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Collection: Original Records > Death Records
Mortuary Records 1966-11 to 1967-08 - Chronological Only (247 pages)
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Page: of 247
206
Peal sic) ALT a are ORE Cie vag Me ee IE” SeAleAt DSME Mie: Fa SRNR LTE ead
RECORD OF FUNERAL
geetd Ni c.niss 3 ccvs-sies separ ptptewns Mee! _ Yearly No.
ime of Deceased.. Ad Lbte. Weve ne ine ay
© Married Single 0 Widowed = Divorced et LiZe
(Husband (Wife (Widow
« G.< PN, et eee e of Age of Husband or Wife (if living).. Years
meus Yes. kk LeKE ae Be bi. KS. Complete Funeral (except outlays)......::.::000 $
idress\D./.:.. pr BD.. MELM DME @.U/... Cah ccc sigh Be ehesag sive voi tevngeld mee, A
der given mae Sd Uenb..lt. ec ia AWS . Burial Vault of Box.\ CMnteL. Liat (on
‘or informant) :
yw secured......5 mf, 8 Ce 2 eel peel Rie etary eer ek ame Embalming Body....... Pa ec ereany aaa
Veteran, Nonie of Was = Barber, ssa ieee Hair Dressing, $.......:0:c000000
» Name of Waite.. Siaccccsccssescssssasiecasessecrsnsseeenssesnctectent Dressing ¥, Serpe Giplecwear, $52..
oS
:cupation./ TZ. Huse Oud nese.. Moth) KE PSsai-or-Bres s WAAL Poo lay ee eet eg Ee
(Social Security Number) ca Kind and Color)
ployer and Address.. s.¢ AA SS etsarnocthe si ordylOaeye.<seenete mie ae queen ere hantictes ot ee
Le ‘olding Chairs, $...... MEDAN; Go iccaen neal gsensal eesavdcteeensgedfeaccienatens
ite of Death (9.0) +r a ass “a oi lls tense Candelabrum, $ ae Ve . ! OE ee . OV . ac
tte of Birth 77V.S... x. G6 G..Age. Z2. i ale sf ap ape 7 oeeresag
FoR os. ys uneral Car,
ame of Father. BLY, nee i LS reel one Limousines to Cemetery....
s Birthplace......0... IER e as coceeecccccccsee estes eengisateesseeceeenees Extra Limousines......-..0..
Autos to R. R. Station...
aiden Name of Mother. 3. fi Wi} E/11). iA. NET: ELC Getting Remains from...
ar Birthplace........:00Ex Taking Remains to........
Trip to Coroner’s Inquest..
ite of rey 8.2 lol 4 Delivering Box to..
rvices at... IABDCA—..L ¢ A Deliver Flowers to..
Ws Removal Chanrges........ . a
ergyman.. JO: tei. MF “. Procuring Burial Permiit....0..0.ccccccccccccccecseseeeeeeseeees
sligion of the ee OX, Centif. Copies of Death Certificates Now.. eB. AGO hee
State Physician's or roner's)
rthplace..... erie _. Pall Bearer Service, $....Use of ii its: See
Gross Total for Sales Tax ede ep Ms vencaxaieFleleapaunraens
ssided in the State....ccccccccccccescscecapeeseee eet AD coocccsesesepereed Chelay ise Loe
(or U.S. or City of o) e,. Bie = ae Sots agetigeae Teale 5 == cudnt Glas -qpdpnusSaccety oupieu sxe <axel kysppss eRe yk ie eNE TRS =E Toes AN
ace of Dea ARAM SOLE. f4 r pe vacleatedes ose eat . EE ee. IL eed
»/4 4 (4 eS; Z . Sel 2] Flowers, $oo. Palms, $. ‘Matting, $. nde lene
ause of Deat (Uc Ny ASA). <4 Rental of Tent, $....0f Tani rary Vault, $. a i .
yntributory Causes.... (4 ‘ae (MARL. ent Fa Opening of Grave or Tomb.¥.. C/AS/ZI Goo.. fA..
US 0. i Lining Grave, §...... Lowering Device, $... ;
Bait fi so PELE ay aa [Mk A icine Outlay for Shipping Charges....0..000000000002. Nhe trit
ertifying Physician./7 ‘aoe JURME.. to ra Clergymen, $/d "Ringers, $.... Organist, $5.77 lS..
ieee Ge OS LETT Sf. — { Tickets, $.... — Service, $...000000M00.
: or} Sie et ‘. Telegr., Phone, Cable or Radio Charges..0..0...J}0000 0 func.
oter { Remains to... Cash Advanced.w....0.0000.cc0.
be ® of Caske/A /2a D5, di Ls Lagen tae . Out of town Funeral Director’s Charges.
PevSanid Service sass s5 sax, dsauccss psscasysoanmes oecstatetevscecebecdlbetets o4llenexeet eeeeves
{anufactured by. LAS we : RR ede Nett, eo oa
4
seer WG 1 Lumpe.. ees eens
BotNogs. 1. .c.:
pin We er Ao a ge a rea gee ie . arian”
Section Now.. esses Total Footing of Bilbo eeeceeeee SIAL.. . 42...
Block Now.. RS rt eases Mal scares domenica $
Ralanne