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Page: of 213
EER RAE a LE I ETRE BE aE
RECORD OF FUNERAL (5Total, No.2 Yearly No,...AG49..... Date of Entry../ ARC fk 4 le 1945 ~
N ame of Deceased LAL ae ta L Cd. 2uER dhe Flaster
0 Married ie Single 0 Widowed o Divorced (What Race)
CHusband OWife OWidow
Residence. 472 —Jaal FelLibe aSy oJ, Le, on a Age of Husband or Wife (if living).. Years
Charge to./ pel. Abd Sl ULER.
a z Complete Funeral (except outlays) $
Address.. £4. Sra) hekige Su J, fea
ee ae gy Y ‘ Casket ast
Order given by dh: Cel. IOLA. GE Buna Vaultor Bomewee alent . Seb ogee oa 1 . e
(or informant)
7 (State Kind)
How Secured SRG ALLL. Embalming Body (Name of Embalmev)
et Bather, SLi Hair Dressing, $
Vet _N f ¢ :
att nae ome ane Dressing Body, $....... Underwear, $
Occupation = : Pesce Sl Suit or Dress
(Social Security Number) : (State Kind and Color)
Employer and Address es Slippers, $ Hose, $
os Folding Chairs, $...00.... Tarpaulin, $
c é
Date ot Death ga 4. “Bay é. 26s er . Candelabrum, $...0.002.2... Candles, $
Date of Birth Zale ot 16. ag “Gy. Ages Si £. L.. Door Spray, Seeernnnnnn Gloves, $
@ oe (Mos) (Days) . Funeral Car, 9.0.0.0. Ambulance, $
Name of Father Hake Lal ELavii Limousines to Cemetery @ $
His Birthplace Bk -£ Extra Limousines @ $
: ae AM hire Autos to R. R. Station @ $
y Cc iA (Sop. f 3
Maiden Name of Mother 2d. A$ Jf hon Getting Reronied fro
Her Birthplace Lak. LL. yz) Taking Remains to
Toa. eres Trip to Coroner’s Inquest.
WTARCK helo LUCE cor disrdlM. UP 1.
Rate ot Rena (Date) UE of Week) aod i Delivering Box to
Services aco KS dpe to are . Deliver Flowers to
. Removal Charges ;
Clergyman en ft han. Procuring Burial Permit Sie Nie BS
(Stat uml ane istrict
Religion of the eey marseccetaernssenstanenneegeraaetennatensancnsenan. Of Certif. Copies of Death Certificates No.. f. e0
tate ‘sician s or ‘oner’s)
Birthplace la LLL Pall Bearer Service, $..... Use of Chapel, $.
Resided in tha State ZS Gross Total for Sales Tax $
ea .S, or City ia a (Years) (Months) Outlay for Lot
Place of Death “, ¢/ 44 Cremation
Flowers, ...... Palms, §...... Matting, $
C th 4 2 ’
ater gh Dea Rental of Tent, $.... of Temporary Vault, $
Contributory Causes Opening of Grave or Tomb
Lining Grave, $...... Lowering Device, $.
Outlay for Shipping Charges
Certifying Physician Clergymen, §..... Singers, $.... Organist, $
} (or Coroner) Railroad { 5 AeroHis Address or Motor § Tickets, $...... plane Service, $
Motor : Telegr., Phone, Cable or Radio Charges
Ship t Remains to Cash Advanced
Size of Casket a Out of town Funeral Director’s Charges
= (State Color and Number) Pe na ervice :
Manufactured by.. ey a th.. LUMA. Neevice._. . __ Sol an
Pc t Pe Yee ovk «ake ah eas lees eet line Death Notices in Papers
Lot No. LP (Names of Newspapers)
Grave No...72
So 3 il [2 aes. ee Sales Tax
Total Footing of Bill $I. .9.8.1¢2..
Block No. Less $
Owns Balance $
ne Te Tees ; Entered into Ledger. nage or below.