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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
AGS
RECORD OF FUNERAL
Total No. 1G8 SSE tA elec GOT DOORS So ainicsc ac nes eae? Date Vie palaces 39 Al Aeris St 1
) ;
Name of Deceased. .44¢ 2 . MMtTTAth. Eee ees ace RE) sbolalas ee eerste ot cece SL STUES, «sola M Eee ete Dele etharate
DO Married D Single [YB Widowed O Divorced (What Race)
Residence. Lirads ek Ya ee hy rade kien gi AMG cia One ae oe BS us rel
‘ OE ves dibs Ls case shine of
Charge to:. 7a Ah.. 40 CEPR HE ee oe, :
Complete Funeral.. .. 2.0.02 eee eee ot Ble. cece el,
Address.. //.8. Ce Rate tt doch alas «
. / Casket.... Y LUAAIEOA cece eee elf. 7S),
Order given by.... 4@7mM. ne sbne eine sense eeeacien os Burial Vault or Box .....--eeceeeeeeeecdl cece.
. (or informant)
(State Kind)
How Secured.:.... Chars Pikes ick oR rat aaa . Embalming Body ... ESP cme hla aaa ok
ERI csi cless otis anidlsvin suena (oo Hen aghal wand. adn ica Hair Dressing, $....].... .
(Social Security Number) . Dressing Body, $..... Underwear, $.../}....4.
Name of Employer..... BAL en! fee ah . ee Gust ov Des. a ee ok
ae (State Kind and Color)
Address .... i i i ii Slippers, $....... oo Foes Mel eee
Date of Death, fory 29" JI 44.0.0.. 2/04 rt. . Folding Chairs, §.... Tarpaulin, $.....]]....}.
(Date) (Hour) . Candelabrum, $.... Candles, 9: 555 soc allt sv aco oe be
Date of Birth. . Ae. hx 13. BM ence as 1822, i Aaa nts Peace Door Spray, $..... Gloves, $......]}..../.
rane Z g 2 Je Funeral Car, $.... Ambulance, $.....}}....1.
nea ary (Wears) 9°” Gite ays) Limousines to Cemetery... OS. Gee ee
Date of Funeral, far. 3. Prcdtoy 0.. 22 Fw, Autos to R. R. Station. ... ig Aer ese en arey &
‘i a, ) Cae a) oe gecatmees Getting Remains from...........-])....
Services at. : +7. yee % Mero. .draptth. oc.. Taking Remains to.. 0.. ..sccceccccccsecelee ces cle
OA, ae ee, AO ae ak Trip to Coroner’s Inquest .........-f....].
Delivering Box t0 = oes so os ake essere calle cook
Deliver Flowers t0.....ccccceeeeeeeeeeed cece ede
cl, em Oo eh See ol RE Is Silivinse vo teed abies «ho bik bags > clea
Procuring Burial Permit...........])....[¢
ee eer Heer sl cant wb, aati lesels! ave nleee We . : (State Number and District)
(Years) (Months) . —_Certif.Copiesof Death CertificatesNo.______. ]....].
Ce ed
eee ee eee eee eee eee eee ee eereseeeeneee
See ROTH HHH HEE HEHEHE HEE HHH HEHEHE HEHEHE HEHEHE HH HHO EEE
er
el a ee Se
:
His Birthplace. .~.......%7
Maiden Name of Mother
Fler: Birthplace 5 Faas.) civs.-0 0 sisle ose oo ee ee neo wee mie
Lg
Size of Casket fO/2. Aigh Farah, Mac,
eee eee eee ee ewer eee eee reese eeeseeeses
i
l Ray
Diagram of Lot or Vault
(State Physician’s or Coroner's )
Pall Bearer Service, $.. Use of Chapel,$...
Personal Service.... apne < @ oa inlaid alten
a a
ed
Gross Total for Sales Tax.......5. ! $
Outlay Tor dob. coca ane oes tales i Sard bee
Cremation CC
wee wees
Rt A Sia ie! 1 TSEC ge a oe
Flowers, $... Pa ms, $. ee Matting, $...
Rental of Tent, $..of Temporary Vault,$..
Opening of Grave or Tomb.........
Lining Grave, $...Lowering Device, $...
Outlay for Shipping Charges. ........ z
Clergyman,$... Singers,$..Organist,$... 5
eroMotcr } Tickets, ee ee plane Service,$...
Telegr., Phone, Cable or Radio Charges.... a
Cash Advanced.. coches ccecrlecnessceds
ry
Entered into
ee i
a ec i
a ce it
Nato . ] Amant Paid Ralenre Ln. ee
. Awmanvent DAL3 . -