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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
3
T=
Se Dewabice of bd
Charge to ..
Address
HOw: SECURED 1x ccoaiece hep on gisth = ies wlohe o wrejb Sia Wes aelesioresecatl
ee ad
Date of Funeral..
Residence . eeeeeerene
Place of Death.
Funeral Services at. Peewee eee eset Maen ee eeseseeeeeeere
——
Time of Funeral Service...c.eseeeeeeeess eeeeerese sel
Certifying Physician
His Residence .. Qe:
Number of Burial Certificat
Cause of Death...
eer eseccevccsceccccesel
epee ee eee reser easnseeeses
We Craccccccsessecccccccccsl
CCOASEH. cere eecweveesesstessseresers,
Date of Death..,
Occupation of the
Single or Married..<7..-Religion .c vi veeseeeeeeees
Date of Birth. .....cccccceccccvncsscccsccccsescoscs
er Or ce
Name of Mother. .
Her Birthplace .. ? 456
Body to be shipped to-+...eseeeeceeccccccccreceessees!
Size and Style of Casket or Coffin. ...e.seeeeeeeeeeeeees
oe Saje.v 4 Wei¥ivis oi welcome eura.s
Pee eee eee rere reereeesenseseseeseseeere
ear e Bree OM Oe eye OER RR Ey : ;
indalncas tase LA. Cot NO
Lot or Grave No. .46.2-.. Section NO. ...scccees
1.
2.
3.
4.
5.
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 s (i)
Use space to the right of Diagram for the names of those
buried in Lot.
Metallie Lining 2.2.. 0 ccc ereweeyse st
Gtate kind)
“Outside Box PO Depts Tae Mie Map.
(State kind)
Grave Vault 2.0. suasess ses eovases not
« ~ Burial Wistar On nth alk oie
“ Burial Slippers and Hose.......
Engraving Plate ssi.. ho0ce ss tede since eeu ae
Embalming Body (with.........Fluid)
Washing and Dressing....+.-seeeeeeeeeee
Shaving sence d cies
Keeping Body on lees. 6 occnsciceciddtcdece sss s's
Disinfecting ROOMS) 5 p5s/o0¢ Veit. 0 de woes oe 5
Use of Catafalque and Drapery.....+.++--“ Folding Chairs
“
een e eee ee
Candelabrum and Candles.........]].
GlOVES Gon vi ss'c cece ces Crap€ Gino's ccisecipe cscs
Door Crape §. <0).. <0:06'e+. CANOPY, $. osie oso cies ll,
FROATOG. atic sce 0:39: 450 8'4 och ein'n <lpelb mele eluiig tiissiietes
Carriages to Cemetery...@ $..sseceececes
Automobiles to Cemetery..@ $..eseeeeeees
Wagon Deliveries ...csesesceceeecreervenes
City Calls (Coaches)...sseessscsseccceccess
Death Notices in....Newspapers....
Pee Ree OO TSHH OHO SHE HEHEHE HEHEHE HEHEHE EROS
(Names of Newspapers)»
BIGWets Go aicaisleetiaeuseewies pels slatelsalernioldctleqicers
Oittlaystor UG sees. a clens.ssie psiseped orrisine punts
Opening Grave or Vault......0.0eeeseeees
TIMING COPANO oa. c corse ay's'es folve seston cemetiie ts
EV VOCOTOOD Cece o-6 sicigretis.ssicas's « siviciemisinigh'saeiee waists
Tent or Awning Charges......2eeeeeeees
Waste) Ramtabhe <5 ok 5 caused cote oder cuea ee
Shipping Charges, prepaid.....6.0.0000000 1].
Removal Charges :. oii -0i0: eer. otsveipreise 6.010 0 -ererete
Cremamon CHarg6s <cccicsic:s cscs ccs ocisiniss aes
POLters D. vise veneue = » VWVAECHETS (Qos en gees ests . . .
Personal Services ...sessseceeceecceceseess. [un
Musi .suiines «3 Sinise elgivie'es Uisle d'vininad Sinise alone g sill
Church Charges cy o.s:s lane o's 0 piste ails wip inte args sates
eee eee eee ee ee ee
ee ay
Total Footing of Bille) cescdsae ees
By Amount Paid in Advances sages Coss shee ae
Balance ie. cece cece ol seceacelt
Entered into Ledger, page.......or below ‘
Price of Casket or Coffttis..crarereeessaee98 Aba VA Q). r
sas eeewes
et
ssaveesenee
xf
bea
To Funeral Charges...Total,$ LE Y/ ae AAA. By Ce ccshs Lies. 1tt BO
V