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Collection: Original Records > Death Records

Mortuary Records 1959-04 to 1960-10 - Book 30 (326 pages)

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Name of Deceased. A Married CL Single ah Residence: ; ee ed t Gla. Chae rle, ST a eee Age of Husband or Wife (if living) ++ Vex aoe Acres i cae sie 2 SS) O18 0! O58 (0.6 Fe Ss F.0 5 0160 © 64586 6 Be .0 6 é\ml ee ial Security’ Number) SOOM CSO tere r ce ees ose weer essvceves Sis. Ze. (Hour) Date of Birt’ “>. Oe on .Age £2. a foie 4, ae eg oe oa are ee, (ee Religion of*the Deceased -. or ese “iat tray fe a Birthplace c STG BR Bac cae eae a mry pertain a Smelt a Resided in the States. 2 & slarlbatoph'y pl’ Wdadaeball en Uke Cause of Death ste 2 ee FE decd eu Contributory Causes...... 000. cee ceecceeceecee ee. "a er) His Address. —s Calle, es Ae A Name of F pa ee A ere 2 ty PES His. Birthplace: .. gai. 605 ooo co cds cence ok. Maiden Name of Mother [email protected] 00. cccccceece Her Birthplace. .Z7gsaf. ip occ cecccececececececccccee. fee of Funeral Hae. a. a ES 5 wn “¥¢. ite M, aioe ca Reeroging tO 0.00 ot hea Fiend, ee vec eae Size of Casket “e477. At De ain 8 oe Cis ails ate (State Color and Number) Manufactured by Chae LO. asa Ven Kohno em Vee. feet i Hee Grave Nox. eos. al. Section No........ L__ r— Block No..... se Dhanrarhok tod ce Vans oo Serpe ERP MEH i Miscellaneous. .. 0.00.. 0.0. 000. cecceesceeecccccc ce. Complete Funeral (except outlays)...... $ Casket. aa, Ye Puan ACER Fine om Joke ATK. . AO. Burial Vault or Box Cxz, € OF arsed Klee (State Kind) Hunbalming Bedy = foo: st eceaceseclse le Nels. (Name of Embalmer) Barber, $...... Hair Dressing, $..... . ..../.. Dressing Body, $..... Underwear,$.... . .... .. ROE TTR ie cuneate vay Gules. oe Wet teeta (State Kind and Color) Slippers, $.63 55. es. PROD oa) os Sal's sin olecs th od ed Cee Folding Chairs, $.... Tarpaulin, $.....H....}.. ‘. Candelabrum, $.... Candles, $......1]....[.. Door Spray, $.:.... 2 a ea a oe ee Funeral Car, $.... Ambulance, $...../)..../. Limousines to Cemetery.. . Se SE ae en ee Ee Fa Extra Limousines ...... Ch ARIE eer Mine! prea ha cote” open Autos to R. R. Station, ... ex on ie oka Mee ae Getting Remains from...........]..._. . Peking Remains tony. Fil wus oes. coSe co ulle. Soa te, Trip to Coroner’s Inquest ..........1]..._]. Delivering Bax toi.. 26. sce. tee cees secede un bec. Deliver Wlowers to.. oi. iss any scen nk WALES on leas SPOOR OHRIE Eis ogee vc Eat ce Nr ea le Procuring Burial Permit...........1.... 2 ons State Number and District) x Certif.Copiesof Death CertificatesNio 12 IAC. (State Physician’s or Coroner’ 8) Pall Bearer Service, $.. Use of Chapel, $... Gross Total for Sales Tax atovaletet sali ale ioe betes . Eee, Bea UNG TOP IM wise ss en selec hoe. s cece eile Wee WU See Fs erent My oats Fs ssh, ts” Wee oe aa te Flowers, $... Palms, $.::; s Matting) $08 oY et. Rental of Tent, $..of Temporary Vault,$..]1.... ... Opening of Grave or Tomb......... 1 lO. Lining Grave, $... Lowering Device, $... . .... ... Outlay for Shippipg 2 a a re, eee Cmem Clergyman, yee-Singers,$. . Organist, gre AFA, Ranroad \ Tickets, Bic! css plane Service,$...1]....]. ‘ss Telegr., Phone, Cable or Radio Charges....]....]... Cash Advanerd?: 7) esiedeectienctcs ee ee, Out of town Prineva Director’s Charges....,.... ... POMONA BENNIOS. 6 seo « cis Sas anes terol kad line Death Notices in... Papers ....}]....[..6OP acnca af Newenepeyt ttt eefese ese elewees eT ay. At de ees sie apis ety Ll, Ff EFr Total Footing of Bill........... SIZE. . OK7. MM edn, «elm g-o tra sae GN, Lee $ Balance. ..)..... Sl hss 'oxshel at] wate’ <i Entered into Ledger, page... or below. Mar Rein” oe . S lS PINAR eles Sa trdlsiilerole 9-019), @\pia sh eneverane’s. e sieis ees Beg Meee Miscellaneous. .