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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
RECORD OF FUNERAL.
No. Jf1On.-80e : No
* (Total-Number) ‘4, '
Name of Deceasea LAliz..U ot Shy Lbs Lk winks COS
(What Re¢e) 4A WhereBorn) .
ee ces foe Fv eding 5 vl oa Whe saisae nalts ns duke Byaratag ets y's Order Given by Iex. 5 Qet he. Le antacnkd
Charge to Little t LENS. in nrabd osaiatiee
Price of Casket or Coffin.....eeeeeeeeveee $\. _ 4201 Z.
*AGATOSS. Soi « 3s nein ce salen ss vs cco en Glens: o0% sens oesienee > Metallic iting ves. sos shes Betases enc vas Me os ees
P
(State kind)
How Secured . Gp asbia ss elatG cies sis enero mea aiecrmcn’ aici eine “~~ Outside: Box: ..5..-19 cio steers treet Leseraresse Gb. gy.
(Seate kind) i
sata. bay Sia ia siege he dcteaae baa “ — Grave Vault ..cccceccecreise Ae ey . See ees aie
F tate kind)
tac se eh oe a a ial sible 9 Te RSET EG ICO EMO ota pic:ala'a 's Sta ei ole = oo wcpre Sie 6 ose if frac SM od Tol Newathsosoos
Place of Death...43.4.. faMeeeeees theeeeecseeeecent “ Burial Slippers and Hose. .. 0.000045 . fsncssscnsee. cannes
Funeral Services at..40..4$..0002, te rere Rnwraving: Pinte, << 2.0% snes ee ssoe vn ee deeses
Time of Funeral Service. fa. ©. OE fh Oe ere OPEL Embalming Body (with
Washing and Dressing...-.s++see+seeeeeeee
Clergyman ...-+++oe wO cases @ pinmsoge © seven Nein. S SHAVING Nsies sis'oice are wateip « pple eiedinins celeike eareeollt eek AUP cMtachd css
Certifying Physician .A~. a ae Keeping Body on Ice...seseecsererees seeees =
Hib ‘Résidence i. . , . Disinfecting Rooms ...++++eseeeeeeerererces
: ; _. Use of Catafalque and Drapery
Number of Burial Certificate..s.secsseeeceeeseeeees ‘. © Folding Chairs .....cescseececsceeees ;
Cause of Death.. ... cece ccc cme e creer nnternterscees i “ Candelabrum and Candles.......-6+. fs
i )
Sale of Dathn h poche Glo For Gloves $...-.00se00.. Crape$
Occupation of the Decease Ade
Single or Married. Secee. ¢ Religion Mh . C.
Hearse: «2 << 0.00 seiss Reg autn spline’ elec s hice Cane Sis
Carriages to Cemetery... @ $on cAbeee <7 4 mee.
Date of Birth... AONE some ae ee Automobiles to Cemetery.4.@ $.Banhir>**
62 Lh Wagon Deliveries ...+eesereeereeers otgeeess
Aged.. oCcece Years, oecee Arr M nths,. hes ..Days. City Calls (Coaches) ee odes eerie. 2
Name of Father % Qn Ofna oviese sin Death Notices in.... Newspapers....
His Birthplace ....4 é ta =a ie Le day beeeeice eb pte os vedios : etetdcsesosedces
Name of Mothers Aveneccet: EDS tte FIOWEES 20.0). oginceecness teseseuse aoa eeeceeees Ree
(Maigen Name) Mistlay for Lt. es sje s ads a Bact RDF a) Sr ce es . . Mes x te a a
Her Birthplace ne thanfle Sonate dour oes sae 4 WAVY Opening Grave or Vault.....+ ne deneartae So ie eee
Body to be shipped to-+..ssseececceeeseeeseensesrsenes -. Lining Grave. o..0.ssenscseedeseseeveesoness cacao EEO
Size and Style of Casket or Coffin. ...ssseeeeeeseereeeee Evergreen . ira siaaee® 3) g asTaycie sien yee */ aS mae ate
Tent or Awning Charges....seeseeereceeees
iieenomals sitll bs th daghe mat oRes panppieton ta tea teletemralnr. PARE Reith We ua es sys owlagtn
Manufactured by... Shipping Charges, prepaid
Tntectient at “Wea CGMAM“ATA CE Removal Charges ....cecseecccssrossoeces ke
Cremation Charges ....csecececcsnccsceces
Lot or Grave No...+-.+++0+. Boren, = tilt, a
Personal ServiceS ...cesccccecceecsvceceess :
semen ewe nce mareeeraeeseee reese eeeeeeere
I Totali Footing OF Bill x.. csisices ccc peu sen evs Berd Se Ld
Diagram of Lot or Vault
—_—
Designate all Graves in Lot with Numbers (1, 2, 3, 4, etc.), By Amount Paid in AVANCE. <¢ hG is eee ose secs» tasecesun! wa
and mark space for this Funeral with a cross (+).
Designate place for Monument with a small square ( MBalance® acs cabs oceans vases bE ee ENS fe NO &
Use space to the right of Diagram for the names of those
buried in iy
7
Madde, ae To Funeral Charges... Total, $ _fadod 5D. latiale, / fal . BYaGAsE sca ties lgae Gee siome « . ZZ wZ7y,
i“