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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

RECORD OF FUNERAL
Total No. 2%. ..esc0ee5-. Yearly Nowe.. 0.0.. ssceeeee pe te, 2h 194
Name of Deceased.. /Aorrrad . Jolann 4 Rica en ew tila Menistagers ob ‘sag lnrratarersears.@ savas sverersicis ice vineenetliv wile cuca
WA C Married OD Single D0 Widowed OO Divorced * (What Race)
Residence. .. “4%”. Aasmacacia Ear eas olin ude as Set FSP: ere ee
, aac QR a ciete MOS ol eCe dialed of
Charge to:.. Alalid 1. & ETON pan evicted tend tes Jo kL
sine «wa oe ne Mthe o eaee Wee
Address.. //23. Sucker. 417 ban dame, pige = Benepe ;
RM, Fe eas, or os eae «oe lias a 60s wie asw Zarate Mie sem ae
Order given by... ae tte tee eee e eee ee eens Burial Vault-or Box ......0.c0ecee eee.. AONB.
(or informant) (State Kind)
How Secured.... Lberont. et ermcde alan ary es ea Re 0) Embalming Body ..... PU DUE atm Sone
5 (Name of Emi
Deemed: «Ine, FT iy acre <elatee a= x Barber, $...... Hair Dressing, $....]]....]..
(Social Security Number) . Dressing Body, $..... Underwear,$...l}..../..
Name of Employer.... Oral © auatelGhn sud rai oie fepbes ts, Uses ease fe Suit or Dress. . 0.00.0.. ceccccceecseeeeeec Aww,
(State Kind and Color)
cs I ab gah Sia wUlals) 6:0 eel wi erwinuee ars Slippers, a . Hose, $ Se en ay deen . me a
Date of Death. A fc.. ie ee he <a LO20. f°» . Folding Chairs, . weg *. Tarpaulin, $..... )..../..
(Date) (Hour) . Candelabrum, $. . "y2Candles, A ORR . ee aeae .
Date of Birth. ag. AY. SS, my paer nates eugeds she x aes Door Spray, $..... Gloves, $. 46.05 cease vss daele oe
Age. J3 nat 4 Funeral Car, $.... Ambulance, $...../1....
pee wee a a Limousines to Cemetery...@$......l]....[..
Date of ee 28. ey 130 hou. Autos to R. R. Station. ... 8 Fea) Sele Ae
en (Dag. of Wee ile eT Getting Remains from.........../)..,..
Services at. Natntabe. Me. har. Patri cecceee. Taking Remains to........0eec0cee eH eee efeee
Clergyman.:....... eee ee Nig” Rona oy Trip to Coroner’s Inquest .........-f. 00..
ie; (Address) Detivering Box to.. ai.. cece oesececcealles cou,
Religion of the Deceased...: ee ee Deliver Flowers t0......0ceceeceeeeceeclle...
Birthplace .. .JAre xz a, Rate Ve Removal Charger.. ..52:ipeccsnestosccs tlle. cas.
Resid s Procuring Burial Permit. Gath wane yet fe
aiuto unlit ho 5 SARE Gea ied" . CertitsContanot Sages al
ite cian’s or Coroner’s
Place of Death. VHIVEMRED eee eee Pall Bearer Service,$.. Use of Chapel, $... . ....
Cause of Death. Cy-zprary. fe Ss Poe Personal Service............00-.40.../00Contributory Causes. Mya decrdikads dee etc is edi vta ope ety Bs rupee Bey oe
pB sieht ga STs ely ly eee eeseeeeeesss] Gr08s Total for Sales Tax.. 22. .ecc cece. $f . .
SF fo ge. ne ee: ere fs
ne Physician. co : OF m7.. falar ree ceeeeeees Cc femation ep aL Ce rene en eA
line Death Notices in... Papers ....}]....)..
Sas bales hu diery TERIOR Peaenioes Be
Flowers, $... Palms, . ae Matting, $... ].... ae
Rental of Tent, $7¢'9.of Temporary Vault,$... . ... rie
Opening of Grave or Tomb.........]].. JZ) 50
Lining Grave, $... Lowering Device, $...]].... ..
Outlay for Shipping Charges. ........]. ..:.]..
Clergyman,$... Singers,$..Organist,$...l]....].
Ratroad \Tickets, . rae Aro Service,$... [....[.Telegr., Phone, Cable or Radio Charges....}}....].
Cash Advanced.. . 0.0.. cece ccc ccecccccecceccles
Out of town Unsere Charges. ......]]..../).
OM a eee,
Total Footing of Bill......0...0004. $]..3. 213.
EA el dtr Mik ene Got oo at ts doce sce se >) . . S a (ous
Balance....... b .
Diagram of Lot or Vault Orne ow. Ft ed oink wie ns Entered into Ledger, page. ... or below.
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