Se Te eos wae eo eeisidinrs aeiaered opeees
Outlay for Lot.
eens eeeteenes
eee ee cece ceceeeeee
Her Birthplace ....ccc
Mother’s Maiden Name......s:eeeeeeeeeeeeeee aia§
Body to be shipped to..... pee
Size and Style of Casket or Coffin..¢74%
——~
= oF
Candelabrum and Candles......2. 0000s hae
WISRIRHe oS sind lhe © srerarerasere esiewenle sel
..
eeeees
00 se eeeee deren
Occupation. of the Deceased..
Aged.ns A
“ Folding Chairs
[Secondary]
mary)
SORE. Yue. Fennou Co xno
Opening Grave or Vault
Lining Grave errr ee ee ee
er
Vault Rental 2.0.0.2..
ccc eee eee eee eee ene
Shipping. Charges, prepaid....e.eee eevee ees
Removal Charges
Cremation Charges
Wiel Sie phe + oo doeceibia goidbisig d EaRRe POrters © 5s sinsinie os sisieie o's 6 wialeretg se cuseieie no oe 00g wee
Manufactured by: sieescee cio
ooo eee. Cemetery. Watchers
Interment at....+++ ABMS,
ection No.3...2526 i
Lot or Grave No. ...0606.
4
nee teees
cere e een e0ee
Personal Services ....-.
ee ee ee
Music ee ee
2
3.
ee
4.
ee
ee
ee
eo
6.
6.
Total Footing
of Bill. .....s..ee
eee seves $llies
By Amount Paid in Advance er
Diagram otLot or Vault.
. Designate all Graves in Lot with Numbers a, 2, 8, 4, ete.), and
che this Funeral with a cross (+).
mark space
esignate place for Monument with a small square (
the right of Diagram for the names of t ee buried
Use apaes
To Funeral Charges... Total, $
02h
Names. of Pall Bearers.. sea 44 q ermine ose wcuracma ane Rin 84 B08 .
Balancesis ¢ sssiasis sose¥ess ween webs
Entered into Ledger, page.+...+.-. ..or below. . !
_ By Cash, Aeorenactd>..$