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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
202
RECORD OF FUNERAL
Total No...---eeeceeeee Se Yearly No.....
Name of eh ek, Se oo.
Tt Married
Residence. _damanateartle Sameer Ah Spe lial Ma ae
Widowed 0 Divorced (What Race)
Sigs (Husband ]Wwite[_]widow
Saree Se tines boca iee meno
eeeeeee
Charge to:.Z. eZ. bins Siries
Address. . 4/% 5 SF.
Order given by. : ee Buria}Vault or Box
& State Kind)
How Secured.:. L2 f . Embalming Body ... ; Se Be eee Oe ae ed
5 s
(Name of Embalmer)
Occupation . . Cnteeanat rare fet Barber, $......Hair Dressing, $...---]]---+++-. -Dressing Body, $....-Underwear, $...-. . .---+-]-Name of Employer....-.-+eeeeeeeeere se eeser erent Suit or Dress
Paes eer Sse Meee Eee x
ACAYESS 2.0 ccc cc cece cece cece nrc ese nese css eeense auplcnee Slippers, $...-+ee0e: 3 it UR Ree “bree a
Date of Death. H BABB. IGG GHA, Belding Chairs,$..-Tarpaulin, $....+-. )..+++es
(Hour) . Candelabrum, Peri cccease LF\4
Date of Birth. C6JZEC1. 0 KOA Av wv ec ccrrrcenes Door Spray, $.:,+----Gloves, $.2. FAI eee ANS
Maes Fa Te Funeral Car, $ ha Ambulance, $....--. . -++ 12\Q
Limousines to Cemetery.. .Be ele aes Shee
Date of Funeral. . . Autos to R. R. Station.... OO SS Gs Fees BS
i (pur) yGetting Remains from....+--++erereere referers ef
Services at/:F.4Taking Remains to....--sseseeeeerer ee eier erect
Clergyman: : / A, Trip to Coroner’s Inquest ...-.-+++++ereee efor sees:
ip PO ae Oe Delivering Box t0.... cece ee eee e rece eee te nena
Religion of the D : he gees sees Deliver Flowers t0...-sseeeeeeeeeeeee ete pen eee ede:
Birthplace Lk, -. oD a ea Removal Charges....0ceeeeeeeee eee cers fer ee ee eds
eas aetiied Procuring Burial Permit. « “se es werner et
te Num! an istrict
ee A * lr U. Ser City cr Gounty) (Years (M suths) . ——Certif.Copiesof Death CertificatesNo. eae
ician’s or Coroner’s
Place of Death.“ & tetdA. Leaf ctdaAd.... Pall Bearer Service, $.. Use of Chapel, $. ints Salant ©
: ersenat Service Ass tail peered to a AAG.. hack cu assailant, Seaman AAS
Contributory Causes <aafolh Loree lA.. Die ak ies Pas ee certs Une dst ae res
lt Le i ee deinkeds.\..c ss Gicue total few Bales Fosse) o\ 4. re
Outlay for Lot..... cece eee cece eee eden eee ets
ertitying Physician, . 72 AP. oa tar TAP ooo ee a
His Address: < Pte hited ois ..line Death Notices in, Spike ens Papers .... ].---++}Phe on ED ee han Bs wn, Sa wese teak eS RCs Oreo ae! pai
Name of Father. . 4 2 aie MEUETET + + Flowers, $... : Palms, : ch Matting, ~ Sa ea . att
His Birthplace.... @<& : i. Ft MMS sco i Rental of Tent, $7 Zsof ioe se Soe uae ae
Maiden Name of Mother. . & va cof bees eee Opening-of Grave or-Femb “tt On teas reel . cl 74).
: Lining Grave, $..-.Lowering Device, $... . ----FI.
Her Birthplace Outlay for Shipping Charges. ...-.----+-+e efor ers h
Motor ; Clergyman, $5: Singers,$#-Organist,$... LAL
otor Remains to. Railro e ‘
=; } oF 4 More. }Tickets, She wees rel Service,$... [.---++
Size of Casket.7.4...: Telegr., Phone, Cable or Radio Charges..... }-++++-Manufactured by. :::.-—ioee sree cece reece ereeeeess ret pelea’ es LE eet ea 95 GF
to ’s ChargeS....-----\[eeeeee
ee eer ae Oar pee
so Soi er iT tl RG CUM ran RPI a eter 0 IN ee a oan fog cin creat. igh El
Lot No.. ..++2eeeeeeeee: RN oan iM en RI a Vlaekes m wlth t5.2 HR ane
x Grave NO.. 2i is 0 sce eee Total Footing of Bill.....------ee eee: $}. . f 2 ‘a.
Tei oe cite ete ik eaten ls « a Sania ape ow oe ewceiele cue Ohler
Section No.....-+----: hg 2 ee . Bobmrie
——} ame i i wclit Balance esecccccseeoes $ os» ele es
Diagram of Lot or Vault Owner. ..----+:++-+++>+-. Entered into Ledger, page.. . .or below.
= . Ament Paid Balance . Date*r . . Amount Paid . Ba