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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
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17
9 ,
RECORD OF FUNERAL
Total No. Ls 1) Ee Yearly No... eters ene eeeees Date dey severe's ih =A st Hla sm Sore iy
Name of Deceased. Keen. LET iss : Proll pire Uk, (anenesasuetins dicts Gelsaligewim ins. ainda ist peuligs nary Seo meant owes
. RK) Married OO Single C0 Widowed DD Divorced (What Race)
Residence. 44 he Ae rs ete es, UR) fe ee eal as Rese een en . aD Ip NCOP tad Joplbes & Meate . 2
as Wises vee 3 ee, of
Charge to:/Zive. Chane, J onuy. Spall.. ceccccvcce: )
Address 3049. Waa. Llrrvdor AP. oc cccce cece eens Complete Funeral cece“ . rye
7 roll Casket... LATINA co nang heen cane oem 7.9).
Order given by.“Swr2-4*". . BBE, v0 cates dlowentytins sn Burial Vault or Box .o< cee. sco cere Peewee depp ces eel
(or informant) . (State Kind)
How Secured.:...5 cy, a ene Embalming Body ... Pete eretesedfee seen
Occupation...... Ree en eho 5 Geet eee aie Barber, $.o0s. sees: Hair Dressing, $...-.-]..---. as (Social Security Number) . Dressing Body,$....-Underwear, $..--. . ..---Name of Employer....7..0.eeeee eee e nsec ence renee Cade TWGUR ok dein hese aclnw ide eee name
Address. ...+++-se--LIGA en glam Moots wate Ah Slippers, $....-+5 gs $. = creda Nepean
Date of Deathly. 40". SIR.. 28.48 Grr, . Folding Chairs, $.... Tarpaulin, $...----]----+-(Date) (Hour) . Candelabrum, $.... eRe Se). SE ies cores ahve eles. 6+
Date of Birth, Pedy.." rah Ear de L876 Leche amass Door Saray, $ i435. .~Gloves, $02. sce ea[lae e+ ce]
fs Funeral Car, $33.7. .Ambulance, $....-. nee
AGG. ooo. isn "EIR EETZ eee ” ANE aia “2 A : rs eos ’ :
(Years) (Months) (Days) Limousines to Cemetery... Cir iar Wcesres a
Date of Funeral ./9".. 174, Preten 0.. 1¢,%. Autos to R. R. Station.... OS.. Sian)
e ath ae ha: (Hour Getting Remains from..... pee VM eee
Services at: : AA MAT ETM.. «: PIA cence eee eens Taking Remains to. ....:0eeceeeeeee eee efee neces
Clergyman: Ween Coke ws Rags RuskrrWh Ga ftip to Coroner’s Inquest ....-+++sseeeeeefeee eee
: rn ' (Address) Delivering Box to.. 11.. cece eee cece eee eee cece
Religion of the Deceased 17, 7. cane od : Mee 6: 6 &\e oles © 0: oe Becves Deliver Flowers to W Sae ts al Or tald. ett erp Saapiae uses calace eve SET « caver rs
Birthplace AMdawbrveg. Mtb eevee ces Removal Charges rank aie Peer (eee
Yon : / £ Procuring Burial Permit. fea ig ees a aap + .
Resided in the State.. 40. 47. -.-1s:55-teats . __Certif.Copiesof Death CertificatesNo.__]....
Place of Death hh ee i. : (State Physician’s or Coroner's )
oe MM LG reece reece e eens Pall Bearer Service, $.. Use of Chapel, $... }...Cause of Death Mlyerrarelshie Sa eae Ei ee Personal Service....++++0sseees0eeeceseeddeeeeess
Contributory Causes Ne St Pada! Rae en ene fame ots Seer
1. Luma. 7.. LYE TOE. ccccccccesccresses. Gross Total for Sales Tax.....+.--4+++--$ ee
Oartlsee fOr Ob. coc oo cie alile vyevecsimitig = muecase wletpsalf. ataes oun
Certifying Physician 0° Alera. 148. cece. eed
‘oe Corner’ : eres sees her Tame a ie aes ee he
His Address. 414.. @tteovrrets.. qetteeeeeeeeeees ts ane niieaamees ier lnigasandl ater BDORE. sas tae eo
Name of Father//ZELvUn. : i A. ree, aan Deine sate (Names of Newspapers) RE A Te
: \ : Flowers, $... Palms, $... Matting, $... . .--.-His Birthplace. . Cecken, : Mogscke. : Puch ~ Api helep ent Rental of Tent, $..of Temporary Vault,$... . .-.---Maid N £ Moth Opening of Grave or Tomb.....--.00ee-flereeees
men ene Oe Lining Grave, $... Lowering Device, $... . .--+->Her BirthplaceSO7 4 fle ee ee ct eee e ees Outlay for Shipping Charges. .....-5----. [eeeeee:
Motor) pemains to. . Or ms Clergyman, $ er Singers,$ +1, Organiat,$ ik Wake oe
“9 En 4s ig Morr }Tickets, Pisce wait es plane Service,$...l-+--+:
Size of Casket 79 3 Cmb, hank. & Telegr., Phone, Cable or Radio Charges..... }--++-+
Manufactured by.:::. PBR. oR. ceesbae yeue Shas Cash Advanced. .. 0.2.. cece cece cence nates e 7
Interment at.. SLL. eeveereee (ee Ee gee
Lot Nowe sssssseeeeecee Sao ie ananeneayen A.
Grave MOus ¢. decsiis «+ 00a=s Total Footing Of Bill.. 2.0.0.0 seers eee eee. $3.7.
1 Po ee es ucic tank. Goa palaces be wtaae SEER
Section No....-eeeeeeeef “ise me $i++.
—[ : . cts . BNCO Pe. cs. esas Ohiice os
Diagram of Lot or Vault WHEF . 0 ose cc cersesccccss Entered into Ledger, page..-or below.
7 7 ™. 1 i