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
Total No cee We aE ra 4 Ae Date of Entry. Vie 901d AT AE? 21
Name of Deceasea Lon /eo/, hb vf Lie i) PR Aa
O Married O Single p 4 Widowed de, Divorced Oe ae ee
Residence-3e2-2 hd hd a SZ. Sr rs gs or. of Age of Husband or Wife (if living)
Charge tol ne5 1 ed £7) L, lah ZDurxl
eevvsennenvennnenee ¥ CAFS
=y lete F $ Pee Se oe L Cee / -) Complete Funeral (except outlays) 5 a
Casket > -LA.20\An.
Order given by. L Les. es Loe. ha ALM Lh, ZL Burial Vault or Box CemealZ LLMR. 92D IAD.
(or inform — a (State Kind) .
How Secured \Rd2al Embalming Body. Sang re ry fae eel
If Veteran, Name of — ae Barber, $ sateen amen enna wane Hair Dressing, $ ated . ee Me
Dressing Body, $....... Underwear, $..0.0..2.2-. [e.
Occupation. La@AaAGer S Ld. leo HY, Suit or Dress
Employer and Kdicen Sf ea La Te. > Slippers, $. Hose, §. omy
Date of Deathbfne 1. ae LEGS. Lhe P. Folding Chairs, $. Tarpaulin, $
(Hour) Candelabrum, $...... Candles, $
Date of Birth CK ZL 22. W AEA e 2. Z. Fm 4%£. Door Spray, $2.02 Gloves, $
(Day) (Yr. os.) (Days)
Name of Father Pelee Die ‘ Funeral Car, $.. Ambulance, $
Limousines to Cemetery.. @$
His Birthplace WA ade. Extra Limousines.. @$
Maiden Name of Mother L2 pus (oe CC as Autos to R. R. Station. @$
— Getting Remains from
Her Birthplace £AG. a3 VA Taking Remains to
Date of Funeral4oe Z ve, A?) a WZ Nett) Fx. BA to Coroner s Inquest
(Date) of ve (Hour) elivering Box to.
Services at ID CO Bien Deliver Flowers to.
Th 7) Removal Charges
Clengyman M at idk oaged Procuring Burial Permit Senseo
= tate im id District)
Religion of the Dea F Carte. Copies of Death Certificates No. ZE. 00
tate ician ir ‘oner’s)
Birthplace G: ALLE: Pall Bearer Service, $..... Use of Chapel, $.
Resided in the State. SS Gross Total for Sales\Tax $
J (or USS. or City Leen (Years) Digi Outlay for Lot
Place of Death ee A 1 ee. RS Cremation
Cause of Death Cte enl4e rie wha 7 thea Land Flowers, $...... Palms, $...... Matting, $
ZL Rental of Tent, $..._. of apie» ault, $
Contributory Causes Gen a Ws ERAS & =.. Opening of Grave or Tomb. OSLA.G...\. _..SZiGQ..
_CKAS/S Lining Grave, $..... seen sapien $
. Ps) = WZ Outlay for Shipp Pepe TL aree ca)
Certifying Bee : Le Yen ZL ae) Clergymen, LO. Singers, $$ °”. iced’, PERS a ied . a A ar)
/ or er, Railroa
His Address BSS. Ley Lk Keel pero) { se Bo ennnnnnnene Bions Service, $
Motor Rania to. Telegr., Phone, Cable or Radio Charges
Ship : 4) 28 Cash Advanced.
Size of Casket 77, ef "Ch gpes ZAC Out of town Funeral Director’s Charges
ee lor and N: ) Servi
Manufactured by. Cee BA 46, Z a escnal ta
ear A CP oy 1 line Death Notices in Papers
Lot N (6) (Names of Newspapers)
Grave No e
=
Section No Sales Tax £735 =
Total Footing of Bill $. _-Z3Z.\\S.2Block No. Less. S$
Conkex Balance $
te aipainticig whet es v Entered into Ledger, page.. or below.
isc