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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
RECORD OF FUNERAL
potal No OF a cia e Ses Yearly No.. ..ccceeee senses Date, PUNY.. ae ns
Name of Deceased Litre, Alt, irre. ae ee MST eae gan
Married Single Widowed Divorced (What Race)
Residence. Aras Yatheg Se vc te iedevia Lunches wanie’ © san eei ipa tia aT era ialie
Sharge Sera. TA ALES A lsc aia wal Saseake : ;
Us ee omplete Funeral....--.--0.20. 25+ BY eee
nuniceanrenme on ey ;, s amies ditehis ta sian ear seer = ee eo6 ¥.
Order given by.....@a7—. pon ese ser eereesecesesons Burial Vault or Box ..---secs etter ee eet cee
(or informant) n (State Kind)
How Secured....$ Bo Aa Nala Embalming Body ... PP ae. aa
Occupation......++eee as Peat adie gee abn alle Barber, $.....-Hair Dressing, $..... . .----(Social Security Number) . Dressing Body, $.....Underwear, $...]]....
Name of Employer.... Si ame oe ag as Sarelinng ates + Fea 2 05 Selb Ov PIPOME. bcc <.cidide oe ' a's aocgan 605 4 ele te we mnie
io (State Kind and Color)
DGAPCOR oc sh neln cs tale Semis edie s nisladoaes 400 eeitiie mat» Slippers, $....2000. Hose, $....Ket) Lee
Date of Death o“.%&. . ek Ce Dee eee 13.0 (mr, . Folding Chairs, $.... Tarpaulin, $..:..-[.--+. (Date) (Hour) Candelabrum, $.... Candles, $3 .0-07 2 RA
Date of Birth4#4 M4. Fr Pe PFU seis Wacdiaie se Lid orn Door Spray, $....+: Cn a ere, Aan
er oe ig es Fer Funeral Car, §....Ambulanee, $.2. +++,
ears) (Months) (Days) Limousines to Cemetery... CDI pee eels sia tale Neves eel
Date of Fiat! eae rate BN / Te . Autos to R. R. Station. ... Be yg oie Be kat
pen. 8 (Day Week) (Hour) Getting Remains from.....+.eeseeeeee ester eens
Services at. Meroe. .¥ Us PAM. . CAUSE ove eee en Taking Remains to.. . 2.. eccevctee pee nla epee ees.
Clergyman. Cen. Cat. Cake Be ee oe Trip to Coroner’s Inquest ....--++eeeeeeeflee eee.
(Address) Delivering Box to. ....ceeece rece cece sete ceees
_ Religion of the Deceased. Deliver Flowers t0....-ccceceeccceeeseeeed. cceee
Birthplace . A oduswrt... vr ; Removal Charges.. 0.6 cece ce eesele coe Me wcess
/ ; Procuring Burial Permit. ea ear oes 7 Te M asic lease
gy SO the et a Bi, Hn) ‘eis . : Ceatit. Srombleag eke wail ee
oe ysician ’s or coroner’ : ie
SS Place of eS eee 5s SR Mespahoke. -+++++++-] Pall Bearer Service, $.. Use of Chapel, $... . ...
TS One of Death. CAvemen. Ullige condete Roe Dopacrinh Gere. dibinisu alle ce seas he's sane ee iW se
WPS Contributory Causes. 2.. ccc sc. Tee eee ba ee deceee ecg escprteesdinecnteeseneesenebearescoseresaces tes pe.
a ar eg Fd dey co dain s cw eodats oR cence t sine emia ee 2a Gross Total for Sales Tax:....+.+.+++++Si. ++: :
rue TS aS a Se ne Eee Ee, eae /3
Certifying Physician. A. .2. Mather.. ccecccee. Ape ree
sae eeceneye ESET ie AUR eco shang ian hs oe Da
His Address. Atenroda, ihc eS Oe el ..line Death Notices in... Papers ....j--+--See sateen i ne, 6 eae . ) ee ee ee ee pe et Reh sap, oh Serer . e Ctaines of Mowepe: ed. 8S 8 Oe e6 0 Se be HSH eS SO
ae Na me of Father Flowers, $... Palms, $. vere) Matting, Shige. nelle sels
i. His Birthplace Rental of Tent, $. . .of Temporary: Vault,$... . .---. Opening of Grave or Tomb.......0-++eieerees
M A os Ie ORCI col lychabis ately ;
aiden Name of Mother....: 9 Lining Grave, $... Lowering Device, $... . -----Her Birthplace. .....+++++ ae Ea” Mem ree one eae Outlay for Shipping CHARGER. 0. ok case cane Sauder eee
a Mckee’ WoO. 5. 65d dw oe dda eh a nee eee oe a ee oe i ue.
p aS ? NM f ip or Motor f +1CKEUS, p..---plane EYVICE, Pp.. -iPee eee:
Sie of Casket 7, Gof. hp. i WS. fe oe egr., Phone, Cable or Radio Charges..... . --+-z ie lachared by. Pg ne et ee. ee oS Cae DOMEORO 6 x55 oy Sasi diane ao odoin» watpiane oe ¥ 8H
Interment at.. rn.. figs PAREN er tr ee re
Fuk Wis lecendiee Bey oy ‘en “Tots Sle A ea bet
ve Cove ta. cht eet “#Total Footing of Bill......0.0s0+ 000: gl? 7,
Be. Peas Ca li ha ie: ORY in (a tere lata ls aile-aters eavrsle dietnigte alo wile Usual sen eee 6 steve
one ol Pe Balance. 2.0).. 05.5 eae
ram of Lot or Vault Owner. .....“.s-'e++*] Entered into Ledger, page... or below. Agee 9 Fara pe Oe eee ee }dmobat Paid .