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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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RECORD OF FUNERAL
Total No. d7 psiaieloveie Fe Yearly No.....c.ccccceeee Date. Gy cin osu te ~ Sa som kscme 1
‘Name of Deceased. . ecbanicd vette, pages Fees SSRN sec avid sinls' e's agucdish x sawn Bure eee hahaa:
00 Widowed 4 Divorced (What Race)
Residence...7@ erat 9 ee Re eT Oiusband{Jwitel]widow
a eee Veoh mPa talc a in hou
Charge to..
Complete Funeral........-.00005 + ees ;
Address.441 4
Casket...%.. QV ee. . tama
Order given by. Burial Vault or Box ... daw cas op
tate n
How Secured. ..6. (20047. ccc ccc cece cceeneees Embalming Body ...... 0.. .e cece eee leew eae
(Name of Embalmer)
Oocaation yes lk i. VISE oa wen de tee Wa Dales bu Rome Barner, $24. sc se se ok Hair Dressing, $..... }....].
Dressing Body, $..... Underwear,$.... . ....
Name of Employer PAE EI OGNE cs Seca cag oto et hee bad Ws soe HB wc od
. 7 (State Kind and Color) .
PROGPORS GH. che eooJt cPral GG tee siere Rlave « cvere late etbmace caveu olive Slippers, $....... Hone, LPO dees, Sop] bin
Date of Death Folding Chairs, $.... TarpatlinyS iia os tlbat dene.
Date) ’ (Hour) . Candelabrum, $.... Candles, $2. fe. F.seallecuaae
Date of Birth. . Crt a 3 with pe elem Vn . 7 re Door Spray, $..... Gloves S. .stwe. e. llc,
1 37 : Afi sek / 1 Sell TE Funeral Car, $.... Ambulance, $..:... [....
PP cr ets oh ae ae ieee Er ait Ld ihe Limousines to Cemetery... CQ) B ose eee eaagioh Pett dlsde g
Date of Funeral. Ged. /... Yuctedloy. 0.0.05. / [email protected]. Autos to R. R. Station.... Ve ae pee
(Date) (Day of Wee — (Hour) Getting Remains from..........e0el1..00.
Services at. M% MAA cease de Taking Remains to. ......ceeeeceeeeceallescceee
Clergyman.. Se. oA: Der SS ne <r Trip to Coroner’s Inquest .......2.-.-H.0.0..
____ (Cds) Delivering Box to. ....ccccccececcecescellecccces
Religion of the Deceased i
FAP e eee ee eee ee eee rere ee eeeens Deliver P16 W6rS 0 oc Ss. ic tassios coves ose e steele 044%
Birthplace OS Aetere vitals + UE 2 te Se aa", , Removal Charges......ssssseeeeee cess
Procuring Burial Permit.........../)....
Resided in the State......00ccceee A @cccececeee tate Number and District)
(or U.S. or City’ or Sellen, Ack (Months) __Cer tif. sc agit << Cer reer ea arenbedeantcmraatt (6. ene ith, le
tate Physician’s or Coroner's,
Cause of Death “C4£EA4. . ! Pi ea Danae Cnriclert . Personal Service. ......ccceecceeececcuellececs
— Fe Peer artty eeuesar eee: 4 orale lore erates ists ior alae! g.alanw gekonatunbewlanane ites lances
Contributory Causes. See AKbepots, Heh scl pie Mtuateassatte sine ic Ong: as sae se St Linke lard a asad elanscensierecul. mates
ate ET saveveccseeaes} Crtoas Total for Sales Tax.. 0c, .cisccocsscoSie asc d
Cremation
Cundenca ea udin® Ae Libeun. "hd Sry, mM off Outlay A OR Se era ene eee le 13)
CieBccctiaty Ue etc” UP RMMIE, alee Vin. Sven gal yw ace Bad amet gua es POM BS ea wo
His Address.’ A. ORS, Ve i et 4 Saka sh, cae .. line Death Noticesin... PADOrsilcns .c0ilbie.< « #5
fe es OO, ob ee sad Hoare A rete et ee elfes ene
Name of Father. Serarmett. ‘toe fe ey Flowers, $... Palms, $. oie : "Matting, = ET . . ae
His Birthplace.... Um TOE seep eees Rental of Tent, $..of Temporary Vault,$..]. ....
Maiden Name of Mother/¢747-Ve, At oer, ae of Grave or Tomb. hae co . as ck le
ining Grave, $... Lowering Device, $... . ....
Her Birthplace.... Un Cracecvrm AP ie ae Outlay for Shipping Charges. ........]}...0. ,
: Clergyman,$... Singers, -Organist,$... . ....
aor} Remains to. Chee side Pie o9 slates ed edhe dps Ratiroad len: $ ccalal pO ;
3/ 4 ((. ; Corey. ne Mors. }Tickets, Pia kaa viele plane Service,$... /...Size of Casket. 4° 7..<5 Gi Gan tee eee Telegr., Phone, Cable or Radio Charges..... ]...Manufactured by. . Aan. peta, Ae A mv sl Elie tee + oe tos rey — Sate Pear tee ally jamie
: ut of town Undertaker’s Charges....... /...-.
Interment at.. C44. . Neier ee = a Silt tay Sita pie” ea lian
Lot NO.. 0. seeeeeeeeee eel irae ep, ht coe: ae ee
Grave Bac . ccd. ccc. Total Footing of Bill.......e.e0s0e0. 3.7.7 /
ce se ig pape BN os gph dene Rie ae ak Sen Se ae . . Cee. .
oo ae anima Balance....... Sis. say os
Diagram of Lot or Vault OWE. Ni aibhe «Crone sis vn Entered into Ledger, page... or below.
Date Amount Paid Balance Date Amount Paid Bal
. . . .