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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
60)
RECORD OF FUNERAL
Total No..42..... i Yearly Now.. ....00s000., Date. O%..., 29.000...19%2
5
!
M
Name of DeceasedZ Cot “Tt E ut {k. tia
RE eh: dee ee a ea
:
0 Married ] Single O) Widowed OO Divorced
(What Race) Residence?.¢ 4, Ly. Chunch. A, Manag, Valle. 2) eee ee ais aie] {ed cane settee eae eae ae Charge to: U7. WV. (Saker OT
ten eer
07
A pe
Va 5
Complete Funeral.............
$]. . 23. .6 / : ve oe a ee A 3 24g 3 Bede HT et, Casket.. 7. drarvxte?....
oe. 40/59, Order given by...:....5 Corian “the Hosen Poke Burial Vault or Box ... sesriegee tents ed calaayes seals wey
ir orman’
te How Secured © Meese de © end An oie ua ae 81h ebe Sib ene &: ence Embalming Body te eee (Name ae ee hae 2 fae nme he, . . CPC Aa ier y. (TES OPOMOD since vce yen kee Tole vee tinoel adit, 2 wee Barber, $...... Hair Dressing, $..... )....]..,
:
ak Social Security Number) . Dressing Bode, Siw cakce. < ,-Underwear,$.../].... .
te
Name of Employer.....2070........0
Suit or Dress.... BN acest ee ened oes 1 d é. —
tate nd ans or,
Addres . oF. esececs cece. LOG Oe © ein 6 (0 6:0) wo ww wile o ial ale a Slippers, $ Siva: ote oule goes Hose, $ pivcelares ere 8ix'y o oles ivecsiaillala ee Date of Death Zev. .. Wie ok ..3, Gm, . . Folding Chairs, $.... Tarpaulin, $.....]1..../...
(Date) Z (Hour) / Candelabrum, $.... Candles, $....,..]1....1... Date of Birth. 7% Vins Frees. sacytt Pe oe Door Spray, $..... Gloves, $......fee see cclee ces
iin 7 3 Q = Funeral Car, $.... Ambulance, $.....11....]... aoe ei ets (Years) "°° °° (Months) °°" * "4 (Days) 7°" Limousines to Cemetery ... MOR tivity seed Mee, 2. eae
Date of Funeral/Zoy 22 . dekoaieton ee = art m. Autos to R. R. Station. ... RDP 5) suc umiawll aby x. eaece
(Date) (Day of Wek) iBen) Getting Remains from....0.....0..
00000 P07
Services at: A goetacn. 9, Moan, Pnareasey. tr Taking Remains to............,10000 & Clergyman: :7 GA. . Ip hodh, Av antlers
Trip to Coroner’s Inquest ........0.0)00
0 fo
. i
Delivering Box to. 0c ieiceceeeeseeect
Deliver Flowers 0.0.0.. cscecscetevececee
de te,
eapedshaeh is. a eee es pe RL, . i ite (GR
Procuring Burial Permit. 2.0 02....200.00 Moo dn
(State Number and District)
—Certif.Copiesof Death CertificatesNo.__
sd
(State Physician’s or Coroner's ) ‘. Pall Bearer Service, $.. Use of Chapel, $...1... 000.06.
POMONA MOVIES, Felon. sey cied erences cu, athe ore d
Gross Total for Sales Tax..........
$]... FAP £8
MOONY BOD LID se. soa seat tsnsyscay. orci fee eee
PEE OAIID we ss ony AB echt ons jc. 8e ee ee
.-.-line Death Noticesin... Papers. oo. M8
Flowers, $... ; Palms, $7.” Matting, Fee» sive Oe de slurk eo
His Birthplace.A-Cac4
=
Rental of Tent, $.. .of Temporary Vault,$... . ...
5 a
:
Opening of Grave or Tomb.........
. . A223..
Maiden Name of Mother.///a ‘
Lining Grave, $... Lowering Device, $...\. ....]... Her Birthplace.....4
Outlay for rego: Charges. ........1..
5 mane
;
Clergyman, $ 7.$°0.Si ers,$..0 ist,$...]...2.19
9..
Motor} Se tots Ws % RA iF sina h's 45 aa agence eis eee Balad . v chots : ingers,$ sr hme > : ;
or Motor (des arse plane Pes evillew dave dlp ace ee
Size of Casket”. /.7.7.a6: A ~ : of) iNumbe ” ae Telegr., Phone, Cable or Radio Charges..... ....1.._ Manufactured by. ; : A : P; . oe eS Ae en ie ed Cash 7h get DEEL et REE EON EM . SoiLait) lela
use asta Se (Nae OR sche koatameee (el ee
Lot Nove coossessseeesee] SOL MP Me ine iecmeneiiantg ebay Grave No......... Total Footing of Bill...........
$4.51 . 2. 4. .
Pee Se i
$]../314.9.
Section No........ tien .
Balance.......
$A. % 81.3. .2
Diagram of Lot or Vault OWA Fs sac naseduabed Jz Entered into Ledger, page... or below.
ye
Date
Amount Paid . Balance Date
Amount Paid . eee .
T
ee