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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
eee b bsisieine oie 4m
(Tetal Number)
i Wife--Widow
Son---Daughter of }
Name of bane ty Sin edesceheosonete
fe caglva ss Wate Ant Onder Given by..
piaeSa cnc wile
eereeorsseoe:
(What Race)
"Charge to.. Mh. YYW). Be peace osene
Address io cks cattle ‘ BE ics esas sas eepenese
~ How Secured oe Deihieteiaiht © siareett le mitis.or¢te erueejethioniere'e'n fl
“Date of Funeral. hee
: Funeral Baceinbhcabts Adis
7 Time “of Funeral Servic shaadi.
ettifying Physician a
is Residence nigel fie eeee cent
d Number: ‘of Burial Certificate.....-./ bisecueeeens ads
dtaIAE Death: 0s és: poe S. gx so rol ees ref
is eeeeee er
Occupation of the Decea ed WAnaannty
Single or em
‘Date of Birth.....
“Aged.. ay BS VOCALS) occccs wes enh oeevene-DAYR
Name of Father. AQ. Spo
ane is Birthplace + D> Q. Cade cininahs oat nee!
‘Name ‘of Mother...Q\y~, SAA)?
‘Her Birthplace .. nyohusa
Body to be shipped to--...++eeeseereereeeeeeeeeseeesi
Name)
ize and Style of Casket or Coffin....sssecceceseeeece:
eb eee eee ee Hee rere esses eeeREesessseeeeHEEEH SEES eees!
‘Manufactured by......+.65,
1. i
2.
3.
4.
5.
6.
Interment at
* Dideyann of Lot or Veule
Designate all Graves in Lot with Numbers (1, 2, 3, 4, etc.),
nd mark space for this Funeral with a cross (+).
Designate place for Monument with a small square (a
‘Use space to the right of Diagram for the names of those
é ‘ fEngraving Plate ......hiss See ewes
‘} Outlay for Lot...ceeeeseseeeees
Price of Casket or Coffin. .....0.0eeeeeeee $}. 7
“Metallic Lining ...
(State kind)
# Outside Box ....-.: af ecesha et Eee Re
= (State kind)
OLY Grave Vault: <i iidiee.c.cs v000 toeeccicenen
Burial Robe .:...3. +50 Ais su ames Sata . . fe rc 2
“ Burial Slippers and BAGORS ons Ss 2'5'e3
Embalming Body tithes ages Hhlocs Ped) tewnl
Washing and Dressing.....ssseseeeeeeees
Shaving .5.sisss0e. CR esewas
Keeping Body on Ice..:...eeeeeseecerecees
Disinfecting Rooms ...-..Hietieg eM Bees ton ce . Nas
Use of Catafalque and Drapery.
“ Folding Chairs .....
“ Candelabrum and Candles... Parkas eee
Gloves $..scsesecsees Crape $...cceccseess
Door Crape genie agi Sus acelin sis cease :
Carriages to Cemetery... ‘@ el PY 8 aha Li i
Automobiles to Cemetery..@ $....-. mates
Wagon Deliveries .....+ Nel b abate
City Calls (Coaches).....+eee0e oy 5 lata larere [cs
Death Notices in....Newspapers..,..
ee ee
ee
(Names of Newspapers) ea
POWERS Heine hoard Sed aae eee 30 Be rr
Opening Grave or Vault.....sceeee escent ee mL.
Lining Grave ..ccecseeecseseeeecceeeeeeseees A
Evergreen .
Tent or Awning Charges..
Vault Rental .....ccccceceeeectcesscccees
Shipping Charges, Deere Farag a bests i eet
Removal Charges apireasWeseraesensesesssates
Cremation Charges .....:.s00Edsl tees ale
Porters $.....-.. Watchers $.......
Personal Services . .05}.2 tis Ges sence ots meses
Music
eee meee meso eseerereseresseseseses
ee ceee seer eresesere
Church Charges ).5. cclesas's ss ob sarees Dib nial t wtehe sty
Total Footing of Bill.... 4 divialstn apenas Pre . . be Aer
By Amount Paid in Advance......+.. ime
Balance ... Saeisietens & te SUR
buried in, 7,
q To Funeral Charges...Total,$ / G. 2
Entered és Ledger, PSs6s ccs os oemese or below]]... .
Vs
ON A sinme: Tt) PSll. RORTOPS<.c sc Culewinie ce 6.66 6.0ou ob beh b wawke cone dbbddawe uw ee SESCSESEHORHSSOCHEOSCHSESESSSESSSEOESSMedSeCSsSeEseeerveneers
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