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Page: of 213
a3
Io.. Yearly No..20¢ Date of Entry. / Ue. lg 1906S”
of Deceased Heber woe LLULRCS ih Le
YiMaried Of rp a Widowe (0 Divorced 2 (What Race)
Husband [Wife OWidow
ceeded ad A Vay?) Vee or L ] 2. or. of t Age of Husband or Wife (if living).. Years
to O16 1 ADL S. eh ean J
mplete Funeral (exce
wre ae Ne ca Uo i
Casket.. A AAS CaO uy. deat LY) LO.
riven by L RS. Lb) és Burial Vault or t Box.. SC mews Aime. . . “O_ER...
(or inf eae (State Kind).
scured wD) Lb Embalming Body
(Name of Embalmer)
ran me of War a ha A. a L Barber, es sees ; soe H gh er me
i Dressing Body, $.....-.-nderwear,
itionZ 2 Lid. lf E. A Minushee ee Sake he he =. 62h Suit or Dress
e mber, (State Kind and Color)
yer and siirellasemdby. AE a Sud. Slippers, $.. Hose, $..
£ Death Lee. fi yer he Bete Vs Oe ae Chairs, $........ Tarpaulin, $
(Day) (vr) Moon andelabrum, $......... Candles, $
f Birth& aad vy, SY ahee xAge 73: 7_. Door Spray Oi Gloves, $
SPST NEES yh GS ies (ays) . Funeral Car, $...----.------Ambulance, $
of Father CALC LACS Limousines to Cemetery. @$
-thplace pe, aK. Extra Limousines @ $
v7, Autos to R. R. Station @ $
1 Name of Mother (/2eZ Pe Pn Geiting Remaiaw fark
rthplace SLE. GMAEL. Taking Remains to
: ; ;
f Funeral 772, awe VF. _LUes. ZA KSd L. M. ao See ae = Eanes
fie aE (Ho elivering Box to
s at. bance mr ieee Fated Ak =. Ct An. Deliver Flowers to
Removal Charges
piseves: Sead. ee = Procuring Burial Permit — acces
a= State Number an istrict)
n of the, Deceased 2 Certif. Copies of Death h Certificates No. A ov
tate ician § Or mer
lace. fe MA. qd ys) $71.49 Pall Bearer Service, $..... Cee of Chapel, $.....
= Gross Total for Sales Tax $
din the a (or ‘ay gor City or pop. (Years) (Months) . Outlay for Lot ake LL2X. 00..
xf Death. /VEY, Cremation
of ae oe aed Ae ahLAotagn ugh ony 18) Bannan Palms, $...... Matting, $
hae of Tent, $.... of Temporary Vault, $.
butory Causes/, aA ee F chesocteed Opening of Grave or Tomb.. C/A04A).G... . 95-8 . e
, 27. Kee — IRF Pe. Lining Grave, $....... Lowering Device, $.
d, . Qutlay for Shipping Charges
ring Physician, Gy 7. SDUR ALLY. Ate eD 5 RS Le Singers, $.... Organist, $....]]....... ..ae
Idress Le evaWda ae oe Motor t Tickets, $...... plas Service, $
4 Telegr., Phone, Cable or Radio Charges
t Remains to Cash Advanced
Casket “~/ MO Kase ad eg. Fckine Tar». Out of town Funeral Director’s Charges
te Color d] Num Personal Service
‘actured by Sadi. yeaa lL. Seiad.. SavL. SOAs e £3 . od
bu t FEL, fee pee ae line Death Notices in -Papers
Lot No 5 (Names of Newspapers) 1
Grave No 2
F 30S
Section No,....---s-sececeseeeeee+Sales Tax é
Total Footing of Bill Sle OLLIE.
Block No Less $
bi . Owner Balance $
eS eee Entered into Ledger, page...... or below.
Misc