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
ROUVUARY VL BD WIN Byars aa
i Wa) 2-1 \ (cn Yearly No... Ante. yeah Date of Entry lV] Ui, YK 1¢
Name of Deceased Lh 74) LS. Cc. LL EME Whi Le
Married o Single o Widowed Oo ae Ebates (What Race)
usban: ife idow
Residence 3 Pa ny) BS ch Vad hk. gay: pe of t Age of Husband or Wife (if living)..
vf,
Charge to [Ves Helewde es IM € FTE 1c 1 ie §
plete Funeral (except outlays
Addressa32¢ LV ENY [Z l2 Casket 17S
G
Order given by tte ©. Aw LL adKke Burial Vault or Box see eicas
or informant) tate Kin
How Secured np 1.9 Ale Embalming Body (Name of senna)
a Barber, $....-.-------+-Hair Dressing, $ sh ,
aT Vaue: oy! nt We Z Dressing Body, §.....-.--Underwear, $
Occupation ALL a S772) 7( A Z. Suit or Dress
Oke Aux: ae a y (State Kind and Color)
Employer and Address Z () ; y eae, b Sse eioae ee De em ose, $..
Date of Death/Z4xz....L 4 Z £66. 10. es . Folding Chairs, $. Tarpaulin, $
Ms.) (Day) (Hour) Candelabrum, $......-----Candles, $
Date of Birthwlval€ SO Ke e <6 \% _f4___ LA. Door Spray, $.eccenv-s-ceon-----) sigs (Yr.) (Yrs.) _(Mos.) (Days) . Fyneral Car, $
Name of Father A-ctaz< Ad Ladd cele. Limousines to Cemetery @$
His Birthplace as A doe, Extra Limousines @ $
Autos to R. R. Station @$
Maiden Name of Mother...6Z, oe Getting Remnind trem
Her Birthplace tL NK Taking Remains to
/4 ; . a Je Trip to Coroner’s Inquest
Date of Funeral. 4’72 vf} 2 a) ah. VA al. Delivering Box to
Services at pes JIC 2.. CALCKH, Deliver Flowers to
Removal Charges.
Clergyman Slitin Lekan K. Procuring Burial Permit eC RTE EET
«os
tate Number an istrict:
Religion of the wing at ae Certif. Copies of Death Cert ificates No oro .
° (State ‘ician’s or oner’s,
Birthplace. iy on Zs Pall Bearer Service, $.....Use of Chapel, $..... alae =
Resided in the State VA Kw. Gross Total for Sales Tax $
) (or U: oe Sr Couatf) rears) (Months) . Outlay for Lot
Place of Death. JU/@.i/ aS, Cremation
Cause of Death fe ule Leet Bkod. 4 a. L. Len a ae Flowers, $ Palms, $ Matting, $.....
atl Rental of Tent, $.... of Temporary Vault, $-.... . -..-.-.-Contributory Causes. Ve Ad Whe ASA Opening of Grave or Tomb
Lining Grave, $.....-. Lowering Device, §...-.-.--. . ---------a ~ x Outlay for Shipping Charges
Certifying Physician ae hkl deed LL. Clerzyimen, Soa Singers, $.... Organist, $..... . ..--.---His Address yy CLF o/, Vim “Tt ZA L. ot Mote { Tickets, $-.....plane Service, $......-. . --..---.
Motor . Pemains t 7 Telegr., Phone, Cable or Radio Charges....-..-. . --—---Ship . Remains > Cash Advanced
Size of Casket é 3 Out of town Funeral Director’s Charges.....---.. --------.
Pw oi Color and ber) 7 est! ae eRe = es IA Rai Personal Service
os 7 eee Mas a / ‘Yom Kee sod line Death Notices in Papers
Lot No. Mnungp @ dtd (Names of Newspapers)
Grave No
Section No.. ypesec--c-sccceseecesees Sales Tax.. ——
Total Footing of Bill $. _.2.22.
Block No L Less $
Owner Balance.. $}. ..-.-Saisie bee ene Entered into Ledger, page...... or below
Misc
Misc.