16 nate. ...... E.ehr.1l9..:ry...!±........:j....9..60
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF Yearly No.................. :+..6.................
No............................_ _
Name.................................. LllDllie....E.l!'2ll.?i.Q....!.iJJD.:t;.lgY........................................Sex. ......!1)9:.;J,.~........... Addres.............................................lJ:e.i!~.!y.§..Y..•....A~lf.§:g.s..?:§............................. ~............................................ COunty.............~.~.P.:.~2E............Township ..................... _...................._..... Plwne No ............................ _...............
Where Born. .................._..i.xr...c.l.a.r.k ...c.Q.l.lnty-l-...l~!J.§.!?.Q!J.~t:Race............... ;:vg.:!:~.~ .................
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Date of Birth..........J..a!J..ld1lJ.'x....
J!±.•.....:l:.?!.9.../? ..........Age................... §~......_...._......................................... (Years)
(Months)
(Days)
How Long Resident in Community........................................... _........... _....................... __ .......................................... Single........... _...........Married..ID.a.r.TJ.~.9widowed ....................... Divorced ...................... Child ............................ Husband, Wite or Child of..........................P-ana;y: ... },!l,lntle.;y...... _............................ _................................... Address .........................................................................Gat.el!I.a.Y..,.... A..lJ;aD.!>.i&.§.............................................. Closest Relative..1!!e.t.ty.......1..l!.!.l.e....!?:Y.9..Y.!?L .............. .Addres •........ f:l.~ .;J,.~.glll.?-.~..! ....•~~.s..s..? .~.~.~ Father'. Name.......H.enry.....Hun.t .le.Y. ..................._.. _..::.Birthplace.............................................................. Mother's Maide'r¥ame.. .5UJ3.3!J. ...B.eng.e......,....................Birthplace..._........................................................ . Cause of
Death~~_~.....__ ...contributorY..... _.......... __ ..... _.... __ ............................
Date of Death ......F.eb.r.uar.y.... lj,.~ ....19.6.Q.......................Hour ... _........... 3..;.g.Q....A.,J~..,...........................
Plac~ ~f Deat~·r~Q~1i·:~nl!.2.S.:O'.i..~g.J .......................HOW Long Ill? s PhysIcIan .......................................................................................... Address ..................................................... Occupation of Deceased. ......... .Q.i?,.:f..~.~....§.~.~.~ .!:-.().l?: ..g .1/I.§.ft/;;1 Security No ....... ~2.?:.??:? Name of Employer.____ .. __ ........ __............................. _..__ .._.... ___ ... _.... _._._ ............._~._. __ .. _......__ ......................................... __ .. . Address ________ ...... ___ _. ____ ... _________.. _______ .__ .. _.......................................... __..... __ ... _______ .__ .__ .. __ ..___........................................... __ .__
·····Rog·ii·r·s·;. ·ArkaneiJ. Ir . . . .. ...?L..
Charge to ........Ins.Ul'.aD.QJL ............................................... _Address .................................................................. .
................
Order Given By......l"l.1.f.sL..t;l..!)..Q,....g.?,l:\gh.~..~.r. .Address .................................................................. Date of Funeral... ... E.e.b.l::l.laa.. ..7.•....19.9..Q ....................Time ................................. ,1'..:}v.[ .:....................
?...
Place of Funeral Service.......G9...t.e.W .ay. ....A.
Casket
.,.,.llalllt.,Qs.e.r.yJ.Q.e..s ........
(Style) (No.) Outside Case or Vault............................. . Embalming Body ................................... . ············1Professional Service ........................... _... ···········.1Hair Dresser.............................................. Suit or Dress ........................................... . Shirt, Collar, Tie ..................................... . Shoes $......._............. Hose $..................... . Underclothes ....................... _.................. . Door Spray ............................................... . Gloves $.................... Chairs $................... . Flowers $.................. Palms $............:..... .\ Cremation .................................................. ············1 Ne,vspaper Notices ..................................................... . Tel ephone 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 $..................................... . Cash Advanced .......................................... ................... .
C1ergyman ...... Re:\L....R_... l~ .•...B'O.Y.Ji ............. ,................ '.Call for? .............................................................._
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Total Amount.................................. - - - __ Remains to be shipped-see reverse for details.
Interment at............ .G:a.t.eSiay.....C.flID.
Lodges Pall Bearers
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Death Certificate Payment Arranged
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.................................RQ.s.e.tan...Q\l.Qh.e..§.§....Q.£!?p..~.:-..~!)l.il.}.:1, ...
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FORM !!IU!!I S UPI!:RIOR FUN ER A L SUPPLY CORP •• CLIlYIiLAND, OHIO.
Information Given To: 0 Relatives 0 Musicians
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Attended To:
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Clergyman Singers
o Pennit o Bill Rendered
Data.........
17
..e.9.r.lJ.(l.1'X....2~_.l:3 6 0
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF .
17
Yearly No •... _......_.._.........._...... _...
No•....... _...... _.._._
Name. ...... _........_............ J,,;i,lJ._i.e....hi.•...Hilt.QD........................:.................................Sex:...... f.emal.e ... . Address................................. _.........T.enklna•....M15.S.QJ.l.l;:.:l............................................................................ COunty............. Bar.r.Y......._.......Township....... _........•... _...........................Phone No ............................_.............. .
....... Date of Birth....... F..eQr._ 1JQ,.ry.....?_? ~...J.~.{$.~...........Age..........l2................................................................. (Years) (Months) (Days) Where Born............. _.....B.ar.r.Y.._Q.Q.1\n.1;Y.. ......l,tl&.f?.9_~.~J................... Race.........................~l.l.~~.e.
Cask.t ..=.llauIt",.8.•r.llic.....S...... 1 (Style ) (No.) , :, Outside Case or Vault.............................. ~ Embalming Body .................................... . ............ ! Professional Service ................................ . . .. . ... . . ... J Hair Dresser.............................................. . . ........... 1 Suit or Dress ............................................ . Shirt, Collar, Tie.................................. _... . Shoes $...................... Hose $.......1 .•.9.9 .. .
..
~;::r~;::;~ ~::::::::::::::::::::::::::::::::::::::::::: I
How Long Resident in Community........................................................_..................._.........._... _... _.... ___ . _____.. ___ .......... Single........................Married..... .mI1,.r..rJ~dowed....................... Divorced...................... Child...•........................
...................Address...........................................•..................... Date of F uncraL ....E'..eb.r.uar.y..... a.~ . .J9..9.Q...................Time ............................?..."f'.. ~. l~..:..........................
Gloves $.................... Chairs $................... . F lowel·S $..................Palms $................. . C1,'emation .... _........... _.. _............................. . Newspaper Notices .................................. Telephone and Telegraph.................. _.... . Ambulance ............................................... . Funeral Ceach........................................... . Passenger Cars ........................................ . Pall Bearers' Service .............................. . Transferring Body.................................. . Opening of Grave..............................._.... Cemetery Charges .................................. . Lot ............................................................ . Misc. Transportation .................... _.......... Shipping Charges .................................. . Clergyman ............................................... . Singers $................ Organist :p................. . Cash Advanced ..........................................
.e.r.!..a._illlap..el................................................................................._.
......Sale.s ....T.ax ................................. .
Husband, Wife or Child oL...........................T.lJ..Qrna.8...YL... J:!.lJ,:\!QXL ..................._...................................
Jenkins J.. ............................................................................ Mi ssouri Address ....................... _.._.... _.......................................................... .
Y.L....~.g.~gn:::r~.r.:1.:.~.~.!3...........Address........................................ _........................
Closest Relativ•...T.., ....
Father's Nam•........Ne.:;i..tQU ...Qg.9..l5, ........................._.._.....Birthplace... _.........................•............................... Mother'. Maiden N ame.JM~.~.y.....
J...~.n.:E'l ....El.~.l'~.El.~...........Birthplace..............................................................
Cause of Death ... ~2.t.fu.R~f.L.{..................................Contributory ......................................................... . Date of Death ... _........ Eep..n.\I1,.J;:Y...§ ,.....
J.: 9.§Q................Hour...........l .;)5...J'..•.!(,.................................
Place of D.ath ........ D.9..!!!§..........................................................1Iow Long Ill ?.....................................................
Physician ............Dr.•....G.•... .YL.....$.a.JY..§.r. ......................... Address .............. g?,.~.~.y..i..~.~~.~.....I:I9..:....... Occupation of Deceased. .......... _.........!?:.~.1?- ~.~::·!.~~.~........... _Social Security No .. _...........................................
..
Name of Employer........................................... _... _...................................................................................................... . Address ..................................................................... _...................................................................................................... .
Charge to .........ln.s..\l.J::an9_~....!i;... g),\.\l~.§,l}.
Clergyman ..........Jie"'._.._Er.e.d.. JlunningballL.........Call for? .............................................................._ Address... _.._.._......... Aur.!l.r.a,..._ ;l.!!..S..9..!dr..t.. _.................. _._.... ;.
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Total Amount..................................
Remains to be shipped-see reverse for details.
Clio Cemet ery Intermer.:t at ................. _........ _........ _................................................................. . Lot No ............................................. Section No ............... _............................ Gra'
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Lodges D Pall Bearers
Information Given To: 0 Relatives D Musicians
20;0 ru sset b ronze shaded ailve.
Ramarks .....................L .. _............................................................... .........................
.......... ...............................r.9..!?~.~.!M}. ...g),\'?£l.e..i3..~... ~.r..~.P..e.:::.r~!()..~.~ .f
........... ............................... £lpr.1ng.f.le.l.d ....Q.,H?~.~.t.. J~gEL·.....(}.~ ...... FORM :l2 3!1o S U PIER IOR FUNERA1. SUPP1.Y CORP .• C1.EVELAND, OHIO.
Attended To: D Death Certificate Payment Arranged
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Clergyman Singers
Permit Bill Rendered
IS Date. ......F.e.);>X.ll.ll.r.;L.1......J2.9 0
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FUNERAL RECORD OF
.
No........ _.. _......_.._.._._ _
1S
Name....... _............................Ella....I.
.m.e.fl ............:....tJtll.(l.t.i..:),.g,?,....1i
!'\.:.#?.......I3.~~....E :::. . .................................
Addr..s................................_..fl.Q.r.1g.§.Q.p.- '.....T~~!~.!?....
County...J.9.h.n .§!?.n ..................Township .................................." ..............Phone No .............................................
Cfuio white Where BOrD.._.........._...._.._... _..._......_.........................._.. _ .... _........_............... __ Race................................... _...... _____ _ Date of Birth......NQ:v:.~....3.Q +....1S.6.S.........................Age....................9..~ (Years)
.................. .................................... . (Months ) (Days )
How Long Resident in Community.................................. __ .... __ ._ ..........._........................ _............................ _. __... _____.. Single........................Married. ....................... Widowed.Y!..+.9,!?.\y.~9,Divorced...................... Child........................... . Husband, Wife or Child
ot............................................................................................................................................
Address ....................................._...................................................................................... _.............................................. . Closest Rolativ•. _..
Mr..§.......J .,_...Q.,....HJ.:),.L .....................Address.......g":.~.~.y.:i..~.~.~..!._..I~~~.s..?.=':r' i
Father's Name......................._.......................................................Birthp1ace: ............................................................ . Mother's Maiden Name.................................................................Birthplace.. ~·_ ....................................................... .. Cause of Death. ..............................................................................Contributo"l·y....................... ...... :..................... .......
L ....J9..Q,Q ..........................Hour........................................................................
Date of Death... _.Ee.b.I:l.!.Ery. ..
Place of Dea th.....B..l.!.I'_lS\.9_9.n . .... r..\l.~@...?.......................... .How ~ng TIl? ..................................................... Physician ............................ .............................................. ... .. ........... Address............ ,.................................................... .
Occupation of Deceased....................... hQ)J.!? S\Yi.;l,.f.~ .......... Social Security No .............................................. Name of Employer........................................... _.................................................~ ........................................................ .. Address ............................................................................................................................................................................ ..
Charge to...............childr..e n .............................................. _Address .................................................................. . Order Gi:en By..........cl1ild.;r.e.n....................... Date of Funera1... ... F..e.b1J)Jar..Y...l.'/:T ..I..~ .. Place of Funeral Service............._..S-lJ.all
b.................A~dress....... 7:'i .....................................................
nL. . . . _.......... ... . ... ............
I.t....................Tlme .......~....\:t.. ...K..YJ.o.b ...Chur.ch....Qf.:..O.tU:.t§.t ..................................... _.
a...o.....~........:'\.~................Cal1 for? ......:.........................................................
Clergyman ....
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Casket
Yearly No .... _...... _.............._...........
-:.U.I.d~'-M'1-.': .. ;.,~"""~M. .......,
(No.) Outside Case or va'o' t ..._......................... I............. ............ / Embalming Body .................................... -1-..... ..·........·1Professional Service ...............................
+. . . +............+..... + ...............
::::::::::::\ : : or Dress ............................................... 1... ............ 1..... . Shirt, Colh.l.r, TIE!... ........................ .............. 1 Shoes $....... _............. Hose ~......................... I Underclothes Door Spray .................................... ................ I.............. .. Glovcs $.................... Ch. irs t .................... -J.. .......... .. Flowars $.................. Palms Cremation ................................................... -J.. . -........ . Newspap!!r Notices ..................................... 1.............. Telephone and Teleg:ra:ph ..................... .. I................ Ambuhmce Funeral ~oac'l .. ··.... ··.... · .... ·.... ··· .. ·.... ·.... ··.. ·.... I..·..··....···I··· ..· Passenger v~r" ........................................... I................ I...... ............ / Pall Bearers' .. .......... Transferring "uuy . ....... ............................. -J.. .......... .. .......... / Opening of "".ve:........................................ I............ I...... Cemetery Lot ..·...... ·.... · ............·.... ·.. ···.... ··................ ·.. ···1........·.... ·1.. ··.. Misc. Tr!msIPortation ................................ /............. /..... . Shipping Charges ..................................... 1...... . Clergyman Singers $......... ...... Organist ~.................... I..............I.......
+ .....
+ .............
==:::::::/ ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::11 To ~1 Anloun~ ....................................
1-
I-----I·__
Remains to be shipped-see reverse for details.
Interment at... ... P.,ai12.t.ar... C.e me.t .e.I:y........................................................................................................... .
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=:<~-~~~~~~.~?~=::~~
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FORM !l 2.3S SUPERIOR F UNERAL S U PPLY CORP . • CL SVE L AND, OHIO.
Lodges D Pall Eeal'ers
Information Given To: D Relatives D Musicians
Death Certificate Payment Arrang'ed
Attended To:
o
Clergyman
D Singers
o o
Permit Bill Rendered
Insurance........................................................................................._
19 l:1.... _;!..9 6 0
Date. .. Eabr..u.a.r.:l-..
.
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No........ ___...... _____
Yearly No.... _.. _.~9_......... -...... -.-
Casket ..:+..~ .................... . (Style) (No.) Outside Case or Vault............................ .
Nam"-......_...................... A.llia ...B.lY..tb.e.... P..Ur.!l.QllL .............................................. Sex...... .f~m.~.;J,.~..... Address................................._........-C.g,,\l,g.V.j,l.le,....Jlll.asQur.i..................................................................... . County......Bol,r.r.Y-....._.._.._.._...Township......._........ _... _........................... Phone No ............................ _...............
Embalming Body ................................... Professional Service __ ...................... ______ _ H' air Dresser....__ ..... ___ ______ .. __ ..................__ _ Suit or Dress ........................................... .
.W here Born.............Ba-r.r.y....C.o.unty..•....Mis..6.9.1!.t'..t...... _................. Race .............. .Y.!h.11.t?.................
.?.?............... _............................ _.......
Date of Birth... ~....~+-..-J,.$..1$.g.-..-......-......-..........Age........._........... ~ (Yearsr
(Months)
Shirt, Cellar, Tie.................................... . Shoes $....... _.............Hose $..................... .
(Days)
How Long Resident in Community.............................................. _........ _.................................. _... _.... __ ...._._________ ....... " . Ii.llla~ ~r. ie d W'd · I .. . lowe d....................... D'Ivorce d...................... Ch'ld I ............................ Smg e.......................~arne
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P.
Underclothes ........----... ---.---.............. -...... . Door Spray ...._...__ .._______ ........................ _... . Gloves;.................... Chairs $................... . FI $ P I $ owers .................. a ms --...... _........ . Cremation ................................................ . Newspaper Notices ._.......... _...... _........ __._ ..
A
Husband, Wife or ChIld of..........................C.. _....d •••..•. •.lJJ:'."QlJL.........................................................................
ill Mi i Address ............. _........ _.._.. __ .. _............................ .a.Il.§Y............§ .•..... ,.....'L6.().'J.F.................................................. Q
Closest Relative._ .. ______ .__ ._________.____ .. _. ___._____ .____ ...._. ____.__ ._____ .. _.... __..Address_ .......__ ..........__..._.. __ ._ .. __ .... __.....__ ....... _______ ..
Father's Name.......J.Dhn..B1Y-.the%._....................•.. _.....Birthplace...................................,.......................... Telephone and Telegraph........................ Ambulance ......... --.......... --........................ . Mother's Maiden Name...__... Nan.c;J1....Garn.eY-..................Birthplace..._..................... __ .................................. Cause of DE'atl'L1'Y.:161il&J!:':'..7.J:."t-,K.'""'~~~...;;~.J&~~.t.. ..ConltrillUtorl,.. l:;..,;u'.-oaJ;.~_J.., ... f.I:.ff1'p.<~:&~"""vt""" ··········1 Funeral Coach ............ _............................. . Date of DE'at11...._.._....!~ebJ~Ual~Y.. ...iS.,......•L~.b.\L ...............:EIour.............. ~,.; .,;lJ?.....t.Un,............................
···········1Passenger Cars .........................................
J Ill? ......'i!.. .t;!d
.an.l.§.l ............;.......Address.g..~.§.§.y.±.;J,.:J,~.L ..1Il.i..El.§.CJ.\J:J::.i.....
Pall Bearers' Service ............................... T ransf errmg . B0 dy ................................... Opening of Grave............................... _... .
Occupation of Deceased. ........ .h.o_use~w.lf.e..._. __................. Social Security No._............................................
Cemetery Charges .................................. .
Name of Employer........................................... _.............. __ ............................................................................................ Address ...... _..............................................................._..._........ __ ... _... _......... _... __... _.... _......................................................... m 'D ~ .D. 'IIIT'l:rrtle Fi Cl'hr.<. :yJ Charge to....... C.• .... ~'_ • ....• .l.l.r.""O.DL ."' ... ~!J.........................£-A'aaress ..................................... _.............................
Lot ............................................................ . Misc. Transportation ...........................__ .. Shipping Charges .................................. . CI ergyman .............................. _............... . Singers $................ Organist ~................. .
Place of Death.C&.-S-g"'.;l~le... O.ateD.P.athic....HQ.JStOw Long Physician ........... D.r.._ ....E. •... E..... Q
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6..................Address.................................................................. Date of Fun.raL. .....F.eb.r.ua.~~·ii2·S·t;~· ·~···cri:;;:~~b ··oi ··c~·/i~~··'········ ······· ···········..... Place of Funeral Service............. _..................__._...t?._ .. _.......................................................................................... Order Given By...f.am-i.l.Y.....................................
~~~.~d __;: :::::::::::::::::::::::::::::: :. ~
Clergyman."O'lin...S.tumpff.::".Bh.a.Q.kJ.§.iQ.r..Q. .......Call for? .............................................................. _
(
D
Total Amount.........._....._.................
!
Remains to be shipped-see reverse for details.
Interment at................._Q)J·.Q....g..t?m~.);;.!?.ry ....................................................................................................... . Lot No ......_..........._.......... _.. ___......... Section No ............... _..................... _......Grave No .......... _..._.......... __ .._......_......... .
==~. ::-~~~~~ FoaM !5238 SUPERIOR FUNERAL SU P P L Y COR.... CLEVELAND, OHIC.
o
Lodges D Pall Bearers
o
o
Information Given To : o Relatives o Musicians Attended To:
Death Certificate Payment Arrang'ed
o o o o
Clergyman Singers '
Permit Bill Rendered
Insurance ................................................................... _...............__ ... _.
Data __ E_ ElbJ.'J.\i3._ry.....
9..•...J:.9. 60
. _ " ,FUNERAL RECORD OF
CHECK EACH ITEM AS COMPLETED Casket ..&. ___ Q__,__.J\Q,,____ .................._______ I
Yearly No .............lJIL.................
No................................_ _
Outside cJ~t%;e~ault _______ ~~".:)__________:_. Embalming Body ______ ____________ .. ________________ _
Name. .......................................... -Sn@J)l'!Ial:l ... Huds.on... ___ .............. _...... _.. _.. _........ __.. __ .... Sex.. __ ..ma.l~ .. _ .. _.. _.. Address ________ ............................................J.f1nltinll_•....MJ.§.!?.Qy.r.J.... _ ._........ ___.. _.. ___ ..... ________... _______ .... _.. __________ . COunty__.Bar.r¥..........................Township...... LU,n.~.rJl,J...
.#.g............Phone
No .......... __ .._....... _.. ___ ..... __ _________ .
_ e..._..__ _
Wh.re Born......... ~.~~.~il... .Q.~~.~~X.L...!f:.~ .~_~.~.~E~ ...................... _ .. ____Race.............. __... __ ~a.:_~_~ Date of Birth.________Q_QJ&Q_fi.!:..
J-.7..l-...J.gl.23..... _. ____ .. Ag._____ ........ ___ _6.§ __ .. __ .. ________.... _.. _.... ______________________ .... _.. __ -
(Years)
(Months)
·······.... ·1Professional
Service ................................ . ............ , Hair Dresser.............................................. . ....________ Suit or Dress _.. c.leaning ..... ____ ...... _ Shirt, Collar, Tie ...................................... 1 Shoes $---_........ __________ Hose $__ ... __ .. _____________ _ Underclothes ._ .... ____________ _____ ....... ____ .. _.. _.. __
(Days)
How Long Resident in COmmunity........... _........l i f.a....t .im.e....................:........... _ .................... _....... _______.. ___ ... Singl... ___ .... __ ............ .Married.... ________ .... _...... _Widowed.. _____ .. :.... __.. _____ Divorced_9.J..Yg.r..Q._~ild ___.. ____.. _________________
I
Door Spray ............................................... . Gloves $______ ... ___________ Chairs $..__.. _____________ _ Flowers $ __ __________ .. ____ Palms $______ ____________ I
Hu.band, Wife or Child of_ ......................... _.................. _............. __ ............ ____ .. __.. ___ .... _.. ______ ...... __ .. ____ _.... _________ .... _______ .. Address ___ .___ ..._.________________________.. _______ ...______ .. __ ..._. _______ ..... ____.......... __ .. ___ ...... ____ ._._._._. ______ ~_ .. _...... _... _.. __. ___ ______._._._ .. _____ _
Cremation ................................................. . Newspaper Notices .................................. 1 Telephone and Telegraph........................ I Ambulance ................................................ Funeral Coach ........................................... . Passenger Cars.................................:...... .. Pall Bearers' service.................... __ .. __ ...... 1 Transferring Body... __ ............................. .. Opening of Grave............................... _.... . Cemetery Charges .................................. .. Lot .... ________ _________________________ ____ __________________ .. .
Closest R.lativ..... _Y..e.a.t.e.r'....!}M.9.§Q!}................. _ ........ _.. _Addre.s .. ___ .... _.. _~.~r.::\:-.1._r.:_s..!
__ ...I\l_1._~_~_~YE.l
Father's Nam ........J .......YI.~....Hl.l.dS.Qn................................. .Birtbplace.. _.... ____........ _.................. :.. ___ ................. . Mother's Maiden Nam......... HannalL_ D._Q_:1;_y. __ .............. ____.Birthplace....... _.. _...... __ ............ _.. _.. _.................. ___ ...
Cause of Death...~._~~.. -&'!!.-1~ntributorY--~'-"------ .. ---.--.. .. Date of Death_ ...... _F..fi.Q_r.~..~... ;L.9... Hour.. _.... /l__....'2!!!. ____ ......__ .. ____ .. _______ ....__ ........
9..•_.... 6.g_.... _.... ___.. ____ ..
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Place of Death----... Physician .... __
Occupation of Deceased ......far.mer.___.__ ....................__....... _.Social Security No ............................................. . Name of Employer........................................... _... _...................................................................................................... .
Misc. Transportation .............................. .. Shipping Charges ......................... __........ . Clergyman ....................... _...................... . Singers $_ ............... Organist $................ .. Cash Advanced ......................................... .
Address ..................................................................... _...................................................................................................... . Charge to .. ___ .. __.....br.Q.:th.e_r.s_ _.. ____________________ ...... ______....... ___ .....Address ... __ _.... _.. _.... __ ........... __ .. ___ .... __ ..______ .. ___________ __
~::ro~~::e:~::::::~:F.::;i.~gii~l~~::::f.~?:i?:::::::::~::~::~sSj_-_-_.i___:___~!:":_ _ _ ···_ _ _·_ _ _.-~:-:-_-_ ·_-_ _: _-_-_ ·_ ._ _ _ ._ .-_ _ :._ _ ._ _ _ _.
._..SalB_s ____Tal'--_______ .. __ .. ________ .. __ .. ______ __
P lace of Funeral S.,rvi,ce____ ...._.. J..;•.l.~[l....w.L1JlJ.[lll.al..I.l~....;:l.lA.l-,,j"M,,.l-.; .A ., .. __ ---.----.. ------ _-- ---:.:------.----- -----.. _----co.,--. Clergyman ____ ._Re.l[..• _...Cha.8..•____y.anZ.anQ,.!;;__ ...... ____ .... __.Call lor 1 __ ___ ___ ___ _______
(
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Remains to be shipped-see reverse for details.
Interment at ___________ .. _____..ll~:L(l ...~i~ru. a],B,l:~[ __________________.... ______ . __ ........ -----.. -~
Information Given To : Relatives Musicians
o o
Lodges Pall Bearers
o
Death Certificate Payment Arranged
o
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Attended To:
o o o
o
Clergyman Singers
Pel'mit Bill Rendered
Insurance..................... __ ................................................................... FORM IU.:,III a UPER IOR F UNII:RAL S U PPLY CORP., CLEVELAND, OHI O .
Date. ...f.'.!'l.Qr_~.?-.r.:L .
.±9.L..l960
.
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF . Casket .. &S.e .nr.ic.e.s........................ (Style) (No.)
Yearly No.... _...... _...2.1" ...._...... _...
No........_.........._.. _ . _ _
Name. ......_......................_....... NQah....Ql.1.y.~r.....J..Qmt!'l.............................................. Sex..........Il!g.~.~...... .. Address ................................._........ _.._.R2g.!~
....tt.?:..........!!.!l:.~.~.1l..r:.r1.!.....~.~.~.~.9.~.:..1. ........................ _...
county. )JflJ!g.ng,J.!L..._.._...TOWD8hip......._.. J:.i:>~~.~.i.:n.
............Phone
No ............................ _...............
Where Born............l'..l..a:t:t....Q.Q.1m.ll....._;J;.nJrt..2J_fi......._.................Race ...............\:/~.~.~.~ ................ .
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Date of Birth...Q.QJ!.QQ.!'l.r. ...
l.? ....1!?..!?.2..................Age......... _..J) ...................................................... _....... (Years) (Months) (Days)
How Long Resident in Community................. l.Q ...y.e..,.r.S _........... _................................................................... Single........................Married .... .mar.r.ieWidowed ....................... Divorced...................... Child ........................... . Husband, Wite or Child ol.............................llelma ...Luc.inda... _J.Q.ll.e JL .......... _................................. .. Address ......................._......_.... _............ _................ B.Qu.t .e....#l .......... /aBhbl.l:r.n.,....M.1.ll.!'!.9.:l},.:rl............ Closest Relative......._1Y.:i..f..e.........................................................Address ........................................_....................... . Father's Name.... Chaxl.e.B ...J..Qne..8......................._.. _.....Birthplace............................................................ .. Mother's Maiden Name..._~
:r.Y.... Z..,.....$.p..lJ}~J..~.nK .......Birthplace... _......................................................... Cause of Death ..........Qgr.Q.I}.@,r.y. ... g.~.9..~.~.s..~.().!?: ...........Contributory~......................................................... Date of Death... _...F..!'l.Qr.1•.?-.r.y. ...J.Q......±9..~g .................Hour............... .3...:..~.9. ...I".~..I:~.: .......................... .. Place of Death.................h9..!l!~.................................................. .How Long Ill ? ................................................... ..
. . .... ____ .......................... Dr . Chas R. Bro wn , Missou_.......... ri . PhysicIan __ .. __. ......................................... ___ ...... Address .....Seligman __ ..............................................
f.a:r.m.e.r. ........................................Social
Occupation of Deceased....
Security No ......... 3..9..l.::-.J.:~:::.().~5..5..
Name of Employer.... ___.__ ............ ____ .. __ .... __ ............ _............................................................ __ ... __ .___ .. __ .............. _....... __ .. . Address ....................................... __ ........................................................ _........................................................ _.... _...... ____ ... .
Charge to..............VLtf.~....!!,P.-.~ .. JJ!.§.\l.r.:9,n.~..~............... _.Address ................................................................... O"der Given By.....!!!.:i.f~ ....;'1ng....B.Q.n.!'l...............................Address ................................................................. . Date of Funeral. ........E'.a12.mar..Y .... ;k!±~
....J9..~.Q ..............Time............. g.:.3..Q.J".~..I~.:...............................
Place of F uneral Service.........Ao.t.d&Qh.. _Qh.l<\!:9h ....Q.f ....C..h£.i..s..~
...................................................... _.
Clergyman..... Danald...Wr.lght .........................................Call for? .............................................................. _
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Outside Case or Vault. .................. __ .. ______ _
Embalming Body ............._._. __ ..... __ ......... . ........ __ .. , Professional Service ............................... .
: : : : : : \~:i~~;::~::::t1~::~~d~:;.~:i~: ~:~~r!~~~~"~···~~~~~~~~~~.~.~~. :'~~~:~~~::::~::::::::::
Shirt, Collar, Tie ..................................... . I
Door Spray ............................................... . Gloves $.................... Chairs $................... . Flowers $..................Palms $................. . Crenlntion ................................................. . Newspaper Notices ................................. . Telephone and Telegraph....................... . Ambulance ............................................... . Funeral Coach ........................................... . Passenger Cars ......................................... . . ........... 1 Pall Bearers' Service ............................... . ............ Transferring Body ................................... . Opening of Grave...................................... Cemetery Chal·ges ................................... . T...ot ............................................................. . Misc. Transportation.............................. .. Shipping Charges ................................... . Clergyman ............................................... . . ........... / Singers $................Organist $................ .. _.......... Cash Advanced ........................................ ..
=~::=:.I~s::~: :.: : : .: ..:. :. .::.: : .
Total Amount.................................. 1
Remains to be shipped-see reverse for detaUs.
Inrermentat.........~n!~~!~QD....~.flP.L~~~.E:r;r.~Y.J\9.,~~:l.o ........................... ~ Lot No ............................................. Section No ............................:...............Grave No .............................................. .
Information Given To: Relatives 0 Musicians
o
D Pall Beal'ers
4Sot-2S6 Med Blue no shading-silver hdw.
Ramarks ....................... _........ _....... ~................................................................................................................................. .
D Death Certificate P ayment Arrang ed
Attended To:
o
Clergyman D Singers
o
Permit D Bill Rendered
......................................H ;;3...J .t ....Ql)J.!'l_..g.r.9-....Qh.:l,l}.~... :.r.h.()llIE.~<:l.r1...l?~!?:~.1..... ~~....... .......
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Insurance .................... :.................................................................... .
FORM e:.l31S SUPERIOR F UN ERAL SU PP L Y CORP .. CLE VELAN D , O H IO.
Date. .....F..abrllar.;,c ..14....l9 60
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF
21................_...
No•....... _ ........._ ......._ _
Yearly No ..............
Name....... _...................... _.......VI.H.l .l. •ffi ....$.Jlg..§....~§.J,J............................................ Sex.......... :.... l!l.!1..:J,E3... Addr.ss.................................................Eag.le ..~ . . Q.Q~ .,.....M.:),,~.§g.ld.rJ........... ~..... ~..............................,............ . County......
a.rr.y. ......_.._.._.......Township..B.Q.§._:;:.;l,!2K..!3::!:.y.~E......Phone
N 0 •...••...................... _ ... .....•.....•
Where Born............. _.......__ ....................llifl.B.O.ur.l_ .................................Race ..............lYhJ..t.!L ................
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Date of Birth........
Qy_eJ.nb_~r.....9.......;l$.1!±............ Age............._....~2 ......................................................... (Years)
(Months)
(Days)
How Long Resident in Community..........................................._........... _.................................................................. . Single....................... .Married. ...ffia.r..r..t.!? .
a .),)._........_............................_...................................
Husband, Wife or Child of...........................J ..enu.i .e....
Address ..........................._..............................................~gg)& ...1l9.9.~.•....Ah.?.!'.()y.r..i..0 ................................. Closest Relative.......J.f:rml...LB..al1 ................................. .Address .............~§\-P;.:J,~... :R.:().S.ll:LJ~?
..:.....
w.m.•....Y.§,lg.njJP..~....!3.~g....Lr....Bi~l!'ce..............................................................
Father's Name..........
Mother's Maiden Name... _~g.r.~ ....~.~ .i..~.?:9..e..~.tJ.jlf !l..S{;r1hPlace... _.........................., ..............................
....
Cause of
Death.~.~..~. .f~ntributorY... :~ ........................
7..;.3..'O'.J)..~.I~..•..........................
Date of Death ... _..F.e.br.Uar.y. ....l2.,.... )S6.9................. .Hour ...................
Place of Death ...................p..9.!n.!:l................................................How Long III? .....................................................
.. ..... _......... Dr ~._._ ..E_..~._ ._E....':. ..................................•........... McDaniel . .,....... Address .............•.................................................... Ca ssville , 110 . Physlclan Occupation of Deceased. ........... .f.ar.m.er. ...............................Social Security No .............................................. Name of Employer ........................................... _... _...................................................................................................... . Address ............................................................................................................................................................................. .
Charge to......... J.annl& ...!1.il.ll ...~ ....l;n@..................... ...Address .................~.~~~5:
....~.O'.().){.!.....~I.Q .:..
Order Given By............8.0nEL. .................................................. .Address ........................................... _.................... . Date of
FuneraLxff~j.("... ~./ ..9...(.;>..'L. ....Time ......../..,:.S,?....e..121.,.............................
~~;:::.=~~~~~. :. .-:. .: . ..: :.: : : :. : .:... .:. :~: =
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Remains to be shipped-see reverse for details.
,.Z2::u~ ....e~
Interment at......
Lot No ............................................. Section
.
No ...............................................
~::~~~~~-~~~ F O RM 5238 SUPF.RIOR F U NERAL S U PPLY CORP .. CLEVELAND , OH I O.
...
.v.......
==::::::: J~,~d~~::::::::::::::::::::::::::::::: Amount.................................. I- - - I - _
.
. . .. ..... ..... . . ... . . .. . .... . . . ... ..... . . . ..
I~o .................................. , ......... Grave
Casket -:..1l~.~ ~ (Style) (No.) I •••••••••••• 1 Outside Case or Vault............................. . Embalming Body .................................... Professional Service ............................... . Hair Dresser............................................. . Suit or Dress ........................................... . ............ 1 Shirt, Collar, Tie..................................... . Shoes $......................Hose $..................... . Underclothes ............................................ Door Spray ................................................ Gloves $....................Chairs $.................... I Flowers $....... V .....Palms $.................. , Cremation ................................................. . •••••••••• •• 1 Newspaper Notices .................................. • ••••..••••• 1 Telephone and Telegraph........................1 Ambulance ............................................... . ············1 Funeral Coach........................................... . _··········1 Passenger cars············.·............................ 1 ............ 1 Pall Bearers' Service ............................... . ..•.•...····.1Transferring Body................................... . Opening of tiro.v''---..................................... I • •••••• ••••• 1 Cemet ery ............ 1Lot ...................................................... ··········.1 ............ , Misc. Transportation ............................... Shipping Charges .................................... Clergyman .j ..7 ...................................... . Singers $..... Organist $................. .
D Lodges D Pall Bearers
o
o
Information Given To: D Relatives D Musicians
Death Certificate Payment Arranged
Insuranc
............. ..
\
Attended To:
D Clergyman
o
Singers
D Permit D BiII Rendered
23 Date.E.e.b.r.uar.Y... l4: •.._19.Q.0
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF Yearly NO ....... _.. ?} ........._......_...
No........ _.........._..____
Name. ...... _........_.... _.. _..
[email protected].}Q.~~.§g.If....... _....._.......................................... Sex. .......... ~El.~.~~ Address ....... _........................_.............
11_" ....Q.Q1!lf.Qr..j;.•...Jl!J.§..§9..~r..L ..................................................
cD.Q.n.al&L_.._...Township......._........•..._...........................Phone No ............................•............... Born. ............_.._.MIs..6Q.\ll:i....................... _.. _ ...._...........................Race............ y!)]...tt~....................
County....... Wh.re
Date of Birth.... S.e.p.t.ruub.ar.....l
6.•.....l aS.Q.......... Age..........•..•...?.9............................... _........................... (Years)
(Months)
(Days)
How Long Resident in COmmunity..........................................._.................................... _............................. ___ .......... . SingJe........................Married........................ Widowed .... ~v.~.~t).~y.ElJS\vorced ...................... ChUd........................... . Husband, Wile or Child of..............................................................._........................................................................... Addres •....... _.... _........_.. _.... _.. _............ _........................................... ,......... c.••.•.•••.••.••••..•••••••. ..••••••••••••••••.•••••.•• ••.••••••••••
Closest Relative......._...................................._...............................Address .... __ ......_____ ........... __ .....................................
Father's Name......................................................................_.. _.....Birthplace.. __.____ .................................................... . Mother's Maiden Name... _............................................................Birthplace... _...................................................'''''' Cause of Death...............................................................................Contributory........................................................ .. Date of Death... _....E.e.hr.uar,¥....l
\!-.•....l;J.6~Q.................Hour.................12.;.J Q...p. .•.{;\. •......................:.
Place of Death......... ..ttQ.rn~..............................................-..........How Long Ill? ..................................................... Physician.......................................................................................... Address................................................................ .. Occupation of Deceased .............................................................. Social Security No ............................................. . Name of Employer........................................... _........................................................................................................... . Address ............................................................................................................................................................................. . Charge to....................................................................................... ...Address .................................................................. . Ol'der Given By......................................................................... _.. .Address ................. _.............................................. . Date of FuneraL .............F.ebr.u.ar.Y.....l.7..~.... l9..6.Q.......Time .................f ....
P..,..!il...................................... Place of Funeral Servic •.............R9..Q,k::i.... Q.Qlnf.Q.r..:t.J2.. 9.:\;..t§.:\;.....9.h~.9.h....................................._.
Casket ........................................................ $.................. (Styl.) (No.) Outside Case or Vault................................................. . ............ / Embalming Body ....................................................... . .. .......... [ Professional Service .................................................... Hair Dresser.............................................. .............. .... .. Suit or Dress ............................................................... . Shirt, Collar, Tie ......................................................... . Shoes $...................... Hose $...................... .................... Underclothes ............................................................... . Door Spray ................................................................... . Gloves $.................... Chairs $.................................. ..... . Flowers $..................P.lms $.................. ........... _...... . 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 .......................................... ....... ............ . I
......................................................················1·············· ......
Clergyman ............................................. _.........................................Call for 7..............................................................Address....... _.. _............................ _...................... _ .............................. _............................................................ _.. _.. _.....
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D
Total Amount. ....................... . Remains te be shipped-see reverse for deteUs.
Interment a t ............B.Q.Q.llly_...gg_l)).f.g.r..~ ... g.~ !!!.~.1&ry................................................................................... Lot No ............................................. Section No ............................................ Grave No .............................................. . Ramarks ...................Kr.?,.Y. ... .9.9.~.~.Q!.l. ...E.1..~.~ ....()().~.../3,12.
c:: .:...~~:lC................ ........ ............
o
Lodges D Pall Bearers
Information Given To: Relatives D Musicians
D Death Certificat e D Payment Arranged
o
Attended To:
o
o o o
Clergyman Singers
Permit Bill Rendered
Insul'ance.......................................................................................... FORM 1!1231!1 SUPERIOR FUNERAL. SU?PL.Y CORP. , CL.KVIU..AHD. OHIO.
\
(Boone) Date. ........F.ebr.l!.a..:r.Y......l.l+.•.-1960
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF N 0 •.••••.• _ ••.••...•• _ •• _ •• _ . _ _
Yearly No •... _.... ?_ 1±......._..._......_...
Name. ...•.. _........_............_.......G.e.QJ:.g~.... F..,U?;@........................ _.....................................Sex..... .J.ll!3,;!,.~ ............ Address ................................. _...........',\lhe.'3.t .Q.U•.. JU.!>.S.Q.UJ:.:l-.......................................................................... COunty........Ear.:r.:f............_.......Township ......._.._........ _...........................Phone No ............................................ . Where Born. ...........Qh.".J;:Qli;!;LIl....Q.Q)J.!11y..•....K@.('!§.!3........................Race................. ~,:h..~.:t;~
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)
...............
Date of Birth..... Mar.ch... l.,. ....18.EL5.......................... Age............1.1±........................._............................_....... . (Years) (Months) (Days) How Long Resident in Community............................................................... __ ....... _...._......... _.................................... .
Single....S.lnil.l..~..Marrie(L .....................Widowed....................... Divorced...................... Child ........................... . Husband, Wife or Child oL ............................................................ _........................................................................... Address ............. _........ _.._.. __ .._.... _......_..........................................................................................." ........................ ( .. . Mrs Daisy Boles Southwest vity, Mo Neic Closest Relatlve......._.....__':...........__.............. __............. __ ............. __..Address__ ................................ __.. __, ......... ______ .. __ ......
Father's Name............. __............. __...................................... _.._.....Birthplace .............................................................. Mother's Maiden Name.................................................................Birthplace... _............... :........................................ .
Cause of Deatb······r ·e·brUary····ilj:·;····I9·i)·O················ ..Contributort ..p. ~iL Date of Death ..._........................................................................... .Hour....................................................................... .
..........................................
Place of Deatb.......§.i;.~I.1.{l, ......!:!.Q.§.!?.+..~.!3,-*......................How Long III ? .................................................... . Physician.......................................................................................... Address................................................................. . Occupation of Deceased............................................. _................ Social Security No ............................................ .. Name of Employer........................................... _... _..................................................................................................... .. Address ............................................................................................................................................................................ .. Charge to....................................................................................... ..Address .................................................................. . Order Given By............................................................................. .Address................................................................. .
Date of Funeral ........._... F..ehr'~.y.... l6. •.....l9.6Q.........Time......................Z....P.•I1L................................
Casket ........................................................ $.................. (Style) (No.) Outside Case or Vault................................................. . Embalming Body ....................................................... . .. .......... , Professional Service ................................................... . :::::::::::: 1
~:i~ o~r~:::~.:::::::::::::::::::::::::::::::::::::::::::: :::::::::::::: ::::::
Shirt, Collar, Tie ............ Shoes $...................... Hose $......................................... . Underclothes .............................................................. .. Door Spray ................................................................... . Gloves ; .................... Chairs $............................... _. ..... . Flowers $............_..... Palms $...................................... ) Cremation ..................................................... _...... _...... . e·········· .... Newspaper Notices ...................................................... Telephone and Telegraph........................... _............. .. Ambulance ................................................................... . Funeral Coach ............................................... _............. .. Passenger Cars ............................................................. . Pall Bearers' Service ................................ ........... _...... . Transferring Body...................................................... .. Opening of Grave.......................................................... Cemetery Charges .................................... ................... . Lot ................................................................................. . Misc. Transpor tation ................................................... . Shipping Charges ....................................................... . Clergyman ................................................................... . Singers $................ Organist $.................................... .. _..... ..... Cash Advanced ............................................................. . 4
.............................................
0 _ • • ___ •
Place of Funeral Service...........•OO-Q,<.<-6.el'l-•.Qfi.a,;;:>.e.l. ..................................................................................._. Clergyman ............................................. _.........................................Call for? .......... ~................................................... .. Address................................................................. _ ............................................................................................ _...... _.._.
( )
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:=:::::::.1 :'::.:: ::':":':':.::.::·::::.::..::..::....::::..::::.:..-:::.:.:.1 ::.::.:.::::: :::::: Total Amount.................................. - - - - _
Remains to be shipped-see reverse for details.
Interment at.............. MilllC.eY-....0b..o>-P.e.1 ....C.elll.E\.t .e.r.:!. ................................................................................ Lot No ............................................. Section No .. ;......................................... Grave No ..........................·:.................. ..
Ramarks ....................... _...... gr.ay.....B.t.ee.1....1.l....g1:L,........"n¢.\....Q.. ,.... );>.9.~ ................................................. .
o
Lodges D Pall Bearers
o o
Information Given To : o Relatives D Musicians
Death Certificate Payment Arranged
Attended To :
o o
Clergyman Singers
o Permit o Bill Rendered
Insurance ....................................................................................__;;.. FORM 5238 SUPERIOR FUNERAL SUPPLY CORP., Cl.EVEl.AND, OHIO .
Date.F.fl.p.;r.JJ.a.:r.y. ...J5~.._;)..9. 6 0
25 CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF
No•......._.. _.. _.._..____
Yearly No•... _...... _2;i......._......_...
Name. ....•._ ......._............_.....P.9Y..
...
Addres •......._........................_.........!3.~~!.~E.U.~}Q..I..}!~.1..? .§g.~.i..............._............................................
Bar r y
.
.
COunty.........•............. ____ .... _..__.Townshlp......._.. _........ _........................... Phone No •........................... _.............. . Where Born. ............_.. _.!3.§££Y... .9.2~.!?:~.Y."_ I..... Ai..?_~g.!!:~.i.
................... Race...............~/~.i..~.e. .................
?!?L....~!?7.L ..........Age........................ :.................. _............................_....... . (Years) (Months) (Days)
Date of Birth...........r§:!.\.!!:§:EY.....
.....~ ....ll.§1.r.YJ9..§1..S.::.Y.9,),l).... (Style) (No.) ············ 1 Outside Case or Vault..... ____ .................... . Embalming Body ..................... ___ ..___ .__ .... •. •••....... ! Professional Service .. _................... _________ _ Hair Dresser..........................................___ _ .··.....···.1 Suit or Dress .. _......................................... ············ 1 Shirt, Collar, Tie ........ _............................ . •••••• · ••••• 1 Casket
~:~:sr~~~i~~~····~~~~~~~~~~.~.~.~._~~~~~~~~~::~:::::::::~:
How Long Resident in Community.................................. __ .... ____ ........... _............................................................... _._. Single........................Married. .......................Widowed ....W.Jg9.X!.§1.~ivorced...................... Child........................... . Husband, Wif. or Child of......................J.•....M..•....Gur.l
e.Y-.. _...........................................................................
Addr•••......................._.. _..__.. _•........... _.................................................................._.................................................... . Closest Relative._......Mr.B.•... fuY-....!c.lIally...................Address
[email protected];I.y..l.l.le.., ....tU.S.S.Q.IU'.l. Father's Name........I.o.s"'flh. ..Rid.dle. ................... _.. _.....Birthpl~ce................................. _........................... Mother'. Maiden N ame..._Ma.t .;i,J,g.a.... $.mJ1h.1l9..!L.....llirthplace..._......................................................... Cause of Death ..............................._____ . ____ ......................................Contributory.......................................................... Date of Death..._F.'_~p..r.J,l.?:.ry.....
.1.5.1......1.9..§.Q.....................Hour... _...................................................................
Place of Death... J .an_..ffi1inn ..1Ill:!lp.•._.!!l.e b.b....hU•.1aow Long III ?....................................................• Physician ........l)r..•....C.•...$. ...... G.r.egor.y. ........................... Address... -'y.ebb....Q.ity... ....
i8..s.o.ur.i.
Occupation of Deceased................fLO.Ua.e).~I.lfe ............._.. _.Social Security No .............................................. Name of Employer ...... __ .. ____________ :..... _____ .. ____ .... _... _...... _.............................................................................................. .
Address ..................................................................... _.................................... _........... _..................................................... . Charge to .......... famil
y..... _............:..........................................Address...................................................................
Order Given By........... j;'.Q,ffii.ly..........................................,_...Address ................. _............................................... Date of. FuneraL .....E.ab.r.uar.Y. ...2.Q•.....1.9.6..Q...............Time .............<;... J'.,.kL ...... _................................. Place of Funeral Service..._
I
Door Spray ............................................... . ············1 Gloves $....................Chairs $.................... •••• •••••••• 1 F lowers $.................. Palms $................. . Cre.m ation ._............. _................._......... _...... \ Newspaper Notices .................. _............... ············ 1Telephone and Telegraph ....................... . ••..•........ 1 Ambulance ...................... _..... _.................. . ........ ···.1 Funeral Coach ........................................... . _....·.···.. 1Passenger Cars ......................................... . •....... ··.. 1 Pall Bearers' Service................................ . .... . _ .... 1 Transferring Body................................... . Opening of Grave..................................... . ....········1 Cemetery Charges ................................... . """ "" "1 Lot ............................................................. . ••· •• ··· •••• 1 Misc. Transportation ............................... . Shipping Charges ................................... . Clergyman ................................................ Singers $................ Organist $................. . _ •••.•• · ••• 1 Cash Advanced ......................................... .
t ...... Elaa.s.e.n.t ....Me.:th.o.di.s.t .... Qb.u);'~b........................................._.
......s.a.l.S..s....T.a.x.................................. .
ClE..~~lI'n .....~l~,~ .• :~.~~L~~....~~F.~~g~'.: .......................C:rulfor? .............................................................. .
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Remains to be shipped-see reverse for
Total Amount. ................................ .
d~tails.
Interment at............j,~.1; -•....it-..I.<>a .g
Ivory satin t wi l l interior
................... ..................................i3·;;·i1:::;iiEiI i-·Cii·s"kei"···C·o·:··························....................................
Information Given To: 0 Relatives D Musicians
o o
Lodges P all Bearers
o o
Death Certificate Payment Arranged
Attended To:
o o o o
Clergyman Singers
Pennit Bill Rendered
Insurance.........................................................................................• ",ORM 15238 S UPERIOR FUNERAL SUPPLY COR ... , CLEVELAND, OHIO.
26
(Boone)
l2.......!9 60
Date. .....F.ebr.ua.r.Y. ....
FUNERAL RECORD 6F Y.arly No...._......_2.6........ _......_...
No ...................... _____
Name. .............................. _....J.o t.n....N.!1J.~g.;?, .......:............................................................ sex...lllale. ..............
Address..............................................Exa.t .e.;r........M.~:'?.~Q.1,!.. r..*............................................................................ COunty.......____ .....•..•__ .... __•..•.•.______.TO'WDship .......____ ....______......••..__ .. ___ ...... __.Phone No ............................ ______......... .
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Where Born...................M1l?.~Q)J.rl....................:......_ .._.............................Race................................................ Date of Birth.......~..+.:::11.::'J~.~J............................_....Ag...............(Years) ]~ .................... _........_....................... (Months) (Days)...
CHECK EACH ITEM AS COMPLETED Casket ........................................................ $.................. (Style) (No.) Outside Case or Vault.............................. ................... . Embalming Body ........................................................ ::::::::::: I~:~!eS~~:::~r~e.r~i.c.e::::::::::~:::::::::::::::::::: :::::::::::::: :::::: . ....... · .. . 1 Suit
How Long Resident in COmmunity.......... ________ .__ ....__....................... __ .. __........__ ..... _................. _.... _.......... _____.___ ._._. __ ... .
Singl•........................Married..ma;r.r~.~.g.Widowed....................... Divorced...................... Child............................ Husband, Wife or Child of.........................-Mr.s.•....O~11e...Na~ao.n....:..................................... _............... Address......................._...................................................Exf'.~51..r.•....MJ.~.~Q~.r..3.,.............................................. Closest Relative.__ .___...____ . ________________._._________ ......... _____...... ____.___ .;.. .Address __........ __. __ .........................
yo •••• • •••••••••••• • • •• ••
....···..···r
Father's Name. ............_........ _...................... _...................._.._....~irthpla~e ... _...... ,..........~ .................. _.................. . Mother's rvIaiden Name.................................................................Birthplace... _.:... :.................................................. .
~:::eo;fD~::~~:~::::F.~~:r.ii~i.Y.::j9.:~::j:~:~2::::::::::::::: :~::~i~~.t~".~:::::: ::::: ::::::::::::::::::::::::::::::::::::::::::::::: Place of Death..............A.O'.!!!51...............................................,..- ....How L~ng III ?..................................................... Physician ..........._............................................................................. Address ................................................................. . Occupation of Deceased............................................. _...... _........ Social Security No............................................. .
Charge to.................................................................. :....:............... _.Address ......:.....:...................................................... Order Given By......................................................"........................Address ...... _......................................................... .
Address........... _............................ _...................... _. ..................... ::...... _............................................................ _...... _.._.
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Hose
Gloves
Chairs
Misc. Transportation .................................................... Shipping Charges ....................................................... . Clergyman .............................................................. .... .. Singers $................ Organist $............................. ......... Cash Advanced.......................................... ................... .
Address ............................................................................................................................................................... _........... ..
Cler gyman......... _.............. _.............................._.......... :.................. Call for .?........................................~...................._
Shoes
Lot .............................................................. ....... _...........
Name of Employer ........................................... _..._...................................................................................................... .
Date of FuneraL.......E.e.bruarY...2.1•.....1.9..9..Q.............Time. . .....L ...........?;2.g....p...~.~..•.................... Place of Funeral Service...R1dglay....Qhur..cll....Q!....G.AP.;!,!?.'t;.,............................................................
or Dress ............................................ ........... _..... .. Shirt, Collar, Tie.......................................................... $...................... $......................................... . Underclothes .......................................................... .... .. Door Spray .................................................................. .. $.................... $.................... .............. ..... . F'lowers $..................Palms $.................. ................... . Cremation ..................................................... _............. .. Newspaper Notices ..... - .............................._.............. . Telephone and Telegraph........................... _....._........ Ambulanc2 .................................................................... Funeral Coach............................................................... . Passenger Cars ............................................................. . Pall Bearers' Service ................................................... . Transferring Body.................................... .............. ..... . Opening of Grave...................................... .................... Cemetery Charges .................................... .............. ......
......................................................················1·············· """ _ ..·······1············································.............................................. _ ..··..··-1·············································......................... - Total Amount.................................. - - - _
Remains to be shipped-see reverse for detaiis.
Interment at.........c.r.€la.son...c.eme.t.e~y..........................................................................,............................. Lot No ............................................. Section No .......................................... ~.Grave -No ............................................. .. Ramarks ......................._.. _................................................................................ ~............................................................. ..
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FORM !52815 SUPERIOR P UNI!:RAL SUPP1.Y CORP •• C1.I!:VI!:LA.ND, OHIO.
~
Information Given To: D Relatives Musicians
o
Pall Bearers
o
Death Certific:ate Payment Arranged
o .............................................................................................- .. -......... .. .............................................................................
Lodges
o o
o
Attended To:
o
o
Clergyman Singers
Permit Bill Rendered
Insurance ........................................................................................ ..
27 Date. .. _.....F.ebr.uar~._.2.l..J 960
. .' ,. FUNERAL RECORD OF
No........_.._.._.. ____.._ _
CHECK EACH ITEM AS COMPLETED Yearly No•...- ..- .. - .._..
~
2.7.._...... _...
Casket ..& ...lu!d:.1L ............................ (Styl.) (No.) Out side Case or Vault............ ______ ..... ____ .. . Embalming Body ___ .____ ........................... . Professional Service ............................... . Hair Dresser.............................................. Suit or Dr.ss & ...und.er.c.lo.th ..... Shirt, Collar, Tie...................................... Shoes $...................... Hos. $..................... . Underclothes ........................................... . Door Spray ................................................ I Gloves $.................... Chairs $................... . Flowers $..................Palma $................. . Cremation ................................................. . Newspaper Notices ................................. .
Name. ......_......................_.C.lQJli.s. ..Her.ber.t.....tBlll.. Jp.an.d.e.r.g;r.a.f'.~Sex....!!!al..e.............. Address ................................. _............ _...._.:
[email protected]?1!r.;g.•....M.*.§.§g.~;:A
..........................................................
County......... Bar.ry.......... _.._...Town.hip ...... AM..... _...........................Phone No ............................................ . Where Born............ J4cDon a 1 d ...CO:unt;)t'......Mi.s.S'O.UI'i................ Race............w.ll.J.te .................. ..
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Date of Birth......J.U~....3.Q.......
l9.Q3. ........................Age....................5§.............................................. _....... (Years)
(Months)
(Days)
How Long .Resident in Community........................................................ _.......... __... __ ................................................. . Single........................Marri.d. .......................Widow.d .......................Divorcedd1v.OrC~ild........................... . Husband. Wife or Child of........................................................................................................................... _.............. . Address............................................................................................................................................................................. . Closest R.lativ......Mr.S.•...O.nz.a ...Steph.ens...............Address .......W.a.s.hb.Yr.n.~....M1..ss.Qu;r..l
·...··.·····1 ············1 Tel.phon. In;rTel.graPh························
Fath.r·s Nam•....J..ohn..~.end.e.r.c;r.a.t.~ ........................Birthpl.c•... _........................................................ . Moth.r·s Maid.n Nam•.....1Unn.1.e....La!J&h.l
~~~::::~: ~:: ~::~~n~:a~h:::::::::::::::::::::::::::::::::::: ::::::::
.M1,...........Birthplace..............................................................
Cause of Death................................. _............................................Contributory...................... __ .......... _____ ._______ .. __ ......,
............ Passenger Cars.......................................... I ........... Pall Service............................... .
Zl•.... J.9.Q.C>.....................Hour........................................................................
Date of D.ath..... F..eb.:r.lda.+.'l'.....
Bear~rs'
Place of D.ath...hcme................................................................How Long Ill? .................................................... . Physician ........D.r.A....E.A....E.•.....!v1c.D.a.n.1• .;!,........................ Address ................ .Q.f;!:.!l.!l.Y..!,-),.),~ ......
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Occupation of Dec.ased. ......f.arme.r.................... _.............. _Social S.curity N o•... :::!Q .. -::..t£
Charg. to..............In.8UI'an.c.e.... &....ch.1.lg,;r..e..n ........ _.Address ................................................................... Order Giv.n By.........Chll.dr.e.n. .......................................... .Addr.ss ................................................................. . Dat. of F un.ral. .......E.ebruar.y. ...24. •.....l9.6.Q...............Tim•.............2 ...Ii'.•M.•...................................~ .....
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............ Transferrmg Body .................................... I Opening of Greve. .............................. _.... . Cemetery Charges ................................... . Lot .............................................................. Misc. Transportation............................... . Shipping Charges ................................... . Clergyman ................................................ Singers $................Organist $................. .
..
~:s.~ ~.~~:J1C~~::: ::::::::::::::~::::i
Plac. of Fun.ral S.rvice............B.c.ll.e r....BaJl.ti.e.t....g.b.).U;~~A............................................................... CI.rgyman ..... ReJl .•...Hugh...H.1gg.8 ...................................Call for? ................................................................
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1
=::=:::\::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Total Amount................................. .
Remains to be shipped-see reverse for details.
Interment at...............Rol.1.ar.... .G.eme.t.e.;r;r....................................................................................................... Lot No ............................................. Section No ............................................Grave No .............................................. . Ramarko .......................#26.Q .. Blu.e.... J;!.t.l'l.~.r. .. J!h~9,.~ .Cl.=p..~.r..:r..El().~.~I:):n.....~:t'.~.Il:~
...... ...................................... J.yQ.F..Y.....P..\J9.h.~.~.s.. .. ().:r'~P.El.:::y..1..~~.... y..~.~~~~... ':IIlI.a.:~~....
D Lodges o Beal'erg
Pall
Information Given To: o Relatives o Musicians
pan~lD.ath C.rtificat .
L1l>ayment Arranged
Attended To:
D Cl.rgyman
o
o o
Singers
P.rmit Bill R.nd.r.d
2g Date. ......F.eb.r.uar.;y.....2.Q~....19 60
1
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF Yearly No ..................2.8. ................
No.........................._.__
Name. ....~_ ..................J.amas...Elm.e.r. ...Gar.;r.l.!I.Qn................................................Sex. ...... g\.~.;L.~........... Addr..s ............................W.aahb.ur.14·...M.11Hl9.gr.~ ........................................................................................ COunty....8.
.................
Where Born. .........Ba.r.cr....Qg.1ill.1;y..•....M±.~.!!g.1.!!:~.............................Race .............. :-v~~.t..e.
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. Date
of
Birth.......p.J~g.~.!l!p..~.!: ...
g!±.•...J .?!.?!.5............Age..................... 7.~ ....................................................... (Years) (Months) (Days)
How Long Resident in Community........... llf'.e....t.1me ..................................................................................... Single.. !':I..+.ngJ~ Married ........................ Widowed ....................... Divorced...................... Child ............................
...
Husband, Wife or Child of................................. "'.......................•.... _........................................................ _......... _.... _.. .
·Address ............................................................................................................................................................................. .
Closest Relative...Mr.S..•....)i;.,.....G:., ... I.Y..:t:J:.!!........................Address ...........\~!:'.~.~l:l:F.!.l.!.rM~I3..S..o..~:r:: 1
Father's N ame........... Bamu.el...Garr.1.s.on...................~irthplace............................................................. . · Mother's Maiden Name...Emma...Q.aKl.~y........................... llirthl>laee.................. :.......................................... .
Cause of Death... Q.~.;r..~.l?r.,;l,.l... .Y.~.~.Q.\!:;J,!?-.;: ... ~~.~.1.,9:.@bhtibutory..........................................................
M..,...........................
. Date of Death..F.e.p:rJ.la.n':....29.4 .. ... l9..Q.Q .......................Hour ..............l,.;..;L.9..)!,.,.... Place of Death.....~.U~.!':I.....rJ.!!.Qh.~-*.... ~.t..~~.~
...9..~~ Lbh~EtW~.t..€l:I: ........................................ M.,p..'..... Address.9..().:I:l:l:D.lE.~.~.I.....~.1..s..I3.().:l.:t'.~.......
Physiciall............F..,.....G:§.IT....~JY..~.I)K!!..............
Occupation of Deceased. ...... !_a.~m.~.r .................._....... _ ........Social Security No .............................................. Name of Employer........................_............ _..... _... _........................................."...................................................... ~ ...... .
Address ............................................................................................................................................................................. .
¥.±.s..?g.lJ..:r::-*
Charge to........Mr..s .•....E ......G._... lQtl.e.......... :...................Address ........W9.-.~.Q~.Il.•.....
Order Given By... F.eb.J:'Ua.ry.... 2El.•.... 19.6.Q~~.~.l::.:J:.2.~ess ................................................................. .
Date of FuneraL ...................... _.....................................................Time.......... ~ ..... .2... ..P. .• M.......................................
Place of Funeral Serviee...... O.• X .•...Mi.a.s.1Un..Bap..t.1s.:!i....Q .4w..94.................................................. Clergyman ...... Re.ll .•...l'""'U~ ...w.a:!i.Il.Q.P.................:...........:.Call ·for?: ............................................................... Address ....... _............ W.il,~1?1l.r.!}.J.....MJ.~.~Cl.1l..~.1..............;:.:-..:.~.......................................................................
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D
Remains to be shipped-see reverse for
Casket & ... ser..v1ae.s ........................ (Style) (No.) Outside Case or Vault... _....................... .. ............ Embalming Body ...(C.o.lumb..1a1. .. .......... Professional Service ............................... . ·..·..·.... ·1Hair Dresser.............................................. .···········1Suit or Dr.ss &Unde.r.alD.th Shirt, Collar, Tie .................................... .. Sho.s $...................... Hos. $..................... . Underclothes ........................................... . Door Spray .............................................. .. G1ov.s $.................... Chairs $................... . Flowers $.................. Palms $................. . Cremation ................................................ .. Newspaper Notices ................................ .. Telephone and Telegraph....................... . Ambulance ................................................1 Ftmeral Coach. __ ....................................... .. Passenger Cars .................................. __..... . ............ Pall Bearers' Service ............. _................ .. .. ........ __ Transferring Body.................................. .. Opening of Grave.................................... .. Cemetery Charges ................................... . Lot ............................................................. . Misc. Transportation ..........................__ .. .. Shipping Charges ................................... . Clergyman ............................................... . Singers $................ Organist $... __ ............ .
==:···:·:I~~~~~· : :·: ·: ·:.: : :·:·I _···..···1·············································........................ . Total Amount................................. .
~etails. ~
Interment at.........Kingll....c.eme.t.er.y.......................................................................... ,..................................... Lot No ....... _..... _............................... Section No ......................................~: .... Grave No .............................................. .
Ramarks ....................c.app.er.tone....shade.d...b.r.9.IlZ.e. .... ~,;l,.g,~.g .. J?J·9.n.?;.~.....i!.1;.~.l'!.;!,..
.................................... :r..Q.§.~j;@....~!?-.1;JI}. ... ~:!I.P:.1.....~.l1:~.El.J::~<:l.J::':.~p:t'.~.~.Ci...
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?:I3:.Ci·............... ..........................................11.P..£Jng0S1J9:....9..!'!:.~1.t.~.1;.)A!.~..~ ....9..()..:......................................................
D Lodg.s o Pall Beal'ers
o
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Information Given To: D R.lativ.s 0 Musicians
Death Certificate Payment Arranged
D Clergyman Singers
o
Attended To: D Permit D Bill Rendered
Insurance ............................................................ __ ............. __ ............ .
..-ORM 5235 SUPER IOR FUNERA L SUPPLY CORP .. CLSVELAND, OHIO.
J
:2:'9 Date. ...F.flbI:uarY..... Z.~.....
J ...2..6 0
. FUNERAL RECORD OF
CHECK EACH ITEM AS COMPLETED Yearly No.... _.._.._.._29...._...... _...
Ca~ket ......y.~l,l.:t,~.::::s..~.r..y.~.C..E!.fl .....
Name. ......_.........F.r.adr.1ak.............Yl..•.9.r.t 4.......6.e.!l!l.~ng:!
Outside Case or Vault............................. .
Address ............................... a.as.av:1.Uft.. _..M.l§.!'!.9..v.,r.."................................................................................. .
Embalming Body ................................... .
No.................... _.. _.._.__
(Style)
············1 Professional
Where Born. ............... J.Op~1n.,.... M1.B.s.Qur1._.. _ .... _........ _.................Race............ whJJ;..e.................. ..
Service ............................... . Hair Dresser............................................. . Suit or Dress ....................... BOX .......... .
Date of Birth.......May..._3~~.... lg.7.L_ ........ _............ Age......... _.. _.........~g........................................... _..... .. (Years) (Months) (Days)
Shirt, ~ie....\lIl46Z!111.e.a.r..... Shoes $...................... Hose $.................... ..
COunty..........Bar..r.Y.............._...Township ......._.._........_...........................Phone No ............................ _.............. .
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How Long Resident in Community................................................ _................ ____ .... __ ................................................. .
Single....................... .lII:arried..maI':r1.e.C:widowed....................... Divorced ...................... Child.......................... .. Husband, Wife or Child of.......................... Lau:ra ...I.a.thJ.lIL.:s.~nn;\..!lg.t..Q.!l ..................................... .. Address............._........_.. _...._................................... Q.a!!J!Y.JJ),~ .......M.~.s..!'!.9.!:lo.r.J ......................................... .
....J3.....Hu.t.t.Qn....................Address........C.a!l.~.y..~J),~.... _.M~.!l.!?.Q.h\.r.l Closest Relativ...MI'.s.~ ...W Father's Name. ...... B4,i1ay....Bennlng..t.O'It....._.. _.....Birthplace... _................................................ _..... .. Mother's Maide~.E.enny.....T.o.¥ms..end....................Birthplace... _....................:.................................: .. Cause of Death~~... ~.....Contributor ... . . ...... Date of Death... _....E~'g.~.r..Y..................:J..9..§Q.................Hour .............................................~.'!:.:
. ..
Place of Death ....St.....V.1n.c.e.nt.I.. s...Ro.s.p~., ...........How Long Ill ?..................................................... Physician........l)r.......Chas. .....P.r1.c.e................................. Address ........C.§,.!l.!?.Y.;!..:),J.~Ill....M~.!l.!l.9..Y.,r.l Occupation of Deceased....pr.1n.t.er........................... _........ SOcial Security No............................................. .
• • c
Underclothes ........................................... . Door Spray ................................................ 1 Gloves $.................... Chairs $.................... I Flowers $.................. Palms $................ .. Cremation ................................................. . .........._. Newspaper Notices .............,...7 .('........... . . ........... 1 Telephone and Telegraph.Y ......... _...... . Ambulance ............................................... . ............ Funeral Coach ........................................... . -i";'U'''' Passenger Cars ........................................ .. ............ Pall Bearers' Service................................ i ............ Transferring Body................................... . Opening of Grave..................................... . Cemetery Charges ................................... .
Lot ............................................................ ..
Name of Employer..........................................._... _........................................................................................ _.............
Misc. Transportation ................................ Shipping Charges ................................... . Clergyman ................................................
Address ............................................................................................................................................................................. .
Charge to........... fa.mlly........................................................._.Address .................................................................. . Order Given By......f.a.nl1y .....................................................Address................................................................. .
~l:~e ~f ::::r:~·::;:~:::~:c:~i;.!~T~:::~C.il;w.:;.i::~.i=~:::::: .: : ::::::::~:::~::':~:':::::::::::: ::::::::::::::~: Clergyman ... S.1..:),e.;r.~.C.t\$..n.~.Y.... _.........................................Call for? .....c.........................................................
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(No.)
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sour1
==.:::":1
~~~J.~~;c:i:~:r~a:~i~~::~::::.:: : .: :
.. :.:
~.::::=::: \ ::::::::::::::: ::::: ::::::::::::::::::::::::::::::::::::::::::::::: Total Amount................................ ..
' - -1-
Remains to be shipped-see reverse for details. Information Given To: o Relatives Musicians
Interment at............ O.ak... Hl11 ...C.eme.tery................................................................................................ .. Ramarks.....................E.t.e.r.n.1.t.Y. ...lJLg."... .Ii!:!<.~.~;!, ...
i ....~l:J,.!................................................................ ........... ................. Qg.~.!:l.~y!3.....~.!.!.~.. _'!..~.:t.y.~~ ....~.~.1.:\T.E3.~ ...~.":'l.j:>~..................... .................... ...................... ............J)J~9:...H.g,Y.!.!........A~.!.!0..~_~...~.e._~~.:t.~.1..()....9.1l..~:1!:.~~ ....c..~.~................. . . . . FORM 52315 SUPERIOR FUNERAL S U PPLY CORP •• CLEVELAND; OHIO.
o o
o
Lot No ............................................. Section No ............................................ Grave No.............................................. .
o
o
Attended To: Death Certificate Payment Arranged
o o
Clergyman Singers
Permit Bill Rendered
30
Date. .. .F.e.1?~.rL.?~.J...J·.290
CHECK EACH ITEM AS COMPLEI'ED
FUNERAL RECORD OF No•....... _.. _......_.._ _ _
Yearly No .... _......
_.JO....... _......_...
Name....... _........ _............ _.......... _.............J!.~;!,JY.....!?lW!'.*.~.......................................... Sex.................f..~.!!!~.le Address................................. _.................. _.....!?~.r.r.YyJJJ~
.......:!j,:r.1f..,...............................................................
COunty......Bar.r.y....._...... _.._...TOWDship....... _.. _........_........................... Phone N 0 ............................ _ ............. .. Wh.re Born. ............Nor.th... Car.Q.l1na.........._.. _ ...._...........................Race ................\.g.;!,:to.~.................
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Date of Birth...J.J.UlfL.!I:•._J~$..9_?._
.... _........_............ Age......... _ ...........2I........._................................ _..... . (Years)
(Months)
(Days)
How Long Resident in COmmunity.................___ .................................... _.......... __ ...___ .........__........... _________.. _____ .... __ .....
Single. .......................Marri.d. ....mar.r.l.e 'llidowed ....................... Divorced...................... Child.......................... .. Husband, Wife or Child of.............................C.......E.......a.l.i.:r.:r.1AL .._............................ _................................. .. Address............._........_.._...._........_...... _..........................B.e.r.r.y..Y.l.:),),.e......Ar.~M.!l.~.!L ........................... Closest Relative......
_c......E.......B.u.r.r.ia..............................Address.........J?~rry..y..~JJ~.,....M.~~gs as
Father's Name....Ruaa.ell... C.Q.r.d~~l_.............. _.. _.....Birthplace.............................................................. Mother's Maiden Name..Harri.e.t.t.... W.a.lk.e.r...............Birthplace..._......................................................... Cause of Death...... Ar.ter.19. .e.Il.l~.:rQ.Hg... .Q.?,!'.9,*.!(:0,wg,~'"'.I'....!?:!.~.~.~!!.~~
................:....
Date of Death ... _...2.""22l.....196.Q...........................................Hour................... .:l,.l
...l5 ....A.,.....~.,..................
Place of Death........8.t.a.t .e...Hp.sp....#3....N.e.Y..a.Q,a..... ~..How Long III? ............................................... _.. ..
Physician ..........,J.,.D......c.01rle.lS...... lid.....D_.................... Address., ..................... Ne.'lada.... J49......... Occupation of Deceased ..... h9.:tJJ?~.Y:{.~.f..~_ ........ __________ ..... _Social Security No ............................................. . N arne of Employer ........................................: .. _... _...... _.............................................................................................. . Address ............................................................................................................................................................... _............ .
Charge to .......... C ....... E...... Bur..r.is...................................... _.Address ...........!?~!'.r.Y..Y.-*.l.:;!,~.I... )\:r.)!;..,.... Order Given By.....C....... E. .....l'-u.:r..r.1.§ ............................._...Address........................... "..................................... Date of F uneraL ...Mar.ch....2......l96.0...............................Time ..........I ............Z.. J:'....M'? .............................. Place of Funeral Service... _ ilbnrXj:xltulL.....~1.Q~a ...B.ap..t..1.!?:t .. QJ:!.\!,r.$..................................
Casket ..... & ...bQx................................ .. (Style) (No.) Outside Case or Vault............................. . Embalming Body ................................... . Professional Service ............................... . Hair Dresser.............................................. Suit or Dress &UndeX'-c-lo.1;h...... .. Shirt, Collar, Tie.........................:........... . Shoes $......................Hose $.................... .. Underclothes ............. _............................ . Deor Spray ................................................ 1 Gloves $.................... Chairs $.................. .. Flowers $.................. Palms $.................. , Cremation ................................................ .. Newspaper Notices ............................. _... , Telephone and Telegraph ........................ i Ambulance ... _.......................................... . ............ Funeral Coach ........................................... .
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=::::::::::
~::;e;:::~r~~~~~~;·~~::::::::::::::::::::::::::::::::1
............ Transferring Body.................................... 1 Opening of Grave...................................... i Cemetery Charges ................................... . Lot ............................................................ .. Misc. Transportation .......... :.................... . Shipping Charges .................................... Clergyman ................................................1 Singers $................ Organist $................. . Cash Advanced ........................................ .
....s.alfl.s.... Tax.................................... .
Clergyman ........ .Re.ll'.......Chas ......Y.an.z.nad.:ti.............:.. _Call for? .............................................................._
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Total Amount. ................................. ,
Remains to be shipped-see reverse for_details. Information Given To: 0 Relatives 0 Musicians
Lot No ............................................. Section No ............................................ Grave No ...............................................
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Lodges Pall Bearers
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Death Certificate Payment Arranged
Interment at.. ............... _.. .1[lol.a....Q.eme.:t.er.y................................................................................................... .
Ramarks ................
......................................... s.p.rJ.!lg,f.J~.*.9, ...M.f.K,._.9.P.!.....~p.!'.":~El..<:l: .. l:lc:l!1..•.................... ............ ................................................................................~........................................................................................................... FORM
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SUPER IOR FUNERA L SUPP L Y CORP., CLBYELf ND. OH IO.
Attended To:
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Clergyman Singers
Permit 'D~11
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Date. ........ .F..~J?~.9:!::i....g9.~
(Boone)
..-1-960
., FUNERAL RECORD OF
CHECK EACH ITEM AS COMPLETED Y.arly No ..........};!".......................
No............................___
Casket ........................................................ $................ _ (Style) (No.) Outside Case or Vault................................................. . Embalming Body .................................... .............. ......
Name. ................................Elmer....iYogo.man ................................................................. sex. ........ ID.ale. ...... .. Address .....................................E'a1:r:lC.1e.lIl......M.1.s.s.Qu:r..l
...............................................................................
COunty.............................. _ ......_ ..Township ..................................................Phone No .............................................
Where Born.............._.. __ .._........_.............. _.................._.. _ .... _........__...___. __ .___ ...Race ____ ........... _.. _.............................
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Date of Birth.........................................................................Age.................................................................................. (Years) (Months) (Days)
How Long Resident in COmmunity.......... __ ............................... _........... _.......... ________ ....... __ ..... __ ...... _.......................... Singl.........................Married........................ Wldow.d.......................Divorced...................... Child.......................... .. Husband, Wil. or Child of............................................................................................................................................ Address ............................................................................................................................................................................. . Closest R.lative..............................................................................Address ................................................................ .. Father's Name................................................................................Birtbplace..............................................................
Mother's Maiden Name._ ..............................................................Birthplace ... _.......... ___ ............... _........ _._ ......... ___ ... . Cause of Death....................... _........ _............................................Contributory.......................................................... Date of Death... _.. F.ebr.uar.y. ..
.29.,.....l9.6.Q..................Hour........................................................................
Place of Death............. _................................................................ .How Long Ill ? ..............................................._.. ..
Physician ........... _............................................................................. Address ................................................................. . Occupation of Deceased............................................................... Social Security No ............................................. . Name of Emp)oyer ........................................... _............................................................................................................ Address ..............................................................................................................................................................................
Charge to....................................................................................... _.Address .................................................................. , Order Given By..............................................................................Address .................................................................. Dat. of Funeral... ........Malrch...)..,.... ~9.6.Q .........................Time.........................2....1'.•.M............................... Place of F uneral Service........Ma.l lueen....Qh.a;p.e.J. ......................................................................................... Clergyman........._...._........ _.................._......................................... Call for? .............................................................._ Address ..........._............................_.................................................._.._.............................. _............................ _.._........ .
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~~::::~:::::I::o:es;~oe::~r~.~~~.~.~.: : :::::::::::::::::::::::::::::: :::::::::::::: ~::::: 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 Car s ............................................................. . Pall Bearers' Service ................................ ..........._...... . Transferring Body.................................... ................... . Opening of Grave............................... _........ _......... ...... Cemetery Charges ........................................................ Lot .................... ............................................................ .. Misc. Transportation ................................................... . Shipping Chal:ges .......................................................• ............ Clel'g yman ........................... ................. t...... ....... ..... . _......
~~~~ ~~:~er~:~~~~~~.........~.~~.~~~~~.. ~:::::::::::::...:: .::::::.:::::: ::::::
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Remains to be shipped-see reverse for details.
.
Interment at.. .....
[email protected].~y.._.Qh!),p..~J....c..~.lll~ ~.e..~Y.: ..............................._...........................................
Lot No ............................................. Section No ............................................ Grave No ............................................... Ramarks ........................c.o.pp.e.r.:tQne.....sh.aded...br.o.nz.e....:a.t.e.e.J... :11.... ch ................................. ..
rosetan satin t will 1nterior............................................................................................................................................................................................ Snrayed Hdw. Springfield Casket Co. ••••• •••• •••••• •...••.••••.•.....•••••.•...•..•••. F.': •••••• _ ••_ •••..••••..•••••.••••••••••• _ ••••••••••••• •••••••••••••• ••••••••••.••••••....••. ...... .•.•..••••••••.••••••••.••.••••.•••• ........ .............................................Q.Q.nQ.r.e.1<.EZ ... P..Q.~............................................................................. ....... FO RM 15 2311 SUPERIOR FUNERAL SUPPLY CORP . , CLEVELAND , OHIO.
Informat ion Given To: Relatives o Musicians
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Lodges Pan Bearers
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Death Certificate Payment Arranged
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Attended To:
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Clergyman Singers
Permit Bill Rendered
Insurance .........................................................................................
