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Collection: Original Records > Death Records
Mortuary Records 1940-06 to 1943-05 - Index Included (324 pages)
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Page: of 324
LED
RECORD OF FUNERAL
Total No. > ai Ee Weethy NOs) oc cg caw enee os Date.. (Lum.. Pr iets see 197:
Name of Deceased..4/ 4%1..4; A crteoad Sea aig cates oh 6 Cee! Wiad neta Me ater ys SIRE TRB ON wale srulcbyers atetarprerp at eae
: & Married DC Single (0 Widowed D Divorced (What Race)
Residence. og De ee Sy ee Te ie a le ae pga NE dete, peer eanes aula Lech ya a
Pv eice capeeusess< of
_Charge to: Zine. rae et siege Leper ale tae ;
Complete Funeral ......--2 eee e eee Dee. fe ee
wae Aes MORAG, MI icin ble vie vl oalbs vee :
ates nO ana ean 27 ety eee ezale
Order given by....: Herre.. bilipa anit Hak to's a.winisie’ Hide 0s Burial Vault or Box ....-ccce eee e ee ee eleeecceeleee
(or informant) . (State Kind)
How Secured.:... Op / rea IR eois-a's gain aN «Sousa bles se vt Embalming Body ... Cee et aE see oe
Occupation...... Seer alc 5 cE ot Jen tet Barber,.$.0. -cisses Hair Dressing, $..... . ....
(Social Security Number> . Dressing Body, $.....Underwear,$...f....f..
Name of Employer.... tte teeter etre ence e tenes A a Sa oe RR, Oe ar, © . RSs Gh
(State Kind and Color)
PATOSS 25 sce siare tae wleie dae Sess elicsal ever ouavertrest)s wieial Rete crnlens ole Slippers, $....... iia). re es ORS
Date of Death.. Be Rite ta S37. ™, . Folding Chairs, $.... Tarpaulin, $..... [....[.Date) (Hour) Candelabrum, $.... Candles, $. 2.. 6.. csff ee sce
Date of Birth. . das apis (3 Bee kre aPete 18273 Were: olsie ile: alern = Door Spray, $.:..+.: OVER het ‘seen! seomlateale ietanuescllent
4 ae ae ethan Funeral Car, $.... Ambulance, $ic25:. dco. sms eke
sc aideae et ay 2 ears) (Months) °°" ”* ae ah Limousines to Cemetery... Oe te ire ser lpia uel
Date of i ate € 2. Cthorday. oc. en. /0.A.m. Autos to R. R. Station.... CBI, intial wrens Beas
. "(Day of W lik zy fae) Getting Ternnane SPOM 6 cs sedis hs ba ew oe ee eee
Services at: : :V.avgeer.¥ Aaa.. Repke. Taking Remains to..... Gels ted Secskls asx ASCE ee oe
lergym 5 ae a ee es neil pr OO Ee ea Fe ee Trip to Coroner’s Inquest ......00.-ee% fleece cafes
‘ 7 (Address) DIGHVORING: BORGO! Go iie o sie selene othe e pees eles late ques
Religion of the Deceased. : athe es a palibesde « 4Gas Deliver Flowers t0.eceeccssuccecescuuceveecdccis.
REMOVE COGRIOR UG loicre vic ciccusein slleise's #68, ve lH Cuisverd
Birthplace ..%
: “i eg Procuring Burial Permit... SEPRSTA GAY cece Meio
Resided in the State ___Certif. Copiesof Death CertificatesNo ~ ee Seid can
Place of Death. cated Pall Bearer Service, $:-.. Use of Chapel, $... . ....
cana ats deena. hse Ril Personal Service. . 0.05.0 ieeeseeeceee eee ceces =e Seer
Contributory FS ROL ee aan repo oe) ROE Se SU Paty ah ieee alm by eee OUI Se emanates . Jee
BMA dardR an 2 a cite elt ain vid a eeu dite veacghunme miles col Gross Total for Sales Tax?.....0...-8)...4]45
Cieblare Were oii iis woe eh o's cain eae ee vey 232\4.6
Certifying Physician," seat bh, ett ee ARAN 5 os ween Fah Cees eas Bee tos Shes eee Bees
His Address: :...44. POULT ee eee eeeeteeseees Se: en coats amet sodaded ul mate
Name of Father. . 2 a cade (Z. rm See ae © Seca te ase Flowers, RE SE aa iaap ‘¥e Matting, Pole: . 01.0.6
_ His Birthplace. .. okender. be Mate Arcee ad ee Rental of Tent, $..of Temporary Vault,$..]].... ..
Maiden N Moth [dreary Ce. whl, Opening of Grave or Tomb. ........cHeeeeeeebece
= pa setantaus inet sa el ie aeiaes Lining Grave, $... Lowering Device, $...]].... ..
Her Birthplace. ... Lorde, are Hal. ae we 4m pce ae? Outlay for Shipping Charges. ......... J-.-++Se
Motor} R Clergyman,$J.7: .Singers,$..Organist,$... . ... 3.1.0, €
Ship sacs HAY cwais eaiceve tre i siois oo hi argh miaioLsyav tiara tale watencens Railroad ),.ees
A] Pi Pm tg oF Moter }Tickets, Sent plane Service,$... ]..---]Size of Casket. .4 4° ix atlas gavel, a ‘: i Le. deboch,. Chor, Telegr., Phone, Cable or Radio Charges..... ]....}..
Manufactured by. : . :-<esr..O. SN.. Cash Advanced. . 2.2.2.. cee cece e eee eee calc eee eefens
Out of town Undertaker’s Charges.....: MBG. oecetee pets
ms Mae. Se ae { Genin Ont of fown Underars Chay ea a AY
Lot NO. cosssseeeeeeef ace ga ci
Gexve Me..d.J0 -..:. Total Footing of Bill......secsee008$15. 7.2).2.
RMD 55 as Bos Se siecle Gl ok abs axon ce dae eG) Coma is
: Section No.......--Balan : —
: —— _.. j
Y ce eee een season c ee ePlie es eee eeloese
Diagram of Lot or Vault Owner. ...--0-+eeeeeees . Entered into Ledger, } Bage..:. or below.
1 1 SA a ] aire . . 1