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Collection: Original Records > Death Records
Mortuary Records 1959-04 to 1960-10 - Book 30 (326 pages)
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Page: of 326
ar°21B
RECORD OF FUNERAL
PGE Noes odo .ace gon eainins Yearly No. 1 fbS.. Date of Entry.. L4G SAN ees 19€.
Name of Deceased. wk. (fea. a: Ad. .: LiMo 2977 BAP Ak. of RMR Se oh en Age Mater, «bea ete ecole denen ar
C1 Married CO Single [BJ Widowed IB) Divorced (What Race)
Residence .~“F. @. Ave Mba Ake. “CLESS Seine: + Coated wusCony 5 “haa ; a. be o, aN ft Be ee a, me
Loon he be € 0 usband or ue SPUR IN on) 205. elk seakos €
Charge 60 SLICE PN rae Rae te LF ph ee ae . Paes ;
Lo ee 2 F ete Fune BS) oes tic ees
hAdvenn. og. ert LORE EE Fieve ves sete 1 ase A ovr
Order given by,</ pi ie ree Lia. chet C47. . Burial Vault or Box Chinen AA te r. ; Re ee a
or informan (State Kind
How Secured. . Slee: pty er ee oe Embalming Body ... pias Seen le
If Veteran, Name of War. Mh , eed oe ee Barber, Deh y ih eects Hair Dressing; SB Ecut are « SH omest allots
£2 Dressing Body, $..... Underwear, $...\... eden
Occupation. PD ha. be ate.. VW, Mater’. Sikon Wpees cs. ele tee ee Weg ah contend asles
W/ if, ; (Social Security Number) (State Kind and Color)
Employer and Address . Ede His bl Ad enc ca eelile Slippers, $....... PORES. et cp ediae.i cis Bc nen eee
Folding Chairs, $.... TarpaulinaS ede sss otdecee wane
4. 2 , < LY 4
Date of Det. VES I by Mele le ein, BAS. a Y “. Candelabrum, $.... Candles; $5.. .asc!ysdlee ole.
Date of Birth. <-¢7. EA LE27. Age Sdn .76..6. Door Spray, $..... Gloves, $. 0040. .0. flees esi
Qo.) Day) (Yrs) (Mos) (Days) . Funeral Car, $.... Ambulance, $..... . .... .-Services GP. CST E Lge Cre OEE: Cow Oe ae Limousines to Cemetery oy @ $ Sete TPS ae % (0h “ee . ae
1 Wy Yo CHES. ey ne ert Extra Limousines ...... $n RY
ae = a be (Address) Autos to R. R. Station. ... "CES 1 Rearend ie =
Religion of the Deceased. . a ee ae Getting Remains from............ [...0e/e
Birthplace . ee ert. ny, hes ek Taking Remains to.........0000005. W oi cinta Gineats
ee Trip to Coroner’s Inquest ..........].c cece fe ee
Resided in the State. Vou. = Sai hayhe oy . “Cyears) . (aon ths) Z ee tats Box he aes satis co: a: eL TDR Sol he ailp cose ok lSpaiceges Se leue lohbieame-¢
Place of Death. 2%. Za parr. SaSe nee Wer Blgwena toe nis ease 8h S ciney So ne Sees we'd
Removal:Charges' ii.. 5.6 oP ects ou tlle fae das
Cause of a eee: Aeanetibageh Procuring Burial Permit. (State Syieniae eed District) » en ST iabs pe 0) 6.2 .
Contributory Cacsin LZ Certif. Copiesof oe CertificatesNo. te Ses
ee ee tate ician’s or Coroner's)
Pall Bearer Service, $. . Use of Chapel L$ Reet
SE ee Naor bid y araids acateinced pes Mtn. wraey etettsalbse PRC eee D eiglle Malerete uektue Fale TIES. Ce aR, aloe i fig ee
Certifying OL Me alk “es ae.lyeed Povevevrcees Cabin Fir Lath sie os « Snes oo oP bale an ; ria . s
7, CPETSUIOB ae gotercet yc sereiees atic: casein! Shy 5 aeomete el aeeciees Veto, «loore Meal aT
His Address.. 4 Akin. Gatg 4 7 eS esa na Flowers, $... Palms, $... Matting; $05. Mes bea. fes
Name of Father. . Wok TT en obit a niebbnerec di tee eee etn fae ne Rental of Tent, $..of Temporary Vault,$..]].... ahs
His Birthplace.. .¢¢cz dh eed ORE a tae Opening of Grave or Tomb? .¢44.6 777.9... pone 34 Baas
"Stage . Eee eo ey . 2 Lining Grave, $ hoe ee pa tate ds ty
Maiden Name of Mother.. ‘te aire OU le ie So Outlay for Shipp ROA ba Wit. 3.45 walls vl ee
Fler Birthplnea, 2.. 2k oi bos ve vereshocadi Clergyman, ¥2 ‘Singers $ 3 “Organist, $3.7). --#e2/#r
Tittdio! Biennial LD LEO. C00 EM iread Wickets, FEY appt plane Service,$... 1....
tes (Date) ‘so ‘(Bay of Week) (Hour) Telegr., Phone, Cable or Radio Charges..... . ....[--Ship a; Retains $00.7 6.) oso sre ea ceca euelha cs eel uwes Cae: Bavanted . <i. he cal, «hsv ce Geas Gee dee
Size of Casket “C2 a T74 hee Gee Shaye Out of town Funeral Director’s Charges.... . .... .“fia aes en i aes tee PETROTIAU OCI VIC) calc ole bicieSoronle ace wciee wales oe [ lene eae ee
Manufactured by See ene fe a eect ae Cy Ee o., ets atenehad sieueae of aankeleheltasieiee elaisis 1 nhs seaveceini ge otlee. ce stopeconed i's a Are «xe elf ts
Cemetery Gemetery Uae et, “i, 5 PLE ae nhh De 6 cite Poe cr IDs ws os Paperas sy. Gs Haell sd
ia so ees ateane ne cesatn es walsh calfetie sable
Grave N BE a ote cree eta Se st tae eine thie 48, 5 elle celin ins 6w: anti 'e) pile [Si a) wile obec) chal . rire ug oe [ree
he Ek ides Mar Sans eine sac dado e g
ica hee aes ke eee ae Total Footing of Bill..........-. $I] S27 . .<
BlockiNoe 7.. ssi. fone Feed . $
Diagram of hetne J. OWnenis. A rs siete aehate os eet See i By les.
Miscellaneous. Peea dass AEC Ee ae Aare Ri aaa
Entered into Ledger, page... or below.
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