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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

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‘RECORD OF FUNER
‘No. ; 7-2 wishin ge0
(Total Number)
Name of Deceased.
No AB. 38.
ee ery
ry
Wite—Widow
Son-Daughter of
Order Given by. Mb. Corts. Slike.
How Secured ....f§...
Date of Funeral..
Residence a)
Funeral Services at.. er an
Time of Funeral Service. lh heeft + dlaggieade*
Clergyman ..... [tex Dad, IPAs..
Certifying Physician ...: Orroned. evan, Meat,
His Residence
?
ee ee ey
Number of Burial Certificate...0... pees eeceeeeeceee
—
Cause of Death See ee wee wen wee serene
Date of Death..
; “ Candelabrum and Candles........0++]f.
Date of Birth.. C400.. ccc cece ence esc cececeeteeeeees Gloves $......085 Crape $..... eens
Occupation of the Deceased 3<-..., . Door Crape $...... Canopy $..c.e eee eee oo cccnee .
Sing! M 4 LO, . a li . Le». , Jeane Hearne. isos axeea.s oagihie eps aldiewion 2 care sinas« sewers §
ingle or Married.. A407, eligion. Carriages fo Cemetery.. LX & @$ Cee, es call,
Aged, 9 . Years,.. 2+.. Months,. .2A..Days. . Automobiles to Cemetery ae .@ $0.5.5040. ‘
a Wagon Deliveries .....6-s0eeeeeeeeeeeeees
City-Calls (Coaches)
Nanié: OF Pathetic. < cccows sietiows + a swears 6a maid 6 4 amine ss Death Notices in.. . =. }
His Birthplace ‘00. sescaes vswses oa siestssswinewisths samen’ . . cca evacceedwnwaseec wees aceon dhtiean a; I tess exes veuy [fnmecommre
(Names of Newspapers)
Name of Mother......:ccccsceeccscscceaeeuceaeeucs FIOWETS doc occeccecccccccccuucccuccncvcutebes
Her Birthplace 00.0.0.. cece cece eset ee ceteeeeeeeeeecees Outlay: fr Loti « «saa cys tigues s easacd eas tees
Mother’s Maiden Name......ecceceeceucesevcevcucs Opening Grave or Vault......++sseeeee, meg
eM Lining Grave .....cccee eee e secre rete een eeee
Body to be shipped Co t+ . Vault Rental oo. .ccccccccccccccccccccccccecece
Size and Style of Casket or Coffin.......0ccececeeeee Shipping Charges, prepaid....... 0.00 ee eee ae
TRPRO Radio oe ngnpg oe enna e oeeelee ee HUN ee Melee o vesseees . Removal Charges .......0eseeeeeeeeereees
Cremation ‘Charges: opcirec s cswsw ss eases os vases
Manufactured by ..yoy, srressereeeees ranges spe Porters ..eeceeeceecsecececcceueeees ae me
Interment at.... LAG. eee Cemetery. . Watchers ......0.secceeceeeeees gas She ‘ets Pees
Lot or Grave No
ee eeses ee ee Akal
seeee
Address
“gy wie Pe es
Charge to Lhd. Canrtf. , btn. Sak i
Cheaeo,.0
a,
eect we ees
' t
Price of Casket or Coffin
s Metallic Lining ee ee
“t Outside Box ee ee ry
*(Btate kind)
Grave Vault .....0 cc cece eee ee eee
(State kind)
Burial Robe
“
ee ee a
Burial Slippers and Hose.......Bagravind Plate, oss sa vciewes Premise « saa ee oes
Embalming Body (with...... Cameras 3 Fluid)
Washing and Dressing.......0ceeeeeeeeee
Shaving ....... Aigies ¥ 4 ew igiig 4 Caeerew Ve mete
Keeping Body on Ice......ccceeeeeeeeeeees
Disinfecting Rooms ......0cseeeeeeeeeeeee
Use of Catafalque and Drapery......0.000%
“ Folding Chairs
Personal Services: oi5:0j0. 2 vs-ccia's ossersie vedagiaddas
Music ee ie a re ar as
1. Church Charged je oiiesc esis Yfas evagige oyedees 3
es a oer a7. ee
i ee ee en Jed Pe é re..
4.
neointima . ont asvabie te gnnver tenes asesinaeey vanes + 00g + Hem manus
eS Total Footing of Bill.. .... ccc cece eee eee $]).
Diagram of Lotor Vault. By Amount Paid in Advance.......0ee008
Designate all Graves in Lot with Numbers (1, 2, 8, 4, etc.), and
mark space Stor this Funeral with a cross (+). Balance... 2.2.. cece Dees eee ee eee
esignate aye for Monument bef] a spell equate (&).
Lot uae space to the right of Diagram for the names of those buried Entered into Ledger, page or ‘below. . ! ......
eaten naeceseee To Funeral Charges... Total, $ . le Pon . By Cash.. .... eee eae $
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