Enter a name, company, place or keywords to search across this item. Then click "Search" (or hit Enter).
Go to the Archive Home
Go to Thumbnail View of this Item
Go to Single Page View of this Item
Download the Page Image
Copy the Page Text to the Clipboard
Don't highlight the search terms on the Image
Show the Page Image
Show the Image Page Text
Reset View and Center Image
Zoom Out
Zoom In
Rotate Left
Rotate Right
Toggle Full Page View
Flip Image Horizontally
More Information About this Image
Get a Citation for Page or Image - Copy to the Clipboard
Go to the Previous Page (or Left Arrow key)
Go to the Next Page (or Right Arrow key)
Page: of 213
RECORD OF FUNERAL i) 9:
Stal Wo.ls. See Yearly No.. a eee Date of Entry EE CO.2d 19 o5
ame of Deceased Wz @S/ iL. ze ¢ 42s. VA Libs Le
0 Married O Single Widowed O Divorced (What Race)
ee OWife OWidow
Seiko Catal) “ads. hcbinrDR eae &. (Se oe t Age of Husband or Wife (if living)____Yeara
harge to. MURS. ies sin “is C_OLE. kK
. H sha Complete Funeral (except outlays) $
ddress... 72S. SIM. hal AD, el Casket AJloo
rder given by.. LF yes 9 Ae a i BL nak, EL ie Burial Vault or Box aie
infor cra . tate Kin
ow Secured Embalming Body
Barber, $ Hair Dressing, $..
‘Veteran, Name of War. a ig feb fame toa ,
ressing Body, $......-Underwear, $.
ccupation.& CMa we. Lal&.. SSH 432 F744 Bai or Dress
(Social Security Number) ‘ (State Kind and Color)
mployer and Address Ee Slippers, $ ose,
= ee peel Folding Chairs, $...... Tarpaulin, $
jate oF Death. Leb. Bal 2 ies 2 als si Candelabrum, $.........Candles, $
date of Birth.-Z2 a) Ae Age Zz Door Spray, ($s. ce es: Gloves, $
f Fath e. eos Salm (Mos.) (Days) . Funeral Car, $.......-.-Ambulance, $
lame of Father Limousines to Cemetery @$
lis Birthplace oe a). 2 : Extra Limousines @$
faiden Name of motherbseab.edbe..LZeatgle e¢pstos EG ed @$
ler Birthplace Us. F? «
etting Remains from
Taking Remains to
yate of Funeral. A¢.4 320.. . Je7. 22d
Trip to Coroner’s Inquest
Delivering Box to
(Date) Ae, of, Week) (Hour) :
ervices at.......42./ dd Yyga.e. ra, UeaVven. med ee ence Deliver Flowers to
‘1 Wa IAS Removal Charges
Sie ac a ae ET on etre ER (Address) Procuring Burial Permit.
eligion of the Deceased = Certif. Copies of Death ‘Certificates No sacs ERS A CR.
Rs LL J D ANd ee
(State Physician’s or Corse 's) i
sirthplace (a LIS KL. Pall Bearer Service, $..... Use of Chapel, $
: : Gross Total for Sales Tax $
tented an = State (or U, oy City o ey ES (Months) Outlay for Lot.2 LEREA. hada lhl.. re £02. EZ.
ace of Death Lie LB. 0S Cremation
Dause of Death 4} Qe Ze eS C ae iC Ween Cee. CaeRByes $n Palms, $.....Matting, $
fal y ental of Tent, $.... of Temporary Vault, $..... _....----. ------ms
Contributory Causes RICOLIS COKER LS be: Opening of Grave or Tomb
Hepe/ Lis Cave Cea d2al. Lining Grave, $.... Loweting Device, $_.] .-. ._-__ 2
¢A = ‘ZK Outlay for Shipping Charges man =. :
Jertifying Physician...: Ga ia ale ree bund 77 KY Cleres ren: $40. “Singers, $.... Organist, $2 Z81.2.9
dis Address Le Jala was (CA pag ir f Tickets, $_.... plane Service, $.crncacfiem-sece nal =
Motor Telegr., Phone, Cable or Radio Charges.
ship Remains baer 5 Cash Advanced
Size of Casket 447 A. @ o) Z Vek.. LA he.. Out of town Funeral Director’s Charges
te Color ang/Npmber) Pe pak i
Manufactured b \ ie Le & hb L. pee ‘Eve ay. LOS Mle Wispap er. eR. Sse
Temetery
= . t V2.2 Aud a ths. pe sae bath Notices i in Paes
Lot No. (Names of Newspapers)
Grave No iP
; G\ af
Section No..u....--secececeseeeee-Sales Tax
Total Footing of Bill $0.02) 5.
Block No. Less $
: Oo
Balance 3 perk ee . [are
EAS LOS SBE ee Entered into Ledger, page...... or below
Misc
Mice