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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
60 RECORD OF FUNERAL
A 4
otal ING ss. 0. ia-e. Wee scatieleele: Yearly Now..2 LS recsccsssssoen _ Date of Entry..... / Wi, yA ant = 1 9 CL
Name of Deceased. HA.CLCLLC.€ Te eae Le, ent ie WIAA S.< wae LP Fexsc Oe ey cr Mam ec a el f v2) a sla
( Married Single “Widowed (] Divorced (What Race)
G a
Residence eA JIG BEL Ber ry, av As Sap be bak Ave.Uy Wb cnn eet eeen este deanna Mysaccgsynas's of t Age of Husband or Wife (if living)........ Years
Charge lalla pAb aa} pee Se , Complete Funeral (except outlays) .......cccc00e: $
Aston. GAMA. LUE Os lol Cate me peeeiyd 777 \e2,
Order given by si/d4 hey Sm LD Pog a Burial Vault of Box. Sain LILLOCLE. Nooo MSD.
‘or informant) ‘i (State Kind)
How secured...... ey, ade Fl Ravateernuey toner te eines me Embalming Body...... _(umeofEmbalme) === S.
os Barber, $...0.0.00.. Blair Dressities oh.. save weicticasen&Seclliceasscver onus eee.
If Veteran, Namg of War.... ee Oa . eae alee Dressing Body, §...... Winderwear (Gs. em nae
Occupation../.7. OFS) / ore Co ee Il CE TIIF NEI ARTE ORM i. ios censaeecaatigpes vbee tenteL dn ve oafidys soe sdoel UME sn cactansiavelll ccrvecedl
(Social Security Number) : (State Kind and Color)
Employer and Address..... Rs RM oe Nee ma we: ee ae 6 as stetsseneesessnecersens. [sseestecsensenealeenaeneens
olding Chairs, $...... BRE UIT cosets Sasacsrexe lesbos consol enue ss
Apa ih. 322, eens U6 renee wed Nard.d ees ceun Candelabrum, $........ BEN Volt Cp ae ee . . [I [Eee
Date of Birth.. A. (SA Age../. GP Sc Door Spray, $.....: CO EELS . Re bee
(Me:} jay), (Yt (Yrs), (Mos.) (Days) Funeral Car, $...... Ambulance $2.5). Me ehsis oll itedsacsecllcesesais
Name of F ather,.«/2A/ WA veseeees o. YELL ES sesqhoasaxecanesetrodasah Limousines to Cemetery.... (CNS aan: oles A . i
His Birthplace......-cccccscs00 LV.p AME Extra Limousines.......... (ONS RRR OR eee 2 . Wedel be el
; 4 ; Autos to R. R. Station...... CBD i rete ro cuales eae
Maiden Name of Mother ‘ r Getting Remains from.i.i.....cccccccccsecscsessesecsscsesccseacf cocoscecoscecccc. coceeesees
Her Birthplace Taking Remains to......ccccccccssccsssssescesoncscssscsecnecaseac. ccccoresconeocedfseesocees
J'4 Vg ( Trip to Coronmer’s Inquest.......0.ccccccccsseeseesseeseesved ecccccosecscessef ccseeseess
Date of Funeral UO ci fis a. A ct liens ane
Beveteds-get . ih a) if CL Cal Deliver Flowers 0...0...cccccccscsscssccsssssssesscsssscscessssscesdf cocecccoccocccedleccecceses
Removal Charges. ..0.6..csiicsse.secissssooressspansssopacccsevsncadl cocscs cocccecsd!coctsesose
Clergyman Ge Procuring Burial Permic.... Ran cie goes essertnesetefecesvsatenesnfooseenees
oe nets: (State Number and Discrict)
Religion of the Tor Ae atlas streamer vag go ttaxs een eMart Mae Eee Certif. Copies of Death Certificates IN Ghetto lescc re alee ee
(State Physician's or Coroner's)
Birthplace........ aki fF aes fe sol a ee Pall Bearer Service, $....Use of Chapel, $...... Misra’
1 for Sales Tax....... 1 ROR.
Resided in the State.....ccccccccccccecccceccescesesseseees TA UE A ae, ao ‘ re Sales Tay . a
ioracies ps or City or ory) (Years) lonths) ut ay (OA . 6 2 an ne a ee as A Fe ES eee, OB . ee ee Oe . e
Place of Death: “4 OWES d Gr J VA. RcP@UTIBUNOMEY (re sec ircosissasysins olboedh coven cesensstat fen ee
wsS/o / ay CG re owers, §.... Palms, §.... Matting, $..0.0.00000000. teint a, co
Cause of Death.7 he. ry. ties /ohes bani ae ALS Yada] Etowes of Tenkt...0f Textpocens Veale. §
Centributory Causes,.47.0° 17.. el vo MAZEL..) Opening of Grave or Tomb.8.C/AS UG WS 7d
Fg CLAS LOO. Sop en SAIS Lining Grave, $...... Lowering Device, $....... Select, Rei
SP CRRA Fa 6d , AS aM RO ag gee Oia GEE pil Re a . Outlay for Shipping Charges.. occ. Pn Rea ers nee
Certifying Physician.... ce wed W aa: Ards ‘Clergymen, $....Singers, $....Organist, &5. et a
‘or Cergher ; « ilroa : Aero‘
His Address...4.-.'S. BSS et ee ‘a7, Ve: fa ae Bhi or Motor Tickets, §.... plane Service, Goossen freeride
28 Telegr., Phone, Cable or Radio Charges........ Ey er pee eearine
ae Remains to...... pabaslis ys daa a ick ae es PROT Be is each Maite Pick aiced ipo iris ders cnspddene sagged oeousslinadbe Raskehes.h
Sine of Caskere3 0. C* oF got Out of town Funeral Director’s Charges....00.00.0H ocho.
—t$tate Color dad Niimber WA eS POrsma SOR vied nil Macc aregedesanysi tech a eclectic ls
Manufactured by adac 78 . Nizke @ /
Cemetery ai line Death Notices in...... Papers. eee llr Neem
Crematory ee ie ee. ee ee eb Be Gg ee es
Oto nae ee.. ek een ye eee ye . ee
ge ete: A Ia ails (fe ALR eC is, nor rea ae Eas ieee Sod etal, Ban
Section Ni aE: ee. ee a oe Lf ot
sian ei naar a ee creme Total Footing of Bil.0.000.5.226.000.iecsnsteccceces $ PO
Block NG ee te . EE eee Oy SOS NOW cE od ene ON $
5 Bal ANCC icc ecient: . TTL Be ek
Diagram of Lot or Vault MINES esesscre tts atta astesencannten ont Entered into Ledger, page...... or below