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Page: of 213
Bees wesw soe ~
vie
Sry iho: 7 ee Yearly Nove-L ed Sdnczceee ae of Entry..» /A/ aL. 19 LS As
eceased ./ Ib, me KreemeaLe BL ach bile.
Married _D¥Single Widowed — ( Divorced (What Race)
Husband Wife DWidow
705 = a Of — a a Gt ree of t Age of Husband or Wife (if living). Years
Le; A REAL
(Ua. tedabl ee. a pa Complete Funeral (except outlays). $
S3. G5ene dread Abe. SA, Casket EIA
apy AdekTee..C Puch e. Lib! Burial Vault or Box..¢ Nomen l. Ate fe SUien.
(or "e nt) (State Kind)
fer Virbac? Pr ae Embalming Body
Barber, $ Hair Dressing, $..
_N f =e ead eee sree ’
— War Dressing Body, $....-.-.-Underwear, $.
1 S Suit or Dress
(Social a ib Number) (State Kind and Color)
PTs Lal Ca Cah os ea a, IR aeRO Dell Say nt en Slippers, $ Hose, $
7 Athol aes S965" 7: engi Folding Chairs, $......---Tarpaulin, $
(Mo.) (Yr.) our) Candelabrum, $ Seeasanstanrenmase Candles, $
arte Mande a. wee ‘Sod. Age L1ioe =—.9.2. Door Spray, $..---.------.--+--+Gloves, $
ihes aay bac Pe Je Mr.) oy (Pays) . Funeral Car, ore . mien, Ambulance, $.
Limousines to Cemetery .@ $
ylace GecRnm an yee Extra Limousines @ $
Autos to R. R. Station @ $
ame of Mother ln LM. Getting Remains from
place Geen an Ye Taking Remains to.
uneral ofall Wee LAues aa 22S EM. pee a Seeast a ia
(Date) y of W pet elivering Box to
t nan ue bi ay ntaend. L. Deliver Flowers to
fZ. Lf He he oan Removal Charges
ie se Procuring Burial Permit ae re
tate Number an istrict)
of the Deceased Taeecnercsseeeteseteseateneesntecastaenntenenens] . Certif. Copies of Death Certificates No :
tate iclan 's or roner’s,
8 Ge La.a bY. Pall Bearer Service, $.....Use of C hapel, waka
t Yok Gross Total for Sales Tax $
a the stale (or U.S ase City or County) (Years) (Months) Outlay for Lot
Death.. fa 5 CACL Al Cremation =-<-xg @
he Dh whe Ais Flowers, $32=>..alms, $...-----Matting, $...... . ...»: a fe +
Death Gesufe. ae We Me ke, “= Rental of Tent, $.... fo) cigar d eV CYST Ugh eaten . Ieee ce eee HE OUEE ER =
tory Causes cash 3 @. Spening of Grave or Tomb CLAS LAL KE 2.0. _ FD
Lining Grave, $....-.-Lowering Device, $...-... . -------+-+----. ------om
CR, ey Outlay for Shi ing Charges
g rye tha Coa. pha LL. C2 Crrgymen, S/o Singers, $. rod ea Organist, $..... . -..4.2. ¢9._
or er, i
ress S;.2aSS. Vahk eK ping ol { Tickets, $= ee Service, $
/) Telegr., Phone, Cable or Radio Charges
Remains to Cash Advanced
casket Ad. 2 Leo lth fe fp -Agst of town Funeral Director's Charges
(Si lor and rt) Servi
stured by 8 HL. YV ede 0/7 Personal vs
, t l AALLAELD aA papi line Death Notices in Papers
Lot No (Names of Newspapers)
Grave No yield
Section No Sales Tax PL Mya"
Total Footing of Bill G17 2.2\7 2.
~ Block No Less $
Owner Balance $
apne ek Eee SAME Entered into Ledger, page....-.--or below.
Misc
ante RO SD