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Collection: Original Records > Death Records

Mortuary Records 1963-06 to 1964-09 - Index Included (334 pages)

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RECORD OF FUNERAL otal No Yearly No...Z.7@ ‘ame of Deceased..C2Z/.5 K. 4, biased Date of Entry LGR. é VA 21 19h sk BeMarried O Single 0 Widowed O Divorced esidence..2.Z. aly. Se Cai Ge. OHusband OWife [Widow harge to °Z2.5S. Se ce. tid icn se77. of Age of Husband or Wife (if living).. Years ddress..72 wel Poe Ope CL. rder given by/Zes areas Mh ta SteZ Ln. (or informant) ‘ow Secured S 2.2.2 “Veteran, Name of War...2.—= ccupations ed. Sal. BL led 809-0 PETS . Complete Funeral (except outlays) $ Casket. Burial Vault or Box CleaaaL.L1ekR.\. .$-d\0¢ (State Kind) Embalming Body. (Name of Embalmer) Barber, potest ae Hair Dressing, Dressing Body, $....... Underwear, $ Suit or Dress $ ial Security a (State Kind and Color) mployer and Address..Z Lb laas.. Be LL. MER. ER UMBPP ELS, Becceonveceeecceeeccnen---Hose, $ 3 Folding Chairs, '$....:..Tarpaulin, $... ate of Death Lae. cd ar (6 Ad. ahe oe Ge 3dr Candelabrum, $......... Candles, $ ate of Births24.G ar Z. AG. vey b. A. wad. ae 4.. Door Spray, $..0.0...-.-.0.0--Gloves, $ pile eves i 8: pie’ . Funeral Car, $...20..1... Ambulance, $ ame of Father.. BBR Yoni Sane ate al kL fa.. Limousines to Cemetery. ees CRT eal . IES "ogee, is Birthplace KL A. Extra Limousines (ba ee el moet oie . cele le cre Autos to R. R. Station @ $ faiden Name of Mother.. Sh hema Ceant oa ne Cetin Eeartinins feta er Birthplace Le. yA ; . Taking Remains to ate of Funeral “Zg2oh, LIAL. [UE BL AUEM. (Date) (Day of Weék) (Hour) orvices at.... He EE, A A 3 Fe LoVe Cie PRS. oN, lergyman..=44.2.... 0. thane h Tia Bea dicen on Ae (Address) eligion of the Deceased irthplace Pe a A$ SOURS. esided in the State =a —_— (or U.S. or City or County) Years) (Months) ace of Death_ aaa. Mis 0S ause of Death Seite ot Hepal: ¢.. batlur ontributory Causes artifying Physician Abe LALA Md). Pals Ypsll. (or, Coroner) is Address C-R.2055 iakidetiyez. otor ¥ a t Remains to ze of Casket. 440d a @ Nich hit al. ESnots age um. we me J -anufactured eis eee, dit ac nygRI inl Lot No. Grave No Section No. Block No. Diagram of Lot or Vault Owner isc. Trip to Coroner’s Inquest Delivering Box to Deliver Flowers to Removal Charges Procuring Burial Permit 3 (State Number and District) rP =. Certif. Copies of Death ‘Certificates No. (State otek 's or Coroner’ 's) Pall Bearer Service, $..... Use of Chapel, $ Gross Total for Sales Tax ¢d Outlay for Lot Cremation Flowers, §...... Palms, §...... Matting, $ Rental of Tent, $.... of tea aged Opening of Grave or Tomb.. CLALIN SI lbp Lining Grave, $...... Lowering Device, $ Outlay for Shipping Charges Clergymen, $4c).°” Singers, $5. ne "Organist, ws . . 2d lye Railroad or Motor { Tickets, $...... reread Service, $ Telegr., Phone, Cable or Radio Charges Cash Advanced Out of town Funeral Director’s Charges Personal Service nsf line Death Notices in.......Papers (Names of Newspapers) Sales Tax d oS _ Total Footing of Bill $HS.X.9. .22.. Less $ Balance $ Entered into Ledger, page>...... or below. Misc.