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Collection: Original Records > Death Records
Mortuary Records 1925 to 1928 - Book 23 & 24 (277 pages)
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Page: of 277
RECORD OF FUNERAL
ene
BSrwKral NOs lecieanoewe’ etRicied
Name of Deceased...}
Wife---Widow
Son---Daughter
of
Husband--t
Order Give ibys a. tsiess a0 tite 4 oes eainisign sips pes Careers oo
Fswi GuouTed . tas sucetscedcne pees . nem matte CA eE ETS”
Date of Funeral. Mermr.comn, «97-4 VAS. Ba os on
Residence ...-.--7¥7 iy he, We Rpt or aioe kor a
Place of Death Waran. Cras eaainia By ase poled =
Funeral Services at.. Sitter ers
Time of Funeral Service. ..% =. 0. . Qe mn. see ce ens
Clergyman . aw.. L ero tee ee eon nC Uon,
Certifying Physician. SOMA.
His Residence...Zac oy ec Gi Oar ches “ar (SPEC
Number of Burial Certificate,...--+----+--+++° Choe See
Cause of Deat assed, (peas oa icant Soa
(Primary) (Secondary) \
Date of Death.\\ MYS@vr4 .Pa eR, ees Sy Ge
Occupation of the Deceased. .. CaO ne ey oS Rr ee
Single or Married.W woke. . Religion. ...0.0esdee8ses
Diaterot Birthiesc yao ote maleie meteiacs tie 0 4 wien mice giatere ates hee
AG@scsiv sees sos Wearss oie. cdess Months....-.+Days
Name of Father. :...2..000ccesscose rec cseceeneeeceers
PUB Birth Plaees <2 soc .5 6 0 wikia aiaie nei ahi See sce wei sgeeirieleR tien att
Name of Mother.....ssecceeeceecsetsrncreestreeenss
(Maiden Name)
Hor. Birthplace. 605 vires. odie 5 oie 0 opts hieie atin to ele weejeect atin s
Body to be Shipped to....--seeeeeesrerssrstceseress
Size and Style of Casket or Coffin, oe
2 SAT ae oR eee Coa
Manufactured by. . f+ ©, aR eg ae ae? en
Interment at OR. gal DS CARS es aos Cemetery
Grave No...--0-+eeee eee
Shotion NOvi ices dee eben s
Diagram of Lot or Vault
chin
ONT D se es He caine eg abe habe ec.
(What Race)
Ne ae Mtg) Fe opyetse Cntr capi Seca men hs eau 2 Oa RT 8a SP a ne
Metallic Lining. .....---sseeee recess:
(State Kind)
Outside Box....----Ri bial oath ona eee ince eshcie
(State ‘Kind)
Grave VaOlti ids oo cate enw cme eee eset wre cee >
(State Kind) ‘
Burial Suit or Dress....-+-+++++ “eee: Baer, egies
Burial Slippers and Hose...-.-.-++++++++5++5
Engraving Plate....+.:++seseeeeereersetees
Embalming Body (with.....-.+++++++ Fluid)
Dressing Body, $...«bree SRB VEN EG Boies ace o's
Hair Dressing...0eeeeeeeeeeseeeeec er enettes
Use of Folding Chairs....+..0se-eueeereee
‘« ¢ Qandelabrum, $....Candles, $...:.<
Door Badge, $..---+++NT ARP AG ono afecn ois Sinnefe Mie Bs ere one vee ahaialelel tore = eel « #8
Auto Limousines to Cemetery.@ $..--++++-+Autos to R. R. Station....-Benen + sieves
Other Vehickt Service. ....eeeseeeeeeeeerees
Aeroplane Service...++ Retiree ke ce cae
Death Notices in....Newspapers...---Lee tigre feleucubielbeabre 1M Gm BNC: S GALES ple eNMne Tee 8 SVA.S S.0i% > ©
(Names of Newspapers)
Flowers, $...++++ Rental of Plants, $....Other Decorations. ....+seesereeereererreess
Outlay for Lot.....seceeeeeeee ere eeec neces
Opening Grave or Vault...+++e+sesee errr ee
Lining Grave with Evergreen or Muslin Siicis
Matting, $....+--Tent Rental, $.....Use of Lowering Device....++++seererrrees
Rental of Vault.. ..cce cece c ence eet eeeeenes
Outlay for Shipping Charges....-++++++++++Removal Charges....++-++e+eereeee es ee
Incineration .....cecesnece ees eeee ner enes
Personal Services...-eese eee sence esr eeeetes
GIA WARE «Pei wale ee ops Tasso olraiere eons eater eieaelt es
Telegrams and Telephone Charges...\ay sh
Pall Bearer Service....--+eeeeeersreeteeee
By Amount Paid in Advance...+-++++++++++ $
Entered into Ledger, page..---+--++> or below
Casket or Coffin. ...-.22e eee cect eer eeee $i. .
Church Charges, $....-Minister, $..... ,
Balanees cc cies ons obs ete see $
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