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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
Aa a No. jhsnies Raina + aes
(Tetal. ibe LE Number
Name of Deceased. Lelia ops Ythric AEE vrs
Date. TS ee see alein 194,F
(Where Leg.
hat Race)
ete ek Bois ocde oi tis Rese, slain eel oe ear Stack erasure seeeeeeeesOrder Given by... alee Rigel bal tiveee ars epee eae ea Ae i
Ch EG) (eicinsiels siding streisstiole ew AV sielela eels hes de dalilaa har :
h aree ira
Price of Casket or Coffin.......c0eeeee $!. _ 720) .ed.
ECE Danesh oP SaPi ca ies cas arid . See. ere ne BMet ale Eines yic'yceshele wrace oie. « 06 ek ee . ea Ne A
TIOWADCGULEGEET. ly wet Lolo ta one Se ityhg etme ed coer i * Cutside Box Gate rind) . ee ag ell a 20
Seate kind Date of Funeral. , Gl fovvrveverercvees ei ‘ inte VE. Koes ne oie) SC . peor eon ;
1e kind, :
Residence . 4.. W700.fade. Soe cc cecpesgececcaceos « _“Borit Robe.. eh i Hf Me eon’
Place of Death. tee e enone “Burial Slippers and Hose.......
Funeral Services At. CO fh os seve ver . Engraving Plate ......
Time of Funeral Service. Ab fe. Mie a ieee (alnvare 31 so aie} Embalming Body (with Rens ti eB as
Washing and Dressing... <
Clergyman . LK. AAT eee ee Pe ESURANCE R ey cis cata iene staal pin iaiseele elias Saleen cca oe ti aul =
Certifying Physician . AY aq‘KR Ea a ee Keeping Body on Ice.:....ceecce eee e eee ee Ye . ,
Eis ‘Ravidenens nay a ae iia cme = Roan Sear
se of Catafalque a
Number of Burial Certificate.....0.ceceeeccsceeees “1 © Folding ee ae Fie ocala ee oe od
Cause of. Death: Siceiaiicadiesos adeiee evelscelec © te i) sie son “ Candelabrum and Candles.........
econ b Ske Denil mere: a; Meh, vecense] Gloves $..04orasdie eeRCrape $
Door Crape §......Canopy $
Occupation of the Deceased late Hearse.... bance sinseptels «i gr¥sis afaistoies
Single or Marviedleee ACL. Religion 4 « . Carriages to Cemetery... (OR NEE Pec . Nike ene
Date of Birth. Le el Eo aise duels Automobiles to Cemetery.. SOS. oscvee ets esl Sf cll Oa
Wagon Deliveries ......+. SUC iy . Maeaeeicseeane leanne
Aged. CZ A.. Years,. FP . 02, . Months,.. o . Days.
Name of Father /7Z Miele WA Ce es ween
His Birthplace ...<
Name of Mother (ZY
Her Birthplace ..
bet oe New ee ooh Besiawte s :
Size and Style of Casket or Coffin......eceeceesecees
Manufactured ibys 0: ay vile otic sues viic owe dtd. vl hineeten es
Interment at ... tga. rig WAbA Live. .Cemetery.
Lot'or Grave Noiiiius seas oes a Section Nos.. 06300. .
1.
2,
3.
4.
5.
6.
. .
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 (+).
City Callsi\(Coaches). 34; sive samt clits ssivin'e us on
Death Notices in....Newspapers....
pr Pesgg saree creda thn Ula Age esonev ake Paes
NG WVOE Ss iA aas clatyt «5% vuln Gow em sfareinle seienequwie Welrereettenss. sucess
Onthayaton Wot ese so orernicindt ce ental naioics we beats
Opening Grave or Vault... Seieiars nie sleco seis: oierelncs
PAB, GLAVE sis, Waveis eaters 5 e'als oysiedsu b of4:kiiecelove! owls
VETRTRCH a Hlele's ¥0.e-5-si5'6 4. oo we ‘i
Tent or Awning Changes. ralvisis EL
WW OIE Rentals. eal oicldowe sed lea ttle « faassen, .
Shipping Charges, prepaid........000. ie
Removal Charges . a a oe es
Cremation Charges .......eceeceseue ces Leslie
Porters $.....00. Watchers $5.. 2.2.32.. =
Personal Services .....cccecececeINESICS safaris» atte sriere le eel elire nian siete eres
Church Charges .... elsig axerviaigie cise ale) steisiave einen ¢
i eo i i a ie re ar
Total Footing of Bill
By Amount Paid in Advance........4.
Designate place for Monument with a small square (a) Balance! 2 sasnu Sa BOS 50 ola eo58 Sil . tanctn bee
Use space to the right of Diagram for the names of those :
buried in Lot. Entered into Ledger, page....... or below fsx . ,
= Sree . ee ee
=~ Z
Jagr.. /3..!To Funeral Charges.. BYMC ASR Fe sce See oat ae $ J EENID Total, $ p-$-O S52. Vlasen §-