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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
164
RECORD OF FUNERAL
Total No. $%..., ae Date.
a a ed
Ce
Date of eet ce ah
te our
ae se a eee /720. A srt.
AS
i
eee we eeee
Ce ee eS Ort a
Oe ee eee eee eee eee eens
eee ee
Sy ec ee ee
—(Years) (Months)
His Birthplace. . . oY) 4
Maiden Name of Mother Z
Her Birthplace
=
Ce eee 2 Se ee
tor} Remains Le Se a ner eegre ore t aoe Gy nee sees
ae of Casket $7 se 199, NO. Marth. Carmen.
(State Color and Number)
Manufactured by: : Ae. OX
’ Interment at
ee ee ee er rr
i ae ar a
Diagram of Lot or Vault
(CBusband[]witel_]widow t
ee er
. Folding Chairs, $....
. Autos to R. R. Station. ... @ $
Complete Funeral .
Casket... Porn na, te a)
Burial ig igass Box
(Name of Embalmer)
Hair Dressing, $.. . a
Underwear, $ eeeeoee ene VICI WAL, Dp. . ee es
ec
Slippers, $
eee ewe www we ew pe RLUDE, Dew eee eee eee nee
Candelabrum, $
Door Spray, $
Funeral Car, $
Limousines to Cemetery
ee ee oo e oe NAALUICD, De. ee see ee ene
ee eee eons
Ambulance, $
@$
eee ew ee eARITLUIAIING, Dee ee wee ee
pesos see ee eee eee
Getting Remains from..........05.
ERIE TROON ED os ona db ceca dive os o-eiele
Trip to Coroner’s Inquest
Delivering Box to.. 22.. cece ccc eee eee
Deliver Flowers to
Removal Charges......0scceeeeeeee vers
Procuring Burial Permit...........
tte Number and District)
——Certif.Copiesof Death CertificatesNo
ee er
Ce a
(State Physician’s or Coroner's )
Pall Bearer Service, $.. Use of Chapel, $
Personal Service. .. 0.60. .c ccc cee ccceeees
ee er ee
Ce
Gross Total for Sales Tax
Outlay for Lot
Cremation
ee
a
a
eee eee
es
(Names of Newspapers,
Flowers, $... Palms, $... Matting, Sa
Rental of Tent, $..of Temporary Vault,$..
Opening of Grave or Tomb.........
Lining Grave, $ Lowering Device, $
Outlay for Shipping Charges, .
Clergyman,§ #.2° bine Singers,$ 7°
or Mote, }Tickets, $ rate
_Telegr., Phone, Cable or Radio ae
Cash Advanced
wee ee eAUWOLINE JYCVILE, DP.. es
eee eee ee
er a a ed
ee os
a if
ee i
see wees
ee oe
ee it
ee iy
eee w reels
a