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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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9.0 REE OF FUNERAL.
“No. G7 re ‘te be smesee aes
(Tot 73.. ‘Yearly Number)
Name of eee ee baie ate SSwiargie o's Tieaisiers cadets
ee
Wife—Widow _
Son-Daughter of
eee wee eene
ee ee
How Secured .... cece ees e cece ee eget ee en een eeseeeces Price of eur rp 2 CBeeigied 20.00eie sees # $
Date of Funeral. Liter. fMA ae NS whe Demiein as Veer’ © seat mele ‘Watatekiaay
* Residence
f Outside Box .ccceesee cee cceeceececes
re he i) delay Daal eee eee eser ere ereeeeee eee : G Vault . tate. kind)
; atlt cece eee e cece ects eee eeree
Place of Death.. 4 EE . , aTAVE as ioe
Funeral Services at. “ Burial Robe ...--+++++ ce eeeeeeeeees
Time of Funeral Service. Burial Stippers and Hose. sere ee a
oo Engraving Plate -...:. Sb SEU asaerode bacwiare ¢
-Clergyman . Ay Embalming Body (with....see+ereees -Fluid)
Certifying Physician’ Lor, Washing and Dressing Ss eebceas we bdescencceeees .
Tis Residence ...:. , 1 Shaving err ee ee
Rael Keeping Body on rice bb dda tied deiccete oe cemosseae i
‘Numbet of Burial C ounce. Lwivvanes po eer qeeeeesgzs++ [Disinfecting Rooms ....++ er a ee, .
Cause of Deathé have, LOG, pe eeenee . . Use of Catafalque and Drapery....-.++:-e2ee° ees
* 2 B veri rigars) Secondary] “ Folding Chairs .....eeeteeeeeeeeeeees.
ate ot -Desitle, ss SLL baseneniths Candelabrum and-Candles:...0.s2252++-ef}Date of pirth. .. 0? Aoiresiee » J IIG cas gecercevesesriens Gloves $...-siewae ds Crape $....0eeee+s
’ Occupation of the Deceased.. 22.. .eeeeeeeeeegeerceyge es ee Crape $...-.-++++ Canopy $.-..--++++++
: F CATSE cece cece cece ceeeeee centre escsenseeneee
Single or Married. ; . Religion A, Cad Carriages to Cemetery..JZ. -@ $.6%. ais sinze
Aged.. af. . Years,...0---+ Months,..... “Days. Automobiles, to Cemetery... @ $..28 0+
© Date of Birth.. 2.. 22. eee ee ee eee ee (isos » be Wagon Deliveries ... Ce ian . ieee
; City Calls (Coaches)...-sseseeeeeeeeeerceces
Name of Father... 0.0.. -c cece ccc ee cee ene eeeeeeeenes Tsegit= Neskete in: s desixc': Newspapers. s.<2::
His Birthplace 2.2.2.2.. 0 eee e eee e eee eect een eeeeee noes cali dou de: vee toen iokdunpeterouannedemners
Nant of Motlver..sssccds snot j idadide sbeeereerenee fibeirite, eclectic iere enthidivecdae sia
Her Birthplace ....-.-+esse ee ee ee Phin bressieseieiped eid diack Outlay for Lot....-. ees eee cece erro erences
Mother’s Maiden Name...--.ssee cence eceeeneneeeeees ny arene, Sate or Vault....+--nie reisibiare 9 S]siele: is
Body to be shipped to.. 2.. cece e eee eee eee cence ee eees Vardlé Reiital cobs. 2% veweee sok waists wearin
Size and Style of Casket or Coffin. ....eeseeeeeeeeeeers Shipping Charges, prepaid...-.---+e+++eeeees
cece c ces cec usecase cece ceene ences estate seen nesenseneeeees Removal Charges ..++++++++eeeeesreeseressesee tle
Manufactured by ...--.ypeess ‘ — Charges .... scl aaobacaa mene
Interment at. . ar Ll ; . . Watchers ....---"Sa Bian sc 2 wail cunieieenres 9 engine
Lot or Grave No....eee sees Personal Services ....sis Caeewene
1.
2.
3.
4.
6."
6.
1
Diagram of Lot or Vault.
Designate all Graves in Lot with Numbers (1, 2, 8, 4, ete.), and
mark space for this Funeral with a cross (+).
esignate ogee for Monument with a smalt square (9).
i wae space to the right of Diagram for the names of © buried
in *
To Funeral Charges. .¢.Total, $