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Collection: Original Records > Death Records

Mortuary Records 1914 to 1919 - Book 13 & 14 (310 pages)

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. 54 RECORD O F FUNERAL. No.9.5. aidsase que ereceie . No (Total Number) (Year, Name of Deceased. .UsUY Mm LV, .. ei ry Date..“ 7A id ahs » dle Designate place for Monument with a small square ({). be ke Use space bo the right of Diagram for the names of those buried in Lot. Entered into Ledger, page........0r below. Wite—Widow ee ee ee Se ee ee ee 7?) 4 oe 8 ee ee ee) AP eee ee Son-Daughter of . Adar eae) 5 cssisiss sdisisinn & s seciae'ewasrers Seperceme s scorecard Bs oe Order Given by... cc cece eee e eens eee eee eeeeeeseenees How Sectived’.s « csiesag ss iwhdies sa aaaas s saws 6 caanwiow ss see Price of Casket or Coffin.... Gas ostateigie & emE $ hD. ae his Metallic Lining ......--0eeeee eee Date of Funeral. . Ke A pee: Nei (State kind) so “Residence Gureat. bal Outside Box ... wusrhces emesis rFiede sssosaanstnntvell saclunscap “« — G Vattlt: oes sicciscnie 5 slaeidees wesicien s saendsnscasseis niin Place of Death.....£..$ rave vai ‘buble Funeral Services at. “ Burial Robe ... diets Hae Cistoceumews ceeeee seceeanene ttre of Funeral Service, ;.2. Td A Burial Slippers and Hose.....++--Engraving Plate ....s.eeeeeeeeeeeeeeee eens srassarasnnal ariocone Clergyman ..< Embalming Body (with...... usecesies . oe Certifying Physician . Washing and Dressing..... somone & earaeme # 6 eee (sees Tlis Residence :.. . a ee wetos Shaving Steed eee nese een e rece eeeewn rece arenes ensd is, on . . Keeping Body on Ice.....2ee eens cere eeeee Number of Burial Certificate..... “o FE wcececaress expgpueceiad Disinfecting Rooms ....e+esseeeeeeeeeeeees f M. ead tu. .. . Use of Catafalque and Drapery seins Secondary] Bolding Chaits 3.0000. ssccccsecscscscces I elec a See fe Seleisiele SS Geiss “ Candelabrum and Candles. 2.20.66 0 60 e eee eTocs cseenennee. see nse Date of Birth. ..... cece cece age eet e eee e eens faved ORs Gloves $....seeeee0s Crape $:...000 ce eeee Seen po ee Occupation of the Deceased. ZA~G/ rif).. Door Crape $.....-.Canopy $.. eee eens ne es, ‘ , : 3 4, y Dh, Ve OAPI aiid sc asiare saab 46 Biaueieiere & erareuens » & wieipiere Single or Married 7A AEE.. Religion.¢y~ Raringts to Cemetery. ...65-@ $isceeeeeeeeee tse serseenene . aseeeeeeAged. a SL.. . Years,....0.. Months,..... Days. Automobiles to Cemetery nee ome @ $. ee cccccecee’ Date of Birth. .....cc0cccccseceecceeeeeeueeutsecees Wagon Deliveries ...+.++++ settee eee eenes vow et] QD City Calls (Coaches)....cceeeeee eee eeeeees sasatssabcesois . lenazeal Name of Father.....c.cceceecccee eee eeceeeneceeens Death Notices in..... Newspapers..... _. re ay Fis: BUCH Pl Ace: erege wale’ caidas oe ascineed oFietegit Vaswedhee . 2. coaiedd debswddeer ‘ndbeine edlspaeenseaacel sew Zee veel sees] snsaoceneee Name of Mother.. ..... ccc cece cece eee een ceeeveees Hlowers sci Livcoie « « wrists o's n crete de editors 0 wierwree » a ae . Her Birthplace 0.0.0.0.. cc cece cee cece cece eee enee eens Outlay for Lot pao (ee Mother’s Maiden Name........+. Peer rer tree Opening Grave or Vault....+ + sees sees ee ees [mm 3 ao : . Tirttay Grave’ vieieicce cieieiece es vreuvic’s od visetiere eanreen ccdbewuies Body to be shipped to Lie pe haktiece bE pibiwan & ¥ alhinindl » ois Mihi Bide 6 9% Vault Rental ..cc.ccccceeceeceeeeesceeee tet Weceme. ccc . Size and Style of Casket or Coffin. ..... ccc cece ween Shipping Charges, prepaid... 6 a6 Avie 6 BaIwOwS a eesssececaceanee . arhial pia eiaraa.s & aA aS Bac & USamTRdE AB RwIB Us HOS FERRE TAS Removal Charges ..-..se seers cree ee en aee tee [oman . mmenmn . Cremation Charges. aisisissi ssceis s edisees og waienees baw sci pices Manufactured by Porters ij aissizeie s waicsiays i 6 siawieie.e samen ss waisieus ¥e sciatica apes Interment at.. f : . Watchers 20.0.. cece cece cece cece ede ceneeneeeee aoeaeSmene . iia Lot or Grave No..... N oigiewa Section No.2.. ..eeeeeee Personal Services . nessa vincane s petueensesee. l ate (OD Misic i sawcas § dauwis caceaaies spisietsia ob senaidie 0 anand ‘a 1. Church Charges .....ceeeeeeceeeceeeeeeeees ceed 2. a 3. ee) _ — 4. Ce aaa ~ ‘. sects: . saphigees *. Total Footing of Bill....c..seceeeeseeei$ ae: 29 Disarain of Later Vault. ; By Amount Paid in Advance... oe vwscee vewest sesso Nacsa _ Designate all Graves in Lot with Numbers (1, 2, 8, 4, etc.), and 4 mark space for this Funeral with a cross (+). Balance... & amet th aeawiaed FEC, . eae, (NN 7 I> S sea Adee. 11.t0 inerat Charges. ..Tota, § —27.\d2. G&. By Cash. .Qeqaad. Ldl..$ . . 254M. nan WANE > he — wn la allt cn . a ln la al