351 Date. ........ O.c.toher..-.l
T".. ~ 9 FUNERAL RECORD OF
CHECK EACH ITEM AS COMPLETED Yearly No.... _.. _.._ll.l
N 0 •........•...••••.••_ ••_ ••_ ••_ _
.... _...........
Cask.t .C.•....boxOcl.o.th-1ng ...... (Style) (No.)
Name. ...... _........ _...........AmQ.8....EdID.Q.nd...H.9.;rne..r. .................................................... Sex. ...............ffill.l.e .. Address ................................. _.-C.as.s:u-.i
ll.e, .... M1.s.sou.r.i
Outside Case or Vault............................. . Embalming Body .................................. .. Professional Service ............................... . Hair Dresser.............................................. . Suit or Dress ........................................... . Shirt, Collar, Tie ...................................... Shoes $......................Hose $..................... . Underclothes ........................................... . Door Spray ................................................
........................................................................... .
COunty......Ba.r.r.:Jl.. _.._.._._._...Township.......- ..- ........ _...................._..... Phone No ............................ _............... mere Born. ........... Allr.o rar ...M1.s.s.0llr.i ..... _.._ ...._........_................. Race ..............wh.l t.e ................. .
(
Date of Birth......... E.e .b .ruar.Y....2.......19.Ql ............Age......... _.5.? ................................. _.................. _....... (Years) (Months) (Days) How Long Resident in Community......................................................... _.................................................................. .
Sing1e. ...... _.._.......... .Married.mar.rl.e.d Widowed ....................... Divorced...................... Child........................... . Husband, Wit. or Child of................••.......Ela.l.n.e._.l'l.ea.the.rl.Y. ... H.Q.m.e.:r.......................................... Address............._........___.___ ..._.._.._................... _..._C.a.a.sy.ll .le.• ....M.1.!>.B.9.1l.r.t. ..................................
Gloves , .................... Chairs $................... . Flowers $..._.............Palms $.................. I Cremation ................................................ .. Newspaper Notices ................................. . Telephone and Telegraph ........................
Closest R.lativ•.......-E.l a.;L."l€l_.Ho.r.ner............................ .Address................................................................. . Father's Name.......A.l b.er.t...JaClkdO.ll... Ho.r.n.e.r .... .Birthplace... - ......................................................... Mother's Maid.n Nam•...)\,9:§: ... !®:~.~ .~.9,13:... ~.~.!?:.~.'?.~...Birthplace... - .....................:................................. . Cause of Death...............................................................................Contributory..........................................................
Date of Death..._ ..Q.Clto.har... l
•....l.95.9.........................Hour..;........ :..................................... _...... _..........._
Place of Death......B.ur.g.e. .. Ho.s:p.~....s.p_r.ingfla.l wow Long Ill ?............................................... _.... Physician.......... D.r..•....T.aang.................................................. Address .......~.P..r..:l,!.!gf.J,.El.;t,g" .....~9..,........ . Occupation of Deceased. ..... far.mar..................... _.............. _Social Security No ......lt.3..Q:::.Ql:::.6.33.Q.....
Ambulance
I
Lot ............................................................. .
Name of Employer........................................... _........................................................................................................... .
Misc. Transportation................................ I Shipping Charges ................................... . Clergyman ............................................... . ............ Singers $................ Organist $................. . Cash Advanced ......................................... .
Address ............................................................................................................................................................................. .
Charge to .......Inaur..anc.e ....an.d ...i'l1.d9Yl................... -Address ................................................................. .. Order Given By...........iY.1.d9.W. ...................................................Address................. _........................ _..................... Date of FuneraL. ....U c_t .Q b.a;r....4.•....195.9......................Time .........................!;..J'.'- J :............................. Place of Funeral Service........ GlI.llz:ar..!.a ...Qha.P..e~................................................................................... _. Clergym.n.....B.ey...•....L.\l.la.n.9......M~y._ ...............................Call for? ............................................................._
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g:::.s..1i..,.kZ.... ~.P.;r...........
Funeral Coach ........................................... . Passenger Cars ........................................ .. ••. _....... Pall Bearers' Service................................ .. .......... Transferring Body.................................. .. Opening of Grave...................................... . Cemetery Charges ................................... .
..Sa.b.e.iL ..'l'.aX ...................................... . Total Amount................................. .
Remains to be shipped-see reverse for details.
o
Intermentat........ _.~~~~~r.,~~...~~pr.J~~~I. - '~ B~~~ .'e~~.......,.............................................. ,
Lodges
D Pall Bearers
Lot No ............................................. Section No ............................................ Grave No ............................................. ..
Information Given To: o Relatives o Musicians
.Pt. .
Ramarks ...............g.Qp...P.JU:t.Q.P..~ ....$..~g.~.g, ... Q.r.9.n.?,.~ .... !l.~.~.El).... g,l1..,..................................... . raae t a n s a tin twill interio r-~Jl:lixlix s p rayed hdw . 0 Death Certificate ................................................................................ _...........................................................................................................
...................................SD.~.~ng.f.~J~Jg, ... Q.
0 Payment Arranged
I
FORM &230 !lUPERIOR FUNERAL SUPPLY CORP •• CLEVELAND, OHIO.
I
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Attended To : OPe Bil
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352 Date. ...••Q.Q .t_QD.e.,f._..ll•.:..
1.35 9
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF Yearly No •... _......_l..lZ..... _......_...
No.............•.......... _.._.•__
1.l e....W1J_s.o.n .................................Sex...femal e ........ Address ................................. _....... .Q~.!'!.~y..~}:1:~.I.....~~.~ .s.'O'.~!..~...........•.......................................................... County.........~?:E.!.:Y.:.._......_._...Town.hip...~~.!Q-.~.~.?-J,... ~P..!..~!)g..~hone No ............................ _...............
Casket
(Style) (No.) Outside Case or Vault.............................. . Embalming Body ................................... . Professional Service .............................. ..
Name. ......_...................... _.El.1z.al1!.e.t h ... B.a l
Where Born............B.a.r:r y.....Q.o.unt .y..•....,Mis.ao.ur.i..........................Race....lIlhit.e. ...........................
J .-:::_.9....:::........ .JL~................Age..............'1.i?:.'................................................ _.......
Date of Birth.........
(
J
(Years)
(Months)
(Days)
How Long Resident in Community..........................................._............................................................................... . Single........................Married. .......................WidowecfNJ,Q,QY!.\").Q,.Divorced......................Child ............................ Husband, Wife or Child of............................................. _................ _.......................................................................... . Addre••....... _. __.. _..__.. _..._ ._...._.. _.._......................................................................................................................... Closest Relative._ ....Q.r.a..E.ail.1.e...................................... .Addre ••...... Gas.s.y..ill.e .•....Mi.B.s.o.uri Father's Name. ..l .s.o.m._F..o..$.:t.e.1.'................................... _.....Birthplace... _........................................................ . Mother's Maiden Name.. J4g.:r.Y..... W.?-gg9.X!:~.r....................Birthplace... _......................................................... Contiibutory:........................................................ . Cause of Death .. .c.~w.~ }~,v.J_.
..
. '...
Date of Death ..._.....Q.c.:tob.e.r....l l •...,.l9.59...................Hour ... ~.,.:.:..:::...:L2.:.1 Q... P..• M._...................... Place of Death.....home.................................._.........................How Long ..Ill ?..................................................... Physician ..........Dr.•....Mar.y....N.e!11Jllan•.............................. Address .........Cas.s.v.l.1.1e·,·.···l\Io·•............ Occupation of Deceased. .......... hQ)J.!l.@Y!.;\..f..@.... _................ Social Security No .............................................. Name of Employer........................................... _........... _............................................................................................... Address ........................................... _................................ _.............................................................................................. . Charge t o......................................................................................" _.A.ddr~s~ .: ........................................... _.................... Order Given By......................................................................... _...Address................. _............................................... Date of FuneraI... .......QQ.t .Q.b.er....~5.•....~9.5.9.................Time .....................2...P..•M.•................................ Place of Funeral S.rvice... _......c~io Communi.t¥....j1luild.ing......................................................._. Clergyman ....Rav....... Ca llr.i n .. H.en der.s.o.n ................Call ' for? ............................................................._ Address... _.............. O'~.!l.!?y.;i,.lJ..e.~.....M.+..§.§.Q.1JP J .......:....:_.._.......:::..,.............,................................._...... _.._.
....
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Remains to be shipped-see reverse for
Lot No ............................................. Seetion No ..............._............................ Grave No .............................:............... ..
Ramark •......................2$.§....S.l
a .t.e. ...no.... sh A ding. .....::..:..:........................................................................
.
........... ...... ....................~y.g.!.Y.: ...sl,.~.
....·· ....··1
::::::::::::1~:i~ o~r;;:::~::::::::::::::::::::::::::::::::::: ::::::::: Shirt, Collar, Tie.................................... .. Shoes $......................Hose $..................... . Underclothes ........................................... . Door Spray .............................................. .. Gloves $.................... Chairs , .................... 1 Flower. $..................Palms $................. . Cremation ................................................. . Newspaper Notices .................................. 1 Telephone and Telegraph........................ Ambulance .............................................. .. Funeral Coach ........................................... . Passenger Cars ......................................... . ............ Pall Bearers' Service ................................ j ............ Transferring Body.................................... . Opening of Grave ............................... _..... I Cemeter y Charges .................................. ..
~~:c>r;~~~;~~~~~;~~::::::::::: : : : : : : : ::: : : I
Shipping Charges .................................. .. Clerg yman .............................................. .. Singers $................ Organist $................. . _......... Cash Advanced ........................................ ..
Total Amount...
detai;~.
Interment at......._... .Gl ia.._C.e.me:t.e.r.y. .......................................................,......... _...........................................
15 2.a SUPERIOR F UNERAL 8UPPLY CORP •• CLEVELAND, OHIO .
C..•.QQ.)S;~.Q.1Q.);.b-..:),ng........... i
n
Information D Rei D Mu
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Death Certificate Attendl Payment Arranged
Lodges D Pall Bearers
Insurance..................................... ..
•.........................................._........ _.\
(Boone!) . Date........Qo..t.o.b£r....l3.,..._l-.95 9
353
.
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF Y.arly NO•... _.._.._..:!:.:!:]............ _...
No•.......___.. _..__. _ _ Nam........_....................lna...fsHi1,r..l-....
M.y..M.+..LIJ·.('!I!...................................................SOL..........f.~.Ill?:.:l,~.
Addr......................_............_......p.J.9.!l~.~.;r.J.....M~.~A'!Q.1,J..!:~...................................:.......................................... COunty.... lilar·r :;y.... _.........._.. _...Town.hip....... _.._.....................................Phon. N 0 ............................ _ .............. . Where Born. ............ _........_........ _..... 1I"'-y.....3.l.,.....l9..Q.? .. _..................:........Race............................................... .
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Date of Birth......... _...N.e.w_to.n....Q .o.unt.J'..,.....MO'.•..Age.................................................................................. (Years) (Months) (Days) How Long Resident in Community........................................................ _.........................__ ..... ___ ............................... . Single........................Married. ....................... Widowed ....................... Divorced ...................... Child........................... . Husband, Wife or Child of........................................................................................................................................... . Addres •....... _.... _.._...._.•_..__.._...._................................................................................................................................. Clo.est Relative......._.................._... _............................................Addres................................................................. .. Father's Name......._.... _._.................................................. _.._.... .Birthplace....................... _.................................... . Mother's Maiden Name..._.........._... __......................................... ..Birthplaee... _............................_.......................... . Cause of Deatb. ..............................................................................COntributory........................................................ .. Date of Death... _...... Jint.Qb.e.r.....13.•.....l9.5.9.................Hour ........................................................................ Place of Death ................................................................................How Long Ill? ................................................... .. Physician __ ......... _............................................................................. Address ... _............................................................ . Occupation of Deceased. ..................................................... ~ ........ Social Security No ............................................. . Name of Employer........................................... _............................................................................................................ Address ........................................... _................................................................................................................................ . Charge to....................................................................................... _Address .................................................................. . Order Given By.............................................................................-Address ................. _.............................................. . Date of Funeral. ........ _............ _...............................................: .....Time ..................................... _................................ .
Casket ........................................................ $.................. (Style) (No.) Outside Case or Vault.............................. .............. ..... . Embalming Body ........................................................ Professional Service ................................................... . Hair Dresser ................................................................. . ·········· .. 1 Suit or Dress .......................................................... ...... Shir t , Collar, Tie ...................................... ................... . Shoes $...................... Hose $...................... .................. .. Underclothes ............................................................... . Door Spray ................................................................... . Gloves $.................... Chairs $............................... _...... . Flowers $.................. Palms $............................. _. ..... . Cremation ..................................._................_......... ...... Newspaper Notices ..................................... _............... Telephone and Telegraph........................... _......._ ...... Ambulance ................................................................... . Funeral Coach ............................................... _......... ...... Passenger Cars .......................................... ................... . Pall Bearers' Service..........................................._..... .. Transferring Body... _................................................. .. Opening of Grave......................................................... . Cemetery Charges .................................... ................... . Lot .................................................................................. Misc. Transportation .................................................... Shipping Charges .................................................. ._.... Clergyman ................................................ .............. ..... . Singers $................ Organist $..................................... . Cash Advanced ..............................................................
Place of Funeral Sernce... _........ _...._............_..........._.._........................................................................................_. Clergyman......... _.............. __................ _...._...................................Cal1 for? ............................................................__ ·· ..·· .................. ·· ........ ·.···.· .. ···· ....................... 1- - - 1
Addres ........ _........................................................_.............................._._............................................................_......_.
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Total AmounL ............................... - - - -_ Remains to be shipped-see reverse for details.
Interment at. ...... _........_........_........ _............................................................................................................................. . Lot No ............................................. Seetion No ...............•............................Grave No .............................................. . Ramarks ....................... _................................................................................................................................................... .
Information Given To: Relatives Musicians
o o
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Lodge. Pall Bearers
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Attended To : Death Certificate _ Payment Arranged
o o o o
Clergyman Singers
Permit Bill Rendered
Insurance......................................................................................... . FORM 152315 S U PERIOR FUNERAL SUPPLY
COR~ ..
CLEVELAND , OHIO • .
354
( Bo one) Date.....Q.Q.t.Q.bar..._~l±•._J,25.9
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF ' Yearly No .... _...1~l±......... _......_...
No•......._.. _.. _.._. ____
. J:9.5.9.........:......,Time............................... "...._., .... ,...............,..........
Casket ... ,......... ' .................. ,............ ,.......... $...............:.. (Style) (No.) Outside Case or Vault.............................. ................... . Embalming Body ...................................................... .. Professional Service .................................................. .. Hair Dresser............................................................ __.. .. Suit or Dress ......................................... __ ................... .. Shirt, Collar, Tie ...................................... .................... Sho.s $...................... Hos. $......................................... . Underclothes .............................................................. .. Door Spray ................................................ __ .................. Gloves $................... ,Ch.irs $........... ,..... ,............. _...... . Flowers $..................Palms $......................:...... _. ..... . Cremation ................................................__ ... _............. .. Newspaper Notices ..................... _...... _...... _......_.... _. Telephone and Telegraph..... ,._ ...... _.......... _........, ...... Ambulance .................................................................... Funeral Coach ............................................... _............. .. Passenger Cars ............................................._............. .. Pall Bearers' Service .................................................. .. Transferring Body........................................................ Opening of Grave............................... _......................... Cemetery Charges ........................................................ Lot ................ ,.. ,................................ ,............................. Misc. Transportation.............................. __ .................... Shipping Charges ......................................... __ ............ . Clergyman .................................................................. .. Singers $................ Organist $...................................... Cash Advanced ............................................................ ..
Place of Funeral Service..._........ _.... _............ __ ._ ...... _.. _.................................. :..................................................... _.
-_·······1·················,·········,·········,,····· ....... '......................................
Clergyman......... _.........._.. __................_........__.... _.........._........... Call
: : : : : : \: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : ==::::::
Name.._..._........ _............_...... E.s.s.ie...L .•....:B.uoZ......... _................................................. s.x.... J!i!m.€!-.~J...... Address......._........................_............ _.... _...................................................................... _........................................... ,.. . COunty......................._.. _......_.._...Township....... _.. _... ,•... _...........................Phone No ............................ _.............. .
Where Born............. _..__.. _........ _.................................. _.. _ ...._........ _.................Race................................... ___ .... _____ _
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Date of Birth......... _........ _.._.................._............................Age ......... _.8.2....................................................... _....... (Y.ars) (Months) (Days) How Long Resident in Community..........................................._................. _.................. __ ............................ _._ ..... _____ . Single..........._...•.......Married. .......... ,............ Widowed....................... Divorced...................... Child, .................. ,....... . Husband. Wife or Child of.............................•........•,.....,................. _...................•.................._......•............................ Address............. _.._.... _.._...._.._............ _........................................................................................................................ . Closest Relative......._........................ _.......... _...............................Address.......................................r
••... • .•...•...........•.
Father's Name......._.... _..____........................................ __.._.....Birtbplace__. ______ ........................_.......................... . Mother's Maiden Name.................................................................Birthplace... _................................................_...... . Cause of Death............. _................................................................Contributory......................................................... . Date of Death ... _....'OC.t.Clber.... llJ,.~ .... 19.5.~....................Hour............. ,............... ,.......................................... Place of Death................................. ,............................................. .How Long lll? ........ " ............................... ,.......... . Physician.......................................................................................... Address ................................................................ .. Occupation of Deceased................................................................ SociaI Security No ............................................. . Name of Employer........................................... _... _....................................................................................................... . Address ........................................... _........................ _..................................................................................................... .. Charge to....................................................................................... ..Address ............................................._.................... Order Given By........................................................................._...Address................. _........................ _.................... . Date of FuneraL ...... .Q9..1;g.Q.~ .r.... ±~.J.
fo~? .............................................................. _
Address..._...... _.. _......_................_.........._..........- ..- ...... - ..............- ..-.-...~... ,...................................................... - ..- .
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D
Totel Amount, .............. ,......... ,........ - - - -_
Remains to be shipped-see reverse for details.
Interment at................. _........_........ _............................................................................................................................ .. Lot No ............................................. Section No ............................................ Grave No ............................................. .. Ramarks ......................._.... _.. _........................................................................................................................................ ..
o
Lodg.s D Pall Bearers
Information Given To: D Relatives D Musicians
D Death Certificate Payment Arranged
o
Attended To:
o
Clergyman
D Singers
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Pennit Bill Rendered
Insurance ................................................................................... _..... FORM 15238 SUPERIOR FUNERAL S U PPLY CO" .... CLI:VELAND, OHIO.
355 Date.....Qg.1;gQ.~~._J.3..,_.~.22.9
..
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No•....... _.._...... __ _ _
Yearly No .... _.._J-J.,5........._...... _...
_
Name....... _........ _............ _Isaao.... Ruaae.ll...G.e bhar..t ......................................... Sex. ...........ma.J&..... Address................................._....... S.e.U!;;m.a.n~.....l!!U,§_f?!?.~.;r;:J......................... _.............................................. . COunty....Earr.y..._.. _.. _.._.. _...ToWDShip....... _.._........ _...........................Phone No ........................................... .. Where Born. ...........&l.m.§!_§x.._...L!JJgg..~.f? ...... _...:.. .. __ ........_.................Race .......v.:~.i..~.~
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.........................
1.8.66.............Age......... _.......9..2..........................................:...... _.......
Date of Birth........Q.o.t.ohe.r....2;i.•_..
(Years)
(Months)
(Days)
How Long Resident in Community..........................................._............_.._.__............ _... __ ......................................... . Single. .........._.......... .Married. ....................... Widowed .. lIIi d O.Vle.cDivorced...................... Child.......................... .. Husband, Wit. or Child of............................................................... _........................................................................... Address................._...._.._.. _ .._...._......_....................................................................................................................... .. Closest R.lativ•._....D.e.lber.t ...Ge.bha.r .t .......................Address.......... J?§1;!,g!!.l.@ -I.....M9..,............. Father's Nam..........B.ussell...Ge.bhar.t..........._.. _.....B.i rthplace. ........... ,.................... _........................... Mother's Maiden Name....Eleano.r.... B.hQ.ada ..............~ir~J'lilce..................................................... _.......
Cause of Death... ~ ..I,,~<.~~~tory..........................................................
Casket ........................................................ 1 . """ ..... (No.) T . . . .~ Outside Case or Embalming Body ............ [ Pro,f essional Service ................................... 1.... ........... 1 Hair Suit or Dress ............................................ 1.............. 1 Shirt, Collar, Tie ...................................... I.............. 1 Shoes $....... _............. Hoset........................ / ..........._.1 Underclothes ............................................ 1................ I· .... · Door Spray ................................................ /.... .......... /..... . Gloves , .................... Chairs $.................... 1............... 1...... . Flowers $.................. Palms , .................. 1............ _. 1..... . Cremation .................................................. 1.....·....··_· 1.... .. Newspaper Notices ............. _................... 1.............. 1..... . Telephone and Telegraph........................ /............... /.... .. Ambulance ................................................ 1.......... ·.... 1·.... · Funeral Coach ............................................ /.............. /..... .
Date of Death ... _..Qr;..t_~.Q.E;lr.....l9.~...):9.5.9......:................ .Hour.......................... :............................................. Plac. of
Deat},$.~g§..§.~....Y.!l:.~}.~Y. ....~~.~.~....tf<:>.Iii.E!.......How Long
Ill? ..........:......................................... .
Physici~n ..... J?r..:.... Q.,....A., ....~~.;:.y.~..~.........................,...... Address ............g.a§.§.'!.J).):~J,.... .M9..,.......... Occupation of Deceased........ __ .....,. .___...i ............................ .......... _Social
Se~urity
No ________ ... _................................. .
Name of Employer........................................... _................................................... :....................................................... . Address ....................................................................._...... _................................................................................ _............ . Charge to.........chlldr.e n .....:....:.. ~ ...................................... ...Address ................................................................... Order Given By....................... ch.i l
.r.en........................ _...Address................. _...............................................
Date of Funeral.......Q_Q.!;g.1?~;r.....?!±~
....J 9.5.9.....................Time..................?....~.~.¥..~.................................... Place of Funeral Service..._.... J?~1.*g!!!~....A~~.~.!!!!?.J,.~X.....o..r.....~I:)9.: ...~.l',l~.().I:t.........................._. Clergyman.......Re.1l......B.Qb_.. '[;UJ:U.t ..E;l .............................Gall for? .............................................................._
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.. ........
Passenger Cars·········································· I.. ·.....- ... -1.... .. Pall Bearers' Service ................................ /............_./ .... .. Transferring Body···································· I.. · ..·.... ·.... I.... .. Opening of Grave...................................... I............... 1.... .. Cemetery "\j"nar~,es ....................................... I.............. /...... Lot Misc. ~l;" Shipping Charges .................................... 1............... 1.... .. Clergyman ................................................ 1.......... ·.... 1· ..... Singers $................ Organist ~,.................. I ............. I ...... 1~ ~.. dva"'Ced·.... ·.......... ·...................... ·.. I........=:.;;.:I ......
==:::::::1";
~
Remains to be shipped-see reverse for details. Information Given To: O. Relatives D Musicians
Interment at..........New ...Sal.em. .. D.e.me.t .e.r.y................................................................................................ ..
o
·No'............................................... Ramarks ................. g.r.ay.....O.O..t .t.on ... p.1UM....9.9..1i....1z... J).h ... ::':'...J'.~.~....I3.,{)...l(.................................. .. ................................ whl.t .e. ....sat.ir.l ...t ..w..U .l...."nt.~;r.Jg.;r........................................................................
D Death Certificate D Payment Arranged
Lot No •............................................Section No.~ ............. _............................ Grave
........................................J3..§n:::Y.Ig,],.._.9.aJ?K§.1i....Qg .,_............ _......................................................................... FORM !l2.S!I SUPERIOR FUNERAL SUPPLY COR ... . CLEVELAND , OHIO.
Lodges D Pall Bearers
Attended To:
o
o
o o
Clergyman Singers
Permit Bill Rendered
Insurance..........................................................................................
1
356 Date. .......Oe-to b.e.!! ..2.D"7....l.9.59
CHECK EACH ITEM AS COMPLETED
FUNERAL ··RECORD OF
...................
Yearly No............~l6
Date of FuneraL. .......QC.t.o.ber ... .22.~ ....
19.5.9.................Time...........................g..J'.,.M..'...........................
Casket ........... __ ........................................... $................ .. (Style) (No.) Outside Case or Vault................................................. . Embalming Body ....................................................... . Professional Service ..................................................... Hair Dresser............................................................ ...... Suit or Dress .......................................................... ..... . Shirt, Collar, Tie......................................................... . Shoes $...................... Hos. $.......................... __ ............. . Underclothes ............................................................... . Door Spray .................................................................... Gloves $.................... Chairs $....................................... . Flowers $.................. Palms $...................................... Cremation .................................................. ... _............... Newspaper Notices ............................. _......_......_.... _. Telephone and Telegraph. .......................... _.............. . Ambulance .............................................................. ..... . Funeral Coach ............................................... _.............. . Passenger Cars ............................................. _............... Pall Bearers' Service ........................................... _. ...... Transferring Body........................................................ Opening of Grave............................... _........................• Cemetery Charges ....................................................... . Lot ........................................... __ .................................... . Misc. Transportation ................................................... . Shipping Charges ........................................................ Clergyman ................................................ .................... Singers $................ Organist $.................. ................... . Cash Advanced ..............................................................
Plac. of F uneral Service......... -Vn.iOll-...Ch.u.r:ch......................................:.......................................................
..·..............·.... ·· ........·....·....·· ......·· ....··· ..·· ......·1 ........·..·........
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Name. .........................................~9.!.lg.Y.:... .Q.. ,.. :.~.~n~~.Y... .................................................SOL ........ .Ee.:lll.a.:~.e.
Addres ..............................................~
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COunty.....: ...................................... Townsbip .................................................. Pbone No ........................................... .. ,W here Born........ _...._....__._........_......................_.............. _ ...............•.........__......Race.. _.......................... _.. _... __ .... ___.__
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Date of Birtb. ........................................................................ Age.............(~~~~~j.......... (M~;;thsj.............(D;;YS).. How Long Resident in Community........................................................................... _.. __ ....... _.................... _........_____ .__ Single....................... ,Marrie'L .....................Widowed.......................Divorced...................... Cbild............... ________ .... . Husband, Wife or Child of........ __ ....... __...... __ ......... __ ............................................. __ ................ __ ..................................... Addres. ................................_ ......................................................................................................................................... .. Closest R.lative............................................................................. .AddreS8 ............................................. __ .... __ ........... .. Father's Name............. _. ___.. _................................................_.....Birthplace........ __ .____ . __ ........................................... . Mother's Maiden Name..._............................................................Birthplace..._...................................... _................. Cause of Deatb...............................................................................Contributory............... __ ........................................ . Date of Deatb ..........o.C.tocer....2D.,.....1;l.;i.';1....................Hour..............12.:..1Q... A ......!l1...... __ ................. Plac. of Deatb............................................................................... .How Long Ill? ..................................................... Physician .......................................................................................... Address ................................................................. . Occupation of Deceased. ............................................ _.............. _Social Security No ............................................. . Name of Employer........................................... _... _...................................................................................................... . Address ........................................... _........................ _...................................................................................................... . Charge to............................................. ;......................................... -Address ................................................................... Order Given By........................................................................._..-Address ................................................................. .
Clergyman......... _..............__..............__...._...._............................. Call for? ............................................................._ ....................· .....................· ...................... --... 1- --
Addres8..........._............................ _...._................ _ .........................._.._._•......................... _............................_.. _.._.._.
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Totel Amount... ............ __ ................. - - - -_ Remains to be shipped-see reverse for details.
Interment at..........!J.nJ.Q.n... Q.fl.!!!~ .1;.~.rY.................................................................................... __ .............. __ ......... Lot No •............................................ Section No ............................................ Grave No .............................................. . Ramarks ......................._.. _............................................................................. ~ ................................................................. .
D Lodges D Pall Bearers
o
Information Given To: D Relatives D Musicians
Death Certificate D Payment Arranged
D Clergyman Singers
o
Attended To: D Permit D Bill Rendered
I nsurance ......................................................................................... . FORM 52315 S U"ERIOR F U NERAL S UPPLY COR" .. CI.I:VELAND , OHIO.
357 Date....•.Qllt.o.ber.._.25. ......l25 9
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'
FUNERAL RECORD OF No.... _.. _.._...... _. __.__
CHECK EACH ITEM AS COMPLETED
117
Yearly No ...._......_...... _...... _...... _...
Name. ....__........ _............_.......... _.I.nfan1;....g~.r.:!,
[email protected]= ........ f.~~.;!,~ .. Address ......._........................_........_.Ex.e.t .frr. ......M.t~.!!.g.J,l;r..'" ................................,.................... ,:..................... COunty.....BarTy........................Town.hip ....... _LJ.P..Il.!:t.Y....................Phone No ................................. ,......... ..
Where Born...............h.OlIlfl ..... _.................................._.. _ .................................Race....... Y!hJ:.'\;,~.........................
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Date of Birth. ..................1Q:::2.~.~.19.~.~.................... ..Age....................... _............. ,_ ................ ,...................... .. (Years) (Months) (Days)
How Long Resident in Community....................................... _____ ....................... __...____......___ ... __ ................................. . Single....... _...............Married. ....................... Widowed ....................... Divorced...................... Child .......................... .. Husband, Wife or Child of.................................................................................... ,.................. _...................... ,.......... .. Addre............... _........ _.._...._.._...................................................................................................................... ,............... . Clo.est Relative,...Al.f..r.~_q...Qh.§.Jl!!!.@
............................Address............... ,~.~.~..e.E.!.....~.~.s..~.C?~,~
Father's Name......._ ............. _................................................_.....Birthplace.............................................................. Mother's Maiden Name..._............................................................Birthplace... _........................................................ . Cause of Death..P.r.emat,u r.i,U .............................. ,...........Contributory" ..................................... ,................ .. Date of Death ..... "'Q.C,t
.Qp..e.:r.....2.5...... J.9.5..9.......................Hour........................................................................
Place of DeaJ.;f;....... .. '
l:t. .1..{.irrl,...~.'!!2..Y.Y.kC.{..HoW Long Ill? .....................................................
Physician ................. Dr.......Ghar.le.s..~ ......p.:r..1.Q.'L ...... Address ................................................................. . Occupation of Deceased.............................................. _.............. _Social Security No ............................................. . Name of Employer........................................... _... _...... _.............................................................................................. . Address ..................................................................... _...... _................................................................................ _............ . Charge to................................. _......................................................Address .................................................................. . Order Given By......................................................................... _..:.Address................. _........................ _.................... . Date of FuneraL ......_O.c.t .Qb.eX:....2.6........1.9.5.9................Time ............ ''''''' ..... ,.. ),,;.J.''O'...:P...,.!~! -'-- .............. Place of Funeral Service...............Map.1J~j~Q.Q.g, .._Q.!l.!!!~.:t~.r.:Y...."""....."...............".... ,,,.........,, ...... ,,,, ......... Clergyman........._.............. __................_...._..__ ............................. Call for? ............................................................._
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Casket " ............................... " ... " .." ............ $..... "" ....... .. (Style) (No.) Outside Case or Vault................................................. . Embalming Body ........... """" ..... " ........ ,, .... " ............ .. . . .......... J Professional Service ............... --........................ _ .. __ ...... Hair Dresser ...................................__ ...................... _ .... _. Suit or Dress .................. _........................ _ .__ ..__ ............ . Shirt, Collar, Tie...................................... ...... ____ .... ..... . Shoes $.. " .................. Ho; e $......... """.,, .... .............. .... .. Underclothes ............................._................ _... _............ . Door Spray _.......................................... _... _ .................... Gloves $.................... Chairs $...... """,, .. ,," " ................ .. Flowers $.................. Palms $.............. " ....,,"............ .. Cremation ....................................................._.. _...... ....... Newspaper Notices ........................ _............ _......__ ...... Telephone and Telegraph ......................... "." ........ ...... Ambulance .................................................................... Funeral Coach ............................................ ... _......... _.... . Passenger Cars .......................................... _.._.._.......... . Pall Bearers' Service ..........................................._....... Transferring Body.................................... ................... . Opening of Grave.................................................. _....... Cemetery Charges .................................... ._......_........... Lot ................... ,....................... "' ... ',, ............. ,,""..... .... .. Misc. Transportation......................___ ......_ .............. ...... Shipping Charges ................_................... .. _.. __ ....... ..... . Clergyman ................................................ ......... _.......... Singers $................ Organist $...................................... Cash Advanced ..............................................................
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Remains to be shipped-see reverse for details.
Interment at.............. MaP.la1·1.0.Qd ...C.eme.t .•.r.Y. ................,."........"" ......................" ..................................... Lot No ........................................... ~.Section No ...................................-......... Grave ··No .............................................. . Ramarks" .............",!1Ihi.t.e...2.'.... mataL,.B.eale.:r....................."""""""".. "" .. "" ........".................. "" .."'"
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Lodges D Pall Bearers
o
o
Information Given To: D Relatives D Musicians
Death Certificate Payment Arranged
Attended To:
o o o o
Clergyman Singers
Permit Bill Rendered
Insurance......................................................................................... . ,.ORM S2S8 SUPERIOR F U NERAL SUPPLY COR ....
CL.VIE~HD,
OH IO.
358 Date. .......QQ.1;.QJ?~.;: .._?..2.L.~ 959
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CHECK EACH ITEM AS COMPLETED
FUNERAL 'RECORD 'OF ' No........................_.. _.._ _
Y.arlY No .... _..
+.. _!J;),§... _...... _...
Name....... _........ _.......~ah.... Elizaba.th.:.San da:r..s....:...............................:.... s.~.t~ma.;J,.e........ .. Address....................................a.a.B.av..i..ll.e.~....M;tgi.§..Q1lr..r
..........:::.:.............................................................
county........Bar.r.y........_._ .......Township..................~........... " ..." ........... ,Phone No .............................................
Wh.re Born.............1Lt..,.....y.e1:!lgn ..... MJ&.§9.1l.!:t........:.................... Rac...........\'I.I:L.j,.~.E:l ......................
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Date of Birth. ... J.anv..I.l.r:Y. .... ?Q4....
J $.1.?............... .. Ag...........................§7................................................. (Years) '
(Months)
(Days)
How Long Resident in Community........................................................_................ _......................___ .. ___................... . Single....................... .Married........................Widowed .....l1IJ.g,Q.l.I!.~orced ...................... Child........................... . Husband, Wife or Child of...............................I).an... .saI'l~r.s .......................................................................... Address.................................................................... _.... D.e.caas.e.Q..:.................................................................... .. Closest R.lativ...........Mr.s......T.o.ID...P..r.5l9.Q.X..............:.: ...Address............Q.?-.~.!?y):}}.~.1.. ...~ ..~ ......... Father's Nam........_I'I.il
lia.m ...Gr..a.Y.......................... ~~~ ..J3lrthplace ............. :...:............................................
Mother's Maid.n Name..._.. El iz.a b.e.th ....v..nkn.gYID. ..Birtbplace:....... :.....................................................
en~ ......... ratio"" .. ... .' ' 1" Cause of Death ........ my..O.C.ar..d ...e. ...."'5lg....... ............,ntributory ........................................................ .. Date of Death.......Qc.t.o.bar.... 29.,.... l9.5.9..................::....Hour............. ),.!.J.5. ... ~..,.M ..'....:......................... Plac. of Death.....HQma.................................._.............::......... .How
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Address ..................................................................... _...................................................................................................... . Charge to......... E.s.t.a.t.e..............................................................Address ...... ,.......................................................... .. Order Given D~·...............'.M ...',..' . ,... ~•." .................................... _ ....I\0'0"..8 ........................., ......" .., .... "' . ..., . , .., Date ofFulnelrnl......... j~Q.Y.l).mQft~...J ...... l~:!~ :rinle............................. ;~~ . 2~~
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Place of Funeral S.:rvi,' e............. .G.u.].ll.!e.r~ ~.!. ....".t1L...l~.t;l.J.................,....:' .................... ......
Clergyman .... !;!.o.r.a.,c.e ... b!u
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Outside Embalming Body .................................. .. Professional Service ............................... . Hair Dresser ............................................ .. Suit or Dress ~..U.\ hll.:.. :.... .... Shirt, Collar, Tie................................... ) Shoes $...................... Hose $.................... .. Underclothes ........................................... . Door Spray ............................................... . Gloves $.................... Chairs $.................. .. Flowers $.................. Palms $.................. . Cremation ................................................. . Newspaper Notices ................................ .. Telephon. and Telegraph...................... .. Ambulance .............................................. .. Funeral Coach ..........................................__ Passenger Cars ......................................... . ............. 1Pan Bearers' Service................................ ............. Transferring Body.................................... .. ........... 1 Opening of Grave .................................... .. Cemetery Charges ................................... . Lot ............................................................ .. Misc. Transportation.......................__ ....... .. .......... 1 Shipping Charges .................................. .. .. .......... 1 Clergyman .............................................. .. . ............ 1 Singers $................ Organist $..................
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t.t"'J.uni.O.r....Mat.:t.l.nwJ..1! for ., .". ............................ . Total Amount................................. .
Remains to be shipped-see reverse for details. ..
Interment at... ................. Ho.r.n.er....C..eJJle.t
.B.:rX.........................................................................,.......................
Lot No ............................................. Section No ............................................Grave No .............................................. .
Ramarks ........... l±.9.9..Jlkng9.."'P..... p..~;:.~~.Y.::: ..s.I:L.'l.cl,~9:
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ivory venus satin interior
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Casket
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8U .. U IOR FU N ERAL a U PPLY CORP •• CLKYIE!:ANO; OHIO.
Information Given To : 0 Relatives 0 Musicians
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Lodges Pall Bearers
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Death Certificate Payment Arranged
0 0
Attended To: OPe Bil
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359 DBte. ....Q.c.t.o.bar.._ll....._.l.95.9
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FUNERAL ' RECORD ' OF Yearly No.... _......_ +.l9...... _...... _...
No•......._.........._..___.__ Name. ...... _...................... _......1Wla... Mi
ll.e.r. ............... _.................................................Sex. ..~.t..elJlalfL ...
Address ....... _........................ _.......E£\.!.!:y..t~!'!.,.....M!.~..'?2~.r..~ .......................................................................... COunty....Ultltlt...N.ll.W.:t9JJ.Township....... _.._....................................Phone No ............................................. Where Born. ............ _........_ .......J .asp.e.r.... .c.QU~. .. _M1.s.S.Q:u.r..1..Race ...... 1'!h.i..t .e........................ ..
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Dat. of Birth........}:&nua.t'¥_... l
l .r_..l'il.Ol.. ...........Ag.......... _.......5EL.............................................. _....... (Years)
(Months)
(Days)
How Long Resident in Community...................... __ ................... _............_...... _........... _......................._....._____ .... ___ ......
Singl ....Single..Married. ....................... Widowed ....................... Divorced...................... Child.......................... .. Husband, Wife or Child of....._........................................................ _............................................:.............................. Address ......._..............___._._.._........_............................................................................................................................ . Clo.est ReIBtiv........Ho.!:a.c.e...Ml1.l.e.:r..............................Addre••.........E~J.:r.y..~?Y!.•...}~~.§..'?
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Remains to be shipped-see reverse for details.
Interment aL .......D.1.c.e ... G.eme.t .:'lr.s: ........ c............................... ,.... .. Lot No .............................................Seetion No ...................·......................... Grave No ..
Ramarks ......................._..... #i±9.9.... h..:l.ng.Q.aQ....!?Uy..Ei.r.:.....s.l:t.~.
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..;..~ Ca.k.t ...................................................... .. Outside ca!~tg'~e~aul@::t~~:)........ Embalming Body ._ ........................... __ ... __ Professional Service ................................ Hair Dresser....__ ...................................... .. Suit or Dress .",dd .. J'-:Y./,.~......"',.. Shirt, Collar, Tie ............. __..................~ .. Shoes $..................... Hose $.................... .. Underelothes _................................. _.... _... _ Door Spray ................................................1 Glove. $.................... Chairs $................... . Flowers $..._.............Palms $..........:....... Cremation .. _............................................... Newspaper Notiees ........................... ___ .. . Telephon. and Telegr."h ...................... .. Ambulance 15.:'?:.:..4.. T.!f.:'!":::4..~.;.. Funeral Coach .......................................... .. Passenger Cars ......................................... . ............ Pall Bearers' Service .............................. .. ............ Transferring Body.................................. .. Opening of Grave.... _................................ . Cemetery Charges ......... __ ....................... ..
s.::::...
~~!c."·;~.~~~~·~~~~~;~~:::::::::::::::::::::::::::::::: I Shipping Charges _............................ __ .... . Clergyman .............................................. __ •...__ ...... Singers $................ Organist $................ .. _.......... Cash Advanced ........................................ .. _ ......... 1 .. A ....,.&.d...
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360 Date. ........O.(Lt.Qb.e.r.._3 .:!-....__!359
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CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF
I
Yearly No •..._...... _...l2.Q.._...... _...
N 0 •••• _ .•_ ••_ ••_ ••_..
Casket ........................................................
Nam........_........ _............_.Y.?1m.{! ... p..~ .!'? ...Mg)}J.f:l.E._.. _..._............................................Sex. .........f..e..J!.la... ;L.~ .. Address......._........................_........G.a.s.ay.l.1le.~ ....M.1s..6.Q.\i.r.J..................................................................... .
COunty..... .B.ar..r.Y.._...... _.._.. _...Township....... _.. _...._... _...........................PhOne No............................ _.............. . Wh.re
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Date of Birth.........NQ.ll.e.IDp..e.r. ...9..,_...19..Ql
...........Age............. _.......5..7............................................._....... (Years)
(Months)
(Days)
How Long Resident in COmmunity..........................................._............................... _............................................... Single..........._._.........Married.mar.r.1.e.Q. Widowed .......................Divorced...................... Child........................... .
Husband. Wife or Child of············ ....······.·.J.eh.l'l... A .•.··· Qa .l-B.J? ..-............................ -.................._............... Address ....... _.... _..__... _.._...___._...._.. _.._................... C.as.sll.ille.,. ...lvU.s.B.o.l!.r.1 ........................................ Closest Relativ•._.J"-Oh.n-...A..._. OOhler.............................Address ..................................... _........................... Father's Nam•....._._.J.~_..schae:t:.er..........._......_.._.....Birthplace... _............................ _.......................... . Mother's Maiden Name-.-Ch.arlQ:t.t .e ....S,yagger......BirthpJa.!l';.;;;;;;:;;:Jl::::;;:.::.;...~";:J Cause of DeathJ.~.~.. ~.~ibM1il:.:T..=:.=...lf....:........~.......?:::. Date of Death... .Q.c.tQb.e.r..... l .9.59..........................Hour............ A.,....M.,....................................... Place of Death....s.t ..•.....'l.in9..en:\;..!..@••••B..~9..P..;l,:\(9.,),..... .How Long Ill? ............................................... _..._ Physician .......D.r. .•_....Cha.Il..•....P.r.J.Q.e.......:........................... Address................... g.~.s..s.y..:i..1..1..e..1. M .()..~ ..
3'l•....
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....
Occupation of D.ceased.
[email protected]..*.f..e.... _................ Social Se~urity No ............................................. . Name of Employer __ ......................................... _... _......_...............................................................................................
_.......... •........... .......... ~ ............ ............
Address ..................................................................... _...... _.............................................................................................. .
Charge to......J.ohn...Mohler. ................................................Address .................................................................. . Order Given By...........J..Qh.n... MQb..:l:.~ .r........................... _...Address................._............................................... Date of Funeral....N.Q.y_em1;l_I;t;r.....3.•.... J.9.5.9.......................Time..................... :E>.!.. Place of Funeral Servic•... _........ ..c..w..¥~r_!.Il-...G.hap.el ............................................................................. _. Clergyman.NQr.man....T.aY.l.Q.r.=Ra.Jr.ID.Q.n~L .B..la9.~all for? :......................................................._._._
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Outside cJ~~~·~ault@)(~~:)............ Embalming Body ................................... . Professional Service ............................... . Hair Dresser ............................................. . Suit or Dress ........................................... . Shirt, Collar, Tie ..................................... . Shoes $...................... Hose $...................... Underclothes ........................................... . Door Spray ............................................... . Gloves $....................Chairs $................... . Flowers $.................. Palms $................. . Cremation ................................................. . Newspaper Notices ............................._.. . Telephone and Telegraph ......._.............. . Ambulance ............................................... . Funeral Coach ........................................... . Passenger Cars ... _.................................... . Pall Bear~rs' service ............................... J TransferrIng Body................................. .. Opening of Grave ...................................... Cemetery Charges ................................... . Lot ............................................................. . Misc. Transporta tion ............................... J Shipping Charges ................................. Clergyman ............................................... . Singers $................ Organist $................. . Cash Advanced ......................................... .
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Address... _......_..............._............_...._................- .. - ..................-.-.-----.-...-....................- ............................ - ..-.. - ..-
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Remains to be shipped-see reverse for details.
Interment at....... _........O.a.k_.H.l1l.. .G.ellle.t.er.Y. ..•.....................•.................................................................... Lot No ............................................. Section No ............................................Grave N~ ...............................................
Ramarks ... _................. !~2.';i.Q .. D.r.chid ....ab.a.de.d ...S.l.J..v..e.:r.~.P..r..e .f
[email protected] .n ....®..~.+.n.~........... .
.........................................I .v..Q.r.y....D.uc.h .e .s.Jl....g.r..ep..e.... :::~r.9J~Jg,...Ka..r.Il:.~ .......'r..l'.:i.In...................... ..................................................Jl.P..r.J.nKn\7.1.9....Q.§:.~~.!'?~.. _M.:f.K:....g.()..,................................................ FORM 152815 SUPERIOR F U NERAL SUPP1.Y COR.... C1.EVELAND. OHIO.
o
Lodges D Pall Bearers
o
o
Information Given To: D Relatives D Musicians
Death Certificate Payment Arranged
Attended To:
o o o o
Clergyman Singers
Permit Bill Rendered
Insurance ......................................................................................... .
.............................................................. ............................................. ;
