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Page: of 213
Total NG.. 25. ea . Yearly No..../ 24, es of Entry Law. 2 1945
Name of Deceased) Wy alt Alans: LpLLe sy 1S De ee Lee ieee ae ay Ah Ze a
Married a Single 0 Widowed D Divorced
(What Race)
(jHushand GlWiteChWidow po oe
Residence. ys t* W2); a pe 5x5 aS ei: or. of Age of Husband or Wife (if living).......... Yea:
eaaree es tn KLM.. ‘= Pavep bi Complete Funeral (except outlays).. $ bas
Address.. py WEE. ASSL — Condes bI2.\ oOrder given by. Les.. RCM 2 Se CChEE. EA Burial Vault or Box. C emcad.. Luneg. hes yo
ae ita
e Kin
How Secured nnn OA LLL Embalming Body or ear a . rE
If Veteran, Name of a CLEL.L. tes 1tp€< a ee te. eB arber, _ ae eae Hair Dressing, . Saati eno somes,
fi Dressing Body, $....... Underwear, §......--20--. . -.-.----.----J.--.
Occupation.. Liss Kp CRU SIR.. SS boS72s “2. 1226 Sit OnMuresoi. eras. The Fy ete, Ne Oe BE ea ele
Lh Ze a i wie Number) : (State Kind and Color)
Employer and Address. “As/€@...77L Rig LLCS Shippers, Pak es ate te ise yee ones. eect. epuee tbls 1
Date of Death\/Je¢. 30.. s7eke Jr of si: Chairs, $........ Tarpaulin, $.....-.. .
Day) (Yr.) (Hour) andelabrum, §........-Candles. (52. Mes oat es
Date of Birth L CPs it OL. Ag gett pa : “der, ate Lfe. Door Spray, $...-----.-s----0-Glevess $i-i aw! dt ad ew Le
aye (Yr hes . ays) . Funeral Car, $.........Ambulance, $
Name of Father. tell ad, LLL nan ©. Le Limousines to Cemetery GP ah a ae anna at . ede eect
His Birthplace (42 Kd Extra Limousines @ $
ee Autos to R. R. Stati he eat flee Maiden Name of Mother. £ Cs Le. Loh. 247.. ponte Sera ay @§
‘. Getting Remains from
Her Birthplace Y/, WA Taking Remains to
. eB Trip to Coroner’s Inquest
Date of Funera a = =) aL. = 403.007. Dewees ee
Services at.. tft B LUC AUEK. Deliver Flowers to
Removal Charges a
Clergyman.25<€. Lt.. ew el) pi ei Procuring Burial Permit Bi rife
es
tate Num an istrict
Religion of the ry © Certif. Copies of Death Certificates No.. IAN
tate sician S Or roner Ss.
Birthplace ‘a vay S Pall Bearer Service, $..... Use of f Chapel, $ he
Read ina Sia Oe Gross Total for Sales Tax $
(or-U r He or ee (Years) (Months) Outlay for Lot
Place of Death..4.€aS. re Cremation
Rael
& Causes of Death. lM Ay. 4. Cpa AL Oey ey Ln lake fos , Flowers, Sadns.¢WPalms, $....Matting, $...... .SST.
Rental of Tent, $.... of Temporary Vault, $....\. ......-. .--:
Contributory Cause.. PATER. 40.8. CLER. 09S4S.. Opening of Grave or Tomb.9...cC/ASLA).6=... . _..sSTG_P
Lining Grave, $...... Lowering Device, §$...... . _..-...-.-. -.-utlay for Shipping Charges
Certifying Physici \ dames ss ae eee C Aare. Wb, ite ane L4G ereymen, $.2k sinaete, $ hoch Ofvanisii6. sn
Rai d : be .
His Address...2 BALLS Peg x ¢ s L Ge Mout { Tickets, $...... cian Service, $...-.-.-. . --.-.---------. -i.
Motor 2 Telegr., Phone, Cable or Radio Charges m4 Remains to
Ship
Cash Advanced
Size of Casket. //.05..77:: Es . Deut le ths Ca dalpQat of town Funeral Director’s Charges
i? lor an ber, 1
cary . or ain L(t. SLeseadet Bre md Se rly Shae
Cemetery igh iS line Death Notices in. ..... Heber ed
GrematorySen Llase.o.. J/LMe2 AR
Lot No. (Names of Newspapers)
Grave No
ogy
Section No. Sales Tax / o_
Total Footing of Bill gL 44 7
Block No Less $ ie
Balance a Sie es : O
ee ee nae wins Entered into Ledger, page...... or below.
Misc.
Misc.