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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
rea RECORD OF FUNERAL
Name of Deceased..a* 4 AM Ae, Geittn SANUS ie nea iingegie Fr Vl-Lite a2 an
: CD Married LD Single DD Widowed D Divorced (What Race)
Residence. . ee Feist. 6 Tey fei imme ec Sey DN Be URRY, gen
Charge nttheoh f kbar dh Reh eo
Address. 3/,F, Leet leark. gions es
Order given by. .~ aes
How Secured. . eee es
(Name of Embalmer)
OOCUNON esi «ne Gada ees ye ee er te Oe! BOEBEE Piiec. eves eo Hair Dressing, $..... }....
(Social Security Number) . Dressing Body,$.....Underwear, $.... . ...:.].
URES OL SOP IO VE oo nns wks vier 's ov pawe tied Reb uies ose eh ie a ake a eee Sieg Ae
angen (State Kind and Color)
Address.... jarat ea x Slag dlack wate bisiorw ales soba aie tear eine ee ‘Slippers, $......0. Bie Since, Se eee. :
‘Date of Death 2 Zi: ae FHA oes. Coie atta — Pie ee ah
(Hour) andelabrum, $.... andles, $..257¢../. ..4%.
Date of Birth. . eB Cn e+. ee Door Spray, $... vest Glover Seo. Seek ea ‘
“Age Le zat LK Funeral Car, $/%. —. Ambulance, $..... 5 Ae
fea eee iaage EA eae eee he (Days) . Limousines to Ceibetery 2.@§ 400O...N...6)48
Date of Funeral. iA BLA Mller. a 6 ~.u. Autos to R. R. Station. ... 58) ee
j Be P) Gettizig Remains from. ¢ 0.0.. cs ok ose we ae Se :
Services at. “~YZAJE47. FF. . Taking Remains to...... alia ay a cae SNORE alietas :
Clergyman. Ltt. JES, ke 2: Trip to Coroner’s Inquest .......000-ef}e. eee ede
‘ ; eH Vering BOs LOS les cs divs 8b ese oe euessin & aM e Gases os ;
_ Religion of the EA LE vege : Deliver Wowers to.; 05. .c0 sieves Sewn ae ee ese. a
Birthplace Lis pa ae tT en Removal Cnearw esis desc ec: veo aie wow wo Sey aie lf ee wae ete
4 Procuring Burial Permit.. . ae eaten aur
Fete Tn te tate Ce Tw Gilg ce Gong rag) {aiéctéss . __Certif. Copiesof Death CertificatesNo. ee 7
. cian’s or Coroner's
Place of Death. Femvetlar. Pall Bearer AES, $250Use of Chapel, $. As sae Bled
_ Cause of Death: gaat Rs ete Se Personal Service..... whack Fi Wr +o Hea ee 4
-Contributory Causes. ff ME SE De, ar ey ee rit cmec tage Tae ReWAaleeemenes ciel oe aekte celal . Se Ree I At
* hs caer “ee ieee mere’ g Gross Total for Sales Tax......dee hoe. 8 e
VAM oo ks se bo stews oa 7.15
Ce ertifying Physician. e aL m8 Outlay for-het Acad 3 Cadanga Fe}
array sates Sin't 078.5) 61 COTOMAUMON a ioc ce oobiss os kp atde Cele ee Ses woe eeu eee es
His Address. Mooegayaad.: ; lafornc ___. -++-line Death Notices in... Papers ooo. .tens dco. sh
a SD ie Cae See (eee a
Name of Father. it mera ps A. Peeawcatea.. Flowers, $:..Paims,$. Matting, $... . .... H
His Birthplace. . Ceters MMlaaa. eorex nes Rental of Tent, $..of Temporary Vault,$../}.... oe
¢ lL, Ue. Opening of Grave or PPOMID a cs ko ai aoc eee 20s AINE
Maiden Name of Mother. &. ge Lining Grave, $... Lowering Device, $...}]-..--ce
Her Birthplace......°. €&.... Outlay for Shipping Charges. ........]}.-.-.oe
gs Remaing : _ See iis Ralad Voy oe apg ed eSae et Net eede a
moe eg ree! Chota, $c: 5. plane Service,$...}..--f
Size of Casket Y M, AL, POL eae Telegr., Phone, Cable or Radio Charges..... . ..---Be
Manufactured hres Caah Advanced : 00.5 i. 2 Wis; ia = Sea ves Eee Oe ee its
ery} Out of town Undertaker’ s Charges TPS PS glayete . . (Siae eee
Interment at. C4422. VCXRPCLELALET.. . Cromatery). o.oo. ceo c ec ceeccccccecedunees Soraune! eee .
ee Tae a cee eee
‘Rotik Wdotingol Bill 25 fo io.. ck. ee $}. &F. .
; RMR Ce cane ee wes a hse esesceccecceccweess cree ore ;
EG — ey te Balanoti. ig ies icy epee a
Diagram of Lot or Vault Owner. ....-Sabato Entered into Ledger. page...or below. . rae
] . ait cs, LOA ne es ee ] 1