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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
" Clergyman ../
RECORD O F FUNERAL.
No. £22..
(Total ‘heimsiven)
Cueto. ME NPS
Ye x foots )
Name of i ate Brac wi pena seen tt. eieieee® Gaile ls 8 keel..
Wife—Widow
Order Given by bhi Dh
How Secured ...,. ccc cece ec ecAccccccecceccecueceecs
Date of Funeral. Cakes $ ns eee
Baeza Residence .<&
Place of Death.
Funeral: Services at...%. [Ze ae 4.5% waalges
Time of Funeral Service. .. Aha.
Cie ~ Sy oe ee eee © S. eee ey
Certifying Physician i bead
His Residence ...
Number of Burial Certificate,
Cause of Death.... 00.. cece ce ey ce cee ee ee seen cnstesens
(Primary) [Secondary]
Date of Death... ER he. MEE AT daxmee
Date of Birth... A¢ e442 Pre 4 Pinicd i tern
Single or Married.. wewFTe eee eis Religion.. 27777....
Aged.....5 Years,.-. pits . Months, .ce2: /. . -Days.
His Birthplace .
Name of Mother. :
Her’ Bisthiplice: gigas « s sawed si olinpew'ea sags a 430
Mother’s: Maisee > emailing:
see eeene
rs
Manufactured by ....
Interment de id,
(Where Born)
RAGES soi5:s disease, doweeid oa vwreincesem che olpeesieis eo eiies es A
Price of Casket or Coffin. ..csscccsceceseeee: $. . a GY.
Metallic Lining Pa sacincvecsiececsdeowes fle . cosceosee
$f Outside Box
“ Grave Vault .
(State kind)
” Burial Robe 2.0.5.5 i sec cece cee seeeeee
Burial Slippers and Hose.......Engraving 1: ee
Embalining Body (with
Washing and Dressing. ...:.:.:.0sesesseeeee eee
Shaving .....;005 ¢ :
Keeping Body on les ere be aaeate) a ieiewary oye wate ov a
Disinfecting Rooms ......:.ceeseeeeceeeee
Use of Catafalque and Drapery
“. Folding Chairs ..... 00.. cece eeeeeeee
“ Candelabrum and Candles ,
Gloves’ $.....00000%
Door Crape $
Hearse 2.0.. ccc cece ese eee eee e eee e ee ceeeees ene
Carriages to Cemetery.....
Automobiles to Cemetery
Wagon Deliveries ......0.0000 08 re teiaceie 08 <oell
City: Galls: (Coaches) :. 0. ois: sci seesis ss palswees sas :
Death Notices in.....
Flowers
Outlay for Lot...... "hve 6 6's alslone" age Snvwlexd a 4 aus '
Opening Grave or Vault
Lining Grave ....... Dane e eee ee eee tenedes M
Vault Rental ..... ccc cece cece cece tence ees
Shipping: Charges, prepaid:
Removal Charges .......0cc cece cece ese eee
Cremation Charges .......00008 2 Baie Hse &
Lot or Grave No....54%.. stcasanantotase . slated
paring ARES;
2
seeeceeee saves. tee iH
9 . . Meg fe nena tiS . Er)
4. or oss
E
. : Total Footing of Bill.......0.ceceeeces $ Lh. Q.2°
Diagram of Lot or Vault. By Amount Paid in Advance......0cece0eee ssworeoresessivg . asec is
Designate all Graves in Lot with Numbers (1, 2, 8, 4, ete.), and rn ' q°
mark space for this Funeral with a cross (+). Balance sia os isciss ssaswieces ceatece. kee nissay
Designate place for Monument with a small square (9).
Ps Use space to the right of Diagram for the names of those buried
ee See
7 7
Cppac. ws To Funeral Charges. ...Total; $ cA LY