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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./ WEY
(Total-Number)
Name of Deceased
Mo. A Zac vereves
i
Wike--Widow
Sen---Danghter of
Charge to
Address
How Secured ..
eee eeeeeree
Date of Funeral. . sees eereeoei
CT eee eee sere ee eeees vf
Residence .. :
Place of Death..
Funeral Services af.
eoesceveveve) Time of Funeral Service.....eeeeecees
' Clergyman .. La
Single or Married.
Date of Birth. AMAL AATIE, AAC HEA
Aged..(//. Years,..(2.++ Months,. 4...Days.
Name of Father. AZZ. POM ARs vvcveees
Bis’ Birthplace, «cs Losses shsatvct cesses sites'cis a selescies
wore weeeene Name of Mother..peqecesGeceeLecececeees
7, GMisiden Name)
CPO SOC e ee eesoeseeeeseeeeeeee Her Birthplace .../.4..
Body to be shipped to-Size and Style of Casket or Coffin.....e0-eeeeeees =
ee eeee tt eseseeeesreres oe
ee er Manufactured by....,.
Interment at ..../, Am Cera eee ucts Cemetery. ,
“Lot or Grave No...seeeeees Section No... sea Melgie ee %
chy Onin Given by. 7 Hah life
—$} ~=«« r-—
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 (am)
Use space to the right of Diagram for the names of those
buried in Pay
J
Price a Casket or Coffin...22. 400%.
“Metallic Lining . pe Bates a
“ . Outside Box ,.<0... saipesicese aes ae
(Seate kind)
Oo; GAVE VEUltiics eicclcc caw coms teuteeaae
(State kind)
OL SD UTIAL ODRs ss 0.50/00. aivie oa epee ee caleures
“
Burial Slippers and Hose.... oan
Engraving Plate ...
Embalming Body (with...... He
Washing: and Dresaings.-.\c0sie0seignisios sees oe 5:0 . lta: ias.
SODA Wis ora 01-633, 01019. e pho opblate oxstuwiane’s
Keeping Body on Ice...ceeeesceseees
Disinfecting Rooms ....sescesceceeees
Use of Catafalque and Drapery.... Siar eieiaarer ere
“ Folding Chairs ...... wie Ale, org tecisrelacste
“ Candelabrum and Candles... Seltorare
Gloves $.....++.++.+ Crape $.
Door Crape $......Canopy $....000.
. Hearse.. eialaigistetsien'e/s a
. Carriages to Cemetery...@ $.gercecereees oe
Automobiles to Cemetery..@ Sean ce evenee ces
Wagon Deliveries ...ececccectcceeccceseees
City Calls (Coaches).. +s qeereceecscevececens
Death Notices ina,..N PETA ss..
Pe COOH OHHH SEH H HEHEHE HHH HEHEHE HOHE TEE OEE EE EEES
(Names éf Newspapers) a
POWERS Ailes eieNibe. e's Soda Saeles erehta a etoile
ri
Outlay for Lot.. 035.056. 6s oe.
Far fs a NN Aiea MG a asta
Lining Grave ....06.
Evergreen ....seeceees
Tent or Awning Charges.
Vault Rental . beiseueeessenigic
Shipping Charges, Ottpddl wi occscedeet tudes
Removal Charges ..... ater
Cremation Charges .... Shs Seal ut do chen
Porters’ Sicicceicse es MOTs $4.4 <'e vecieviesten
Personal Services .... : Ce a)
eee ee ee oe eee woes ereeseeee .
eeecre
i ed
eee teense eeee
eee ee ew weee Pee e meres sone seseesereeeree
Church Charges i515. sesieiee veedebies vices aeeres
ccecaenproenenmenel 6
sovenene:
Total F of Bill. $
She
By ag pe Weil ae Le
Dalatice 5555 asctiescs Peete ced
Entered into Ledger, page....... or below]]........
v4 bo Wd
To Funeral Charges... Total, $ tes By Cash ....
“¢ £9 sa