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Page: of 213
164 AWAY WAY 2S LY ~_ OY 4A YN ee eee oe
Total No Yearly Bos, ie ee
Kd Te
Date of Entry
SASS
Name of Deceased..LMLKV. Neb oy ECLA
OMarried Single / [Widowed C1 Divorced (What Race)
patie tiene sea AASB SMEL, “SB pec arercmecnss 8 reare
Charge to.. / AS. LTR ite.. £ AA) berl.
aulieie > ¢), wipe aban < / y) Safe Funeral (except a $ ies
Order given by LU E-61&. AA m dL C27. Burial Vault or Box C Cae nd. : Kine are)
How Secured % 2 f ane. Sena Body. AS
Tyee Noe ane Dressing Body, 6.. Underwear, §
Occupation 2¢. BH Af 9?
(Social ity N T)
Employer and Address. dl, fete ame ee i On.. I ZEEE ee
6 Date of Deats Jue 4G. OS We 2
‘ a (Yr.) At
Date of Birth.S Nec *B. ABS. SSD Age 17 2Q
Suif or Dress.
(State Kind and Color)
Name of Father. FRe “ii 8, J, pe Seg (Days)
His Birthplace GCOWAMY.
Maiden Name of Mother Lhe Vad rs LL h chs
Slippers, $ Hose, $
Folding Chairs, $........ Tarpaulin, $
Candelabrum, $........-. Candles, $
Door Spray, $....-.-.-2.------Gloves, $
Funeral Car, $.......-.-Ambulance, $
Limousines to Cemetery @$
Extra Limousines @$
Autos to R. R. Station @$
Her Birth ape ERMA fn Eee a. ?
Date of Funeras AVE Se SyWwes
Services at...7 27.0. LLL. : Ves AUR.. cA ep,
Massel 8 LL.
+ Delivering Box to
_. Deliver Flowers to
Getting Remains from
Taking Remains to
Trip to Coroner’s Inquest
Y Removal Charges
Clergyman..$-2.1..0-L. ae ee Procuring Burial Permit. ice BS
inl ‘State Number and District
Religion of the Deceased easiest tegen Certif. Copies of Deas Certificates No Sag . semana
tate ‘sician’s or Coroner’s,
Birthplace Z ae Lu LRLd S. ri Pall Bearer Service, $..... Use of Chapel, $
g Gross Total for Sales Tax $
Resided in the ey a (or U. SAGs ity or “Phe (Years) (Months) . Outlay for Lot 21%
Place of Death Ley, Cremation
Cause of Death Sey Z /'4de Fabens Disas Owers, $ Palms, $ Matting, $ plemmeccuaie . (reg Pca
Thi’ Gs, ental of Tent, $.... of Temporary Wault, $...]] 0..
Contributory Causes IWRC LaLa = Mn Md CL01 UES Opening of Grave or Tomb VY CaS IA_& moe
An) Le ay ae 7 Fe AO aa Lining Grave, $...... Lowering Device, $......-. . _..-.---Outlay for Shipping Charges..
Certifying Physician Clergymen, $.....Singers, $....Organist, oe
] Jy rc Céroner)/ Railroad { 2 Aero:
His Address : ' or Motor § Tickets, $...... plane Service, $....... . ....-.-Motor Telegr., Phone, Cable or Radio Charges......... . --..-----Ship { Remains to.
h Advanced
Size of Casket Lh if (0 eo cuheaal Heke
Manufactured by ~), AC Py o 7 ane CO PZ; Pl
f town Funeral Director’s Charges......... _..-...Personal Service
oem t ogee te a : ABD ol ces a ate line Death Notices in Papers
Lot No 3 (Names of Newspapers)
Grave No....2.6
SectionmiNo.c. cel ee Sales Tax. ; : Bae e
Total Footing of Bill $725
Block No. Less. $
: Owner
Balance $
RR ERE SE Yom Entered into Ledger, page...... or below.
Misc
Misc