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Collection: Original Records > Death Records
Mortuary Records 1919 to 1926 - Book 17 & 18 (287 pages)

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Page: of 287

me AN
RECORD OF sp ey
Dnt NOs et wef 14 ie
_ Name of Deceased.
‘as drag
Charge. to RNC tahins Mee tee a oR dene es teteee Pe tesin Si ci Gain © Rh
Address Vib @o Ware's Salelels Aaateree 1 ak MERE a Sb ae Teraiouole Grelniels “« Metallic Lining = ee ain waa biee tow
. How Secured ......4. L8G ! “Outside Box .. Lee Uesiaee Siveeie sill . acedeae
_ Date of Patera. $56 oe “Grave Vault ... Seapine ae. : F
PREBIGENCE 703 adibise Ss vce e visi ais oe wen vise = abide © Baa Relies i ee oe MP
Place, of felt. -a_/ “ Burial Slippers and Hose: SaBieA viele ace a op
» Funeral Services at. VIA KS, Pelt a deny Sera vie UR IORE ADED bali. beedadelew kena s
Erase Me aca iM YOAY tter. eb, ec Embalming Body (with ee ee eee Fluid)
Be Cay) : Washing and Dressing... oN, Olialecaiact-ace bie sinuses
_ . Clergyman .. ex : SRAVIGE ss s.o5sibie. vies oR ewe i a s'Uninitre s Shipitivre:’ od
Certifying ene YM. Keeping Body on Ice..... as dfoipsalelaie ee a's dieislot
iis Reaidcdce =a Disinfecting Rooms ...... Bs TLS St, eet
Use of Catafalque and Drapery. Seiclaevets get hate
Number of Burial hacen claliaatees ogaSe cee ese ES en late Chale 11 iaG othe teiltes nit «.
Cause of Death s.c5.5..005.% tts eee Sew esis css a eM ; “ Candelabrum and Candles......cc00.
) ‘
ay ‘ . Gloves: $2s). 52). satis Crape $5.58 ioc Utratarsis Nat
Date of Death.. Peis lef if “899! . Door Crape*$....+..Canopy Piel. tees ae
Accupation of the Te ca aso ee PLOALSE. 5. 'ay0°%-sieole Rese eR ct re eens’ Oe aie oes
_ Single or. Marrie ABAS igi AMAA Z,. . Carriages to Cemetery... ‘ yee ee
g. Automobiles to Cemetery. ae fs Rigsti sd Dita ett
Date of Birth... ms isis sis
B°. ¢ Wagon Deliveries .... Speeeie, wcsieieicleie peice eas
Aged... Ae. Years,...%4 Months,.. 4 “#.Days. . City Calls Sena ig RA scot ae! aioe HAL roe ples
Name of Father. . MN).. BTN fo ueseceesees . Death Notices in. .Newspapers....
‘His Birthplace Fel OLENA mip tees tualbal «canta . sete. ile alge Sree ee
Name, Of Mothers.. acest 6.5. 4eececes sigiais waed w'chl. LIOWOR S'S. doi0h can Umea aeuee dad Reis 5s Seel ee eneute
a% %. (Maiden Name) OGtlay tot Lots sc. es panes aus sisi elders as 0s'os tie
“Her Birthplace ....40..64. Heir WN. Silas taew ea twmee ces Opening Grave or Vault.....2.++Sues ote
RS Bédy to be shipped to--...-.0.sssscecssccesccceseesi Wining Grave (5 4s.y see sie seus sis o's cles ois Desire se
Size and Style of Casket or Coffin......cscecseseesee: . RVETETEED co secceseeeseseses Piplgmne gti piats Viereisiale
: Tent or Awning Charges.......04weetee
. Ne AS ee eer ee eeeee eeeoereeeeee DEES 2S SS S0 9 ie eet Vault Rental et MON curate sa AWTe cea wakes me.
‘Manufactured by,..,. ah 0i8 sie ¢ = o\ecm # eipine ole Seeciiee sense ++ . Shipping Charges, prepaid......cce.ecees
Interment at Weil Miiiiz Seep s eisiece oe Cemetery. . Removal Charges .........
Cremation: CHATZES «de gecsieh vee as oond oleh es Lot or Grave No....... Ms ection NO. ..c.d.a0006 Poriere §.. 3. wit. fs Widkehvess &
: Persortal’ Services: fous scralichsstatees cecal’
: 2. Music
‘ > ee ee ire
Dain ita ear e A, LR ere ee eget tk caibed,
ceeut. ll . &:
Diagram of Lot or Vault
4 Designate all Graves in Lot with Numbers (1, 2, 3, 4, ete.),
and mark space for this Funeral with a cross (+).
ay Designate place for Monument with a small square (im)
Use space to the right of Diagram for the names of those
: Lye Re To Funeral Charges... Total, $ a GOL 4 By*Cashe) 4.) 5, seesaw cst $):. ZN
7 UP Moe #s sf
es
me.. 4
“4 4
ftasoth
ames of Pall Bearers..., Bieme Woridie a A