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Page: of 213
RECORD OF FUNERAL 65
PE: fe aT PS Yearly a tree awe Date of Entry JAD 2 19. LS ~
me of Deceased. /A.€ fs) of CLA? ace.. LLa YQDEMR... lb Te.
Married DO Single 0 Widowed 1 Divorced (What Race)
OHusband [Wife DWidow
sidence.ZO6£4.7...¢ es Pa arn 3 Sf x hts 27)" of ' Age of Husband or Wife (if living). Velie
sey ton Gud. i: paca. emus eer Complete Funeral (except outlays) $
dress_£.04.2 td), Ma ee. &. d) Casket SOG) OP
ler given by an CO.. 772 oP) Ce. Burial Vault or Box.. Cnen. Xia CRI. 3S-0) 20.
(or info ant) 7 (State Kin
w Secured aade edi "EF Embalming Body oer oe ghee ra
Veteran, Name of War Ue, ae “a nea ears aos ae a $
re pai oo ee nderwear, $.......-.-.-. . -----rs Sea aN ara ; (State Kind and Color)
yployer and Address.. (2) Slippers, panos ease TIOSG pies ae ee RL See
Folding Chairs, $..... ..--.-Larpaulin, $
te of ta seve nae ees aa L057. Candelabrum, $._ Candles, $
te of Birth. Bn ESab OLA eld.=. fh. Door Spray, $....-.0s0-------Gloves, $..--2.. .
Day): eked! yy eee) Moe) eye) . Burneral Car, $0. oe Ambulance, $
me of Father cL? OB AG. = LO LIAL ~~. Limousines to Cemetery Gyn ad AP aati . oh SS
3 Birthplace ie lad. Tie yy . Extra Limousines.. @$
; Autos to R. R. Station. @$
iden Name of Mother 4 Whe) Ay A. ‘e law “ll Getting Reématus ifaw.
r Birthplace Og Le _.. Taking Remains to
avi , Trip to Coroner’s Inquest
te of Wuneraieeeere od — seo ae rs AP M.) Deliverin Roe OR Ue Ge aed ei ae met et
-vices at Deliver Flowers to
: Removal Charges
ic teat Procuring Burial Permit
i. tate ‘Number and District)
ligion of the Dece, — wosesenenenssneesnneenenenenctnnsenntsnsecsenneaenateneaneel Certif. Copies of Death Certificates No.
= tate sician’s or Coroner’s)
‘thplace <L4. he Z£ 2 Pall Bearer Service, $..... Use of Chapel, $
3 Gross Total for Sales Tax $ .
ae he Ls SC das ee sisiss". Outlay for Lot LL aS LLY 22 2a eo.
ice of Death 244.. ein WP. Cremation .
use of Death. G ee 5% we CCl Vv mie Flowers, $......Palms, $..... Matting, $ .
Rental of Tent, $.... of poporny. Vault, $ El
piubribtinty Cases a En oes cts ndne tl ewtende ens dbeoie ees Opening of Grave or Tomb.. CALLING oS . E2..
Lining Grave, $...... Lowering Device, $
Sa ers) a Serie 4 Ge ey Ae Wh ciae for Shipping Charges .
rtifying Physician... Rite f.. Er K Re..Lod Rae 3S : oF Ciera . ne Singers, $....Organist, gs a2. .22..
U, rye Railroad . Aeros Address ASS re or Motor § Tickets, $_...... plane Service, $
tor 1 p Telegr., Phone, Cable or Radio Charges
i) emains to Cash Advanced
re of Casket 24/9._£ cae LAY, Laneptoeg Vas €. Out of town Funeral Director’s Charges
or ak Ni )
:
anufactured by.....0<. A LE ‘pate ay Hel = [etl Personal Service
sank Se ia eee 6 line Death Notices in Papers
Lot No cS (Names of Newspapers)
Give No 7 ash ¢
Cee ec es ee ea Sales Tax L124
Total Footing of Bill $ GLL ABE..
a . Block No. . Less g
: Owner.. 1 Balance $
is eee eh Yaa Entered into Ledger, page...... or below.
Ye