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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
No. AZ Ae. eee wos
(Tetal-Number)
Name of Deceased.
Wite---Widow
Sons Daughter of }« G4." ee fer
Charge to ... ool
Address
Certifying Physician .
His Residence ... .
Number of Burial Certificate... ia e070: eimie sigh, Hee eBORT i
Cause of Death... naive OAC sont ey ee iste dees}
(Secondary) (Primary)
Date of Death. ALLE -. Lifted. oe ee rene
Occupation of the Dece: “0 we
slsaigle Gaim oleeciealeels sfevae <a
Dae of Fuel. PAR hie Liles atid
eeeceed
Place of Death
Funeral Services at. .
Single or Married
Date of Birth...<*424°773 5
Aged.. AAK. ae
Name of Father..
His Birthplace dl, asa
Name of Mother....<40.4
Her Birthplace ceveeee ee MO. LEE
Body to be shipped to--...+eee,
Interment at .
Lot or Grave No.
teeebeoen '*
oe.
eeeeeeresne
fe eeee
. .
a
R }
Diagram of Lot or Vault
Designate all Graves in Lot with Numbers (1, 2, 3, 4, etc.),
3
a ed
ee a fee airy
Pee es / toeed
eee
a es eeee
Cee
onths, e+.. Days.
eeerecent
“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.
(-)
Price of Casket or Coffin. or" ENR asain ita toute $i].
Metallic Lining ./.... Rate alee tac eat
“ Outside Box .. igus 2 Valeinneis ere vial . eal:
“ Grave Vault seh tguepiacnd FC Rien ts eS
“ Burial Robe ... hanna Sr aers Ssen Hose
“ Burial Slippers and Hose....... E
Engraving Ptate isc ges ee cnsasilete ec ops s7
Embalming Body (with...... ++.e.-Fluid)
Washing and Dressing.......0.eeeeeeees
SHAVING oye ste s wolocare eicerdinte's lanloleserstatecs's?eyerstena E
Keeping Rodyion Ice.. . «ssa edaiveeiielbe 9 hes
Disinfecting Rooms ..... W igtera'eigeg erates Stale $e
Use of Catafalque and Drapery......¢..
Mags) BOlding Chatra toh 0% i500 ad citaele ales cvleenen
“ Candelabrum and Candles......... ioe ea
GIOVES Dive vs's.« anaes CLAPO Si eelevievey «bes
Door Crapé §,..0.000++CanOpy $..c0seeoese
PICAIGG) oy hoa y sh ose Cipeaaned oe be mies Lasublneakts
Carriages to Cemetery...@ eee iiss Se
Automobiles to Cemetery. /.@ $Z Oy echina Be ee :
Wagon Deliveries ...sc.cccccvessescesececs
City Calls { Coaches) :.c% ssl <'ee:sis elsise'elg sige o¢e cis
Death Notices in....Newspapers....
Outlay for otic. .i0.+06s edn siaalsbare: 5! eiwtcia Wes shes :
Opening Grave or Vault......0.0e0000% . . el
Lining Grave ...,.
VELRICOR igs Ullal salelsele sae Sit aie a ataesole ela. Wialwr sinters
Tent or Awning Charges..
Vault’ Rental . i
Shipping: Chari Prepaid ine dsgieseis sees beulees . . ee
Removal Charges .,... eisigieie sos ane ts o A
Cremation Charges .,..... #6 e eie's's ee ¢
Porters $.... eeseee Watchers $... ese
Personal Services ..... due dina‘eene «9'ee eeu ae
MUSIC: Ty's «sae cus Peeseea son's dss bNecile st edghte
Church Charges). osc csces oc chl ipaeee ss cateced
ad
ee ee ee i eee . oe
a ee ee es
Total Footing of Billie ssseerttt cores Mia
By Amount Paid in Advance.....
To Funeral Charges...Total,$ 243),