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Collection: Original Records > Death Records
Mortuary Records 1917 to 1920 - Book 15 & 16 (308 pages)
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Page: of 308
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RECORD OF FUNERAL.
eee, ae Neyo + Date.. Brgdererde BiG ereres19at ee .
(Total Number) . (Yearly Number) is ‘%
Name of Deceased... Gh -fra-at? * SURGE ts Sa meme a hirkies MIS Ke pedheagsincces re. oboe hcinades Li
(What Race) wheres +a
ee ridaeedserecen sree canton cee PUR Dek wat Sars k .+.sOrder Given by..++ case case pawn a seces soem ae Verner =
Charge to aT eee Bie ais Selcetat Cankin ot Gillin. .ccasujess mae Leal Ae
Address ..-NA ogi ac scree eet tence ene nneeeeneee © — Metallic Liming ..+.e cess eee e renee et [Poccsseenmeecesee cremneree
How Secured ...+++-+0: thi ecanaabn nFenatbhnes +28 * Outside Box ss oe i I Seren” x.lee.
Date of Funeral.. Chron.» 2.4% PIER Ss oon a “ Mais Muaie Sit cte eh as ieee dey wens cee
Residence ...+++DAEs leat ch oye +s cial da aea teats ims “Bari (tate kind)
urial Robe ...seee cece tener erereee
Place of Death... FTA La Gowdagn’s sisica vinnie 2 Seas “ Burial Slippers and Hose...+++++++ in:
Funeral Services at. ees! ,. Thatkbhnw ss _. . Engraving Plate ...+++++ Tere ks ;
Time of Funeral tee, aan Fy, eer ey one ees ae ca a -Fluid) . . can Papal
Clergyman ..+svsas¢ EE la he es a hid. © AneBeetdig i coe exact vis Meh ensiood ii . e ah
Certifying Physician Diy Soe es Os ath, seceeeeceres Keeping Body on Ice...-++++ spb species wie Pre . ea
His Residence ..++++ Seis OB av ye v cnlba vate ts og oun $e . . Disinfecting Rooms ..+.+++++++ beteeneeee ees ses
; ‘ Use of Catafalque and Drapery..-.++++++++++
Number of Burial Certificate. ..,.seeneetapegecessinane es ee CATED ous vives sane ipr'tag ober ee
Cause of Death. A ha sor eo ok ; waere “ Candelabrum and Candlés... drole Wistealy ree ete
¢
Date of Death. ier A. we? Gloves $. cess «se0ee0. Crape$ eel heat chars wie Lett
Door Crape $...+++++--Canopy $..+Sonne fe
Seurpation af he ceased.. «Decanter soon ered catia, wiles dann tag eree ye eoas esa eh ee Peppes pel 2
Single or Married. 394 i Religion . oe ilastss Carriages to Cemetery..-@ $.rcceeeccceeee
Date of Birth...-+.-s+++ tia og sta wrath omnia re aie aie ea a nereiginielp Wagan Dante ere i
Wagon Deliveries ..-sdodevcecerecsgescovees
Aged.. Ad.. Years,..4.+++ Months,. 47..++-Days. City Calls (Coaches). ee .
Name of Father.. ace. Adeawarerrti cere eee eens Death Notices in...-~ Newapapetticosess+
His Birthplace ..++.disceseeceeseesMecneceeesenseters reaaupsaenacerseardeemele sabi hers tess ert
Name of Mother.i.setsesccccessceeteseeeees 2a . Flowers .ccecceeseseeeeereeeeeee pele ce res
7 (Maiden Name) Outlay for Lot..--are eee a a ivalal ed nigis6 <%e elerajsvs.e-«
Her Birthplace ..+eeeeseereeceeteseercereccsesscers Opening Grave or Vault...ccsesereseseersers
Body to be shipped to-+..-sseresereezerrregerreee® wees . Lining Grave .seeeeerereeeres Jp RAR ce :
Size and Style of Casket or By May . EY per ML. Evergreen ..-eeeereeeeeeceeeees a iGas ds aeons mes
Tent or Awning Ghaiaeey aes «ash eb des
: Silvie <9 sisseite eine nara ; aie Naat s+ . Vault Rental ...sceeeeeeeeeereeeeees Pe . e
Manufa tured B. Seolics Lucwev at. POU, ic wee Bie Shipping Charges, prepaid...+++:e+se+ese+ Apa .
Interment at . D earvteses AAI oo fate calc Cemetery. Removal Charges .--+++ eapecs wave es simsce'ns® es
G N Section N Cremation Charges ..+++e++eeeeees wikieas aes
Lot or Grave NO..seeeeeeees ection NO..-+++9++ ee ee nee Watsiiens Bo .cnecoeceees
Ls Personal Services .+--s++eeees veceieveusle eernaletears
4 2, Music ....+po vs orsdiate’s odie se Gore e gigolo #9.
: uel Al 3. Church Charges ...-Ao dat eaten e Sale ak Pe TP
if 7 ee ee . conocer he wigs "en tgs teats peepee eReR ESE?
: 5. see e nec e es vecccceserecereeosemeseecererere
&. Total Footing of Bill... pa eos canes emilate
Diagram of Lot or Vault
Designate all Graves in Lot with Numbers (1, 2, 3, 4, etc.),
and mark space for this Funeral with a cross (+).
Designate place for Monument with a small square ()
Use space to the right of Diagram for the names of those
buried in Lot.
By Amount Paid in Advalies.:s+y<evevenserts
Balance’ :..s.eeeceeeereerese
Entered into Ledger, page......-or below]...
_. To Funeral Charges..-Total, ¢
By Cash . eee ee ee Sire Berd Po