258
J.359
Date. .....Eebr.uar.Y....1........
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No.........................._ ._ _
Yearly No.... " .............
.;!;1...............
Casket .....................................................'" Outside cJ~tt;e~ault........ (.~~:).......... .. ............ Embalming Body .................................... · · · ······· . . 1 Pr ofessional Service ............................... . Hair Dresser.............................................. Suit or Dress ........................................... . Shirt, Collar, Tie ...................................... Shoes $......................Hose $.................... ..
Name. ......................Au:tna ...M.UJ'J'j,.~J...:R9..1?1?j,n~" ................................................Sex...f..El.II§.J,.El......... Address.............................. ~~.'!;.e.r.~.....MJ.1?.!'!.Q.\!:;r-*............................................................................................. County.... J!~J'r.y....................... ToWD. hip ......." ....~~E.:!F...................Phone No ........................................... .. Where Born............ T.t'.o~ .....M1.s..EI.Q.v..r.1...............:....................................Race .......
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'N.P.-J..1;.El.........................
Date of Birtl1..... 0.c.:t.o.ber.... 21....~S9.5................ Age................... (Years )
6.3...............(Months) ,........................................ .. (Days)
How Long Resident in Community.....................................................__ ....... _____............ _............................. _...... _........ . d. mar'" ... ··d owed ....................... D'Ivorce d...................... Ch'ld · I e........................Marne... S mg ...*......o" ."1'/1 I .......................... .. Husband, Wife or
Underclothes ············································ 1 Door Spray ................................................ Gloves ~.................... Chairs $.................. .. Fl' P l ' owers 0/.................. a InS ................. .. Cremation '''''''''''''''''''''''''''''''''''''''''''''''''' N ewspa per Notices ........""'"'''''''' ...... ".. . 1
t t L Robb ins Child oL ..............................ey.e.*.~L............,,, ...................................... "'"'''''''''''''''''''''''''''''''' Ex t Mi ri T .
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Address ............. " ........ " .. ".. ,,_ ...........................................~....§'.;r.-1............~.!,!g.~............................................. ............ Closes t Relative... J4r.J!.., ....M.+'J.g.r.~..9:.. J!Q.!,g.gg.~........ .Address.. ...... ..... ........................... .......... ................
Father's Name..........K.1.IlL.H1t!;.!;.9..n........................... _.. ".:r.::-Bn~lace... ".... """"""""""".".""."" ..... "".""""
............ , Telephone and Telegraph ...................... ..
Mother's Maide n e.......... $ .lIIanoY....Emm.allnfl.......5tll'JuMa~.El."......................................................... 6' ,n I to r y. __ .....t •• __•• ••••••••••••••• ••••. •• ••.. ••••••••.••.••• ••. Cause 0 f Death... . .... .. . .. _~ .... _..............Contr'b 1 U '" b 1 1Q h 9 ' 7• <5 '0 M Date of Death ....... ",.e. r.ua ..... ...... .,.",.......................Hour ...........'.,..< .. ......... . ........... ...........................
Ambulanco """ ""''''''''''''''''''''''''''''''''''''''
......... _-- Funeral Coach ............................___ ............ .
-..........
Place of Death......ho.m.e.............................................................How Long Ill ? """"""'"'''''''''''''''''''''''''''''''''''''' Physician....... Dr. ...... E.. ....E.....Mc.Dani.e.L ...................... Address ................Qe&.!iI.Y.J.:l),~ ......Ml.~.!?.9 ur i Occupation of Decease
5, 1959
. Place of Funeral :;elm('e................"."' .•,.""'." ._..." ...." ..e"".'~.": ...... .......
2 P.M. Date of Funeral. ........February _...................................................................Tlme ....................................................................... .
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, ~cJ&.;..~·· ....·..·····.......... ·....·....·.. · .. ·1
~ --_............... \ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Total Amount.................................. I.
Remains to be shipped-see reverse for details.
Interment at................. Maplew.o.o.li-...C..eme:ter.y.......................................................................................... Lot No ............................................. Section No ............................................Grave No .............................................. . Ramarks ......... ·............. --2-3nt ...A..Si1v..e.r. ....shaded.....lt. ... g.unm~.1i.al .......................................... ..
........ .............................. l.y'g.:r.Y..... Q.r.~p'.!,!.... g,.~....g.h .~g..~.... 1.().'-:l.!'.~.El . 'f{.l,.~ ...~.().~..l,f....................... . ..................................3.....~.().£1.~.~.....~.~......."........... _.............................. ..... ....................................
..............................................9..().!!!.l~.~~.y..l,.~.~.~....9"a..~~.~.~... g.C?.~.................................................... ............ FORM
Cemetery Charges .................................. .. .. .......... Lot ............................................................. . Misc. Transportation ....~ ........................... ............ Shipping Charges ................................... . ............ Clergyman ............................................... . ............ Singers $................ Organist $................. . _.......... Cash Advanced ......................................... .
" " " ' " ' ' ' ' ' ' ' ' ' ' ' ' ' ''' ' ' ' ' ' ' '' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' '' ''' ' ' ' ' ' ' ' :';0:' ' '
Clergyman......... ".I!-a=anli-t"'Hugh..H·lggS ............... Call l or I.. ...... ..." ............................o
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Passenger Cars .......................................... P II B 'S' ..._....... a earers ervlce ................................ ............ Transferring BOdy... "............................... 1 ............ Opening of Grave ............................... "... ..
6a3~
S U PERI OR F U N ER A L S U PP L Y CORP •• C LEVELAN D, O H IO.
Information Given To: Relatives Musicians
o
Lodges Pall Beal'ers
o
Death Certificate P ayment Ar ranged
o
o
o o
Attended To:
o o o o
Clergyman Singers
P ermit Bill Rendered
2~9 Date. .. .E~~.Q:r..~.ar.y....J.~
..J·.9.29
CHECK EACH ITEM AS COMPLETED
FUNERAL' RECORD OF
.~
Casket&' v,,"1t . (Style) (No.) OutsIde Cas. or V....'nO"'·'·······························I·········· ,. ..... 1.....• Embalming Body ...................................... 1.......•...... 1 ... .. Professional Service ....... ............................ 1... ....•.•••..• Hwr Dr.'ss'''................................................ 1............... 1 Suit 01' Dress ............................................ Shirt, Collar, Tie ...................................... I.............. 1 Shoes $......................Hose $...................... 1. ..•...••••••. 1 U nderclothes ............................................ 1........ ...... 1 ..... . Door Spray ................................................ 1..... ·········1······ Gloves $.................... Chairs $.................... 1............ _.1 ..... . Flowers $..................Palms $. ................. 1............... 1..... . Cremation .................................................. 1••• _.••••••••-1..... . Newspaper Notices .................................. 1............... 1..... .
Yearly No •... _.. _.._.;J.!'J. ......._...........
No........ _.. _...... _..___•. __
Name. ...... _..................... J:an1c.e ....Suzanne....Ells.t.Q.Il.......................................Sex. ......f~!@,J~ .. .. Addrees.......................... J'iJ_:j,....(:!..•....K~.!!!1?~g.y,gP..,
.....ll.p.!..:\-.l!gf.:\-.~:l.~.I.....~.1..s..<3.9.~!..:\-.....................
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COunty... _........G.r.e.e.nfL.... _... Townahip ......._.. _....•...•...........................Phone No ............................................. Where Born. ............ _...._..s.p.r.Jngf.J~.;),9.-.•....M!.?~gE.!:.*................... Race ............'!".b.::1..~.e.
.....................
Date of Birth...r..e..p.!:~.?-.ry
+ .............+.... .
..}.I..... ~.~.?.~....~.~.~ .:Ag • ......... _..................... .} ...h.oUr..s.................. _....... (Years)
(Months)
(Days)
How Long Resident in COmmunity...................... __.__ ............................. _............. _............................................... _.... . Single........................Marrieci ....................... Widowed ....................... Divorced...................... Child ........g.l~.l,),g,.... Husband, Wife or Child oL.._...................c.ar.l...and .. .Blanc.he.... E.llii:t~ln................................... Address........ _... _..__._.._..__•._............_....................!?~;rJ!')gr..l,.~1sl.I.....~.1..s..~g.t.t.!::1.
........................ ......
Closest R.lative....... _Same. ....................................................... .Address ......................................,. .......................... Father's Nam•........Q.a;r..1....li<1.1~.~.9.!L .................... _.._.....Birthplace............................................................. . Mother's Maiden Name........ L .•....E.l.anQh~ ...B.~.rp..........Birthplace..._......................................................... Cause of Death _____..........................................................................Contributory.............................. ____ ........................
3.•.....1.959.....................Hour...................... l±.~.;!,.C? ...~.•.... ~1.,..................
Date of Death... _....F.ebruar.y:.... Place of Death.......
.s.t..•..lII.Ohn.I..6."'.6p.r.J.ngf.l~ .;J,..!hlow Long Ill? .....................................................
Physician........... D.r..•...J.A.p.... .F..e.r.g)J.~.Q~...........................Address ..............f.lp.:r..i.-.l!g.t:.~'3..1..cl.l
....1.1~..~.
Occupation of Deceased. ......... .l,n:t'.!!:!:l.~................ _................Soci.l Security No ............................................. .
Telephone and Telegraph························I··············I ······ Ambulance ................................................ 1... .•. . ••. .•••• 1•••••• Funeral Coach············································ I····......... 1..... . Passenger Cars··········································I······· ........ 1••••.• Pall Bearers' <:!~~el'vj('e······················· · ······ ··· I ········ .... _.1..... Transferring R".o',""·y······································· I····........... 1 ...•• ............ Opening of Gur"a.v ...L .............••..... . ......... ... ... .. Cemetery ...~.: ...............
+ ............+ ....
Name of Employer..........................................._........................................................................................................... . Address ................. _........................................................................................................................................................... Ch.rge to...........C.arl...Ellst.Qn ..................................... _.Address ...........f?P..:r..1.nKU.~.1.sl.I }1.1..S..f? O ur
...
Order Given By.........C.a.r~ ...E.J..lat.~m ......................... _...Address ................. _.................. I~.... _..................... II DatoofFu.n eral.....]~lJ~ua,~r. ...!~7..... JL~~~~..c•...........:..... j:im•.........................
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1 ............
.......................:
Lot ...;;~~~~;;;~~;;~;~~:::::::::::::::::::::::::::::::: I................... Misc. .................... Shipping Charges ..... . Clergym.n ...... .................._ Singers $................ Organist ~ C.sh • ,......
Place of Funeral Selrvi('•...........JI'J.alll..I.!~:w~9.\2£•..\,'.el~';<..~.!,E.:t. ......................................................... ..oc
........•............................ ................ . ··················· 1···············,······
Clergyman ......Re:v..•. ·..NQ.r.man ...~a¥.lar........................ C.11 for
........................................ ............................... -1- ........... ,....••
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Total A mnunt Remains to be shipped-see reverse for details.
... g.e.!!l.~.~~.J:',\':::'.!J!:".El.~..~.:.!... .~.~.s..~.::~.r..~..................... .... .
Interment at................._~~P.J.e..'!!E.~.cl
Lot No ............................................. Section No............................................ Grave No ...............................................
Ramarks ....................... _.2.L.J?.1rllt....v.elv.et ... baak.e.t ....I'Ll.tl:l ...b~nv....Qn....t.QP.......................... .
............................................. p.1nk....satin...intar.l.o.r...................................................................................
Information Given To: 0 Relatives 0 Musicians
o o
Lodges Pall Bearers
o o
Death Certificate Payment Arranged
Attended To:
o o o o
Clergyman Singers
Permit Bill Rendered
Insuran ce ......................................................................................... . FORM 8238 SUPERI OR F U NERAL B U P PL Y COR P •• CLEVELAND. OH I O.
260 Date.___ EebruarY__ l..___ J3.5.9
CHECK EACH ITEM AS COMPLETED
FUNERAL kECORD OF No. ___________._____________
Yearly No _________
J.~
______._____________.
Name. _____.____________________Er.aamus____ EQ.lgflr _________ "______________________________________________________Sex____!!l~_:),_!L __________ _
_ __ _ ___
Address _______________ __________________ J}Z5 _ ___~_,___J,J~h ____~_~_r.~_~_~_:: s._~ ~ ~.o._13_~pl:l_l ___ ~_~13_~9.~J.: ______ _ COunty______B.Ul::n.a.nan ___________ Township ______________ .. "____________ .__________________Phone No. __________________________ .____ .___________ _ Where Born. _________________,_________J._a!?'P'_~_~_"Q,Q.~j;;Y_I____ !>:!~_? _~~YE:I: _____ Race _____________ ._~~~_~~_e.
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_ _ _ _._ ._ __
.7.9.._ ____________________________________________ __________
Date of Birt'L _____J _ une___ l_6_. ____1~_5_2 ______________________ __Age. ______,________ (Years)
(Months)
(Days)
How Long Resident in COmmunity..................................... ____........................... ___ ..... _.............................................. . Single___________ .____________Married. __ ________ .____________ Widowed_''ildo_ad. __Divorccd___________________ .__ Child___._______... _____ .__ _____ _ Husband, Wife or Child of ___________,___________________________ ._____ .____ ,_______,_______________________ .___________________________________________ ._________.__ Address __________________"_____.._._.•_. ____. _____._____ ._______________________.____ .______________________________________._____ .__ .__ ._________.____ .______________________ _ Closest Relative ________MI's__,__ ..9.-_ e_O_;r.g.e__ ..l";l;J,_!l.~~:w_~_U.Address ________ ~~_,____ '!..Q_!!_~.P.h.l. __ ._M:1..s._s.g_~rl Father's Name. ______-Amon _ _.EoJ.ger______________._________________ ._.Birthplace__ ___________________________________________________________ Mother's Maiden Name __________"__________________ ______________________ ---'-----B.B~%le"d: -- --" - ------ '- - -- ----- - - - ---- - -- - - ------------ ---------'-' Cause of Death__________ Br_Ollch.1aL_P.nell.mO_nla~_____~ontlbutory ______ .._______ .___________ .________ .__._____ .___________ . Date of Death. ______"Eabr.ua.:cY__ ..1., ____;!.,9.5_9. _ ___ .____________ .__Hour ________________________
J. __A~____ :M.:_!______________ .________.
Place of Death________ aj;__•___J_9.'(l.epP.._. _____ M~.§_§g_!:l:_:r.J. ____ ._.How Long Ill ? _____________ .________________ __ _________ .__________ _ Physician............................___. __ ... ___.................................................. Address ................................................................. . Occupation of Decease
'?J::__ .6_?:J f
Name of Employer ........................................... _........................................................................................................... .
"_____ ,_____ 1Casket _____&; __._$._e_IT~~_!l.!L:~_7_____ _ (Style) (No_) ____________ 1 Outside Case or Vault............................. . Embalming Body ................................... . ----- ---__ ·_1 Professional Service ............................... . ________ ___ 1
Door Spray ............................................... . Gloves $___.___ .___._______ .Chairs $___ .__ _____________ _ -________ __1Flowers $__. ____________ .__Palms , __________________ Cremation ................................................. . Notices ............................. _.. . Telephone and Te]egraph ....................... . ________ ____ 1 Ambulance ............................................... . ___' _____ ___ 1 Funeral Coach ............................................ _.--------- I Passenger Cars .......................................... Pall Bearers' Service ............................... . Transferring Body................................... . _____ ______"1Opening of Grave...................................... Cemetery Charg es ................................... . Lot ________________ .__ ._______ ._______.__________________________ . _____ __•__ __ 1
_____ ____ · __ 1 Newspaper
Misc. Transportation ............................... . Shipping Charges ................................... . Clergyman ....................... _...................... . Singers $................Organist $................. .
Ad,~ e ss
Order Given "y.----.. ----..-------------------------- -------------""C-:_·_,__ · _____________·Ad,~e' ss ___________. ____._::----:;:----' c---.-----;c, ------: ___ ~~ - --)~~~2~.""." .._. __ .__.j~ime _____ ______ _____ _.___ .. ~ __ ~~ _ ~ Place of Funeral Oe1""(:e._•. ____ . ____ •_____ "t.I......_y••\.... _" __ ___ ,...,"'.,-,,,_,,, _____ __ ____ _____ _.. _. __.._________ __ __ Clergyman _________Rev:____NQrman___T.ay.~O.;r.____________________Call ~I
(
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I
Shirt, Collar, Tie ..................................... . ---- ------- -1 Shoes $----__ _______________ .Hose $ _____._______ _________ _--.-------_11] n derclothes _._________ ._____________________ __________ _
Address ................. _.................................................. _...................................................................................................... . Chargeto_ . _. __. ____________________. ____. "" __________________ _____ .__ ._________________ .____ . ___ ... ____. ____._______________.___ ._.' ____ ' __ ' _________ ________ ._. _, DateofFUl'e~>l ___ ______ F.~Ql~.i~l
~:ii: :r~~ee:~.::::::::~:::::::::::::::::::::::::::::::::::
~_._ __ _ _I~~a~:::::::::::::::::::::::::::::::::::::1 '_··"-""---1 .------------------------""--. ----"" ------. _____ . _______ --___________ _
-------1 --.-""".--.---,,------.-------.------""--------,,-----.---,,--------< Total Amount..................................j
Remains to be shipped- see reverse f or details.
Intermenta~ _____.__._.__"". ____.._~Ui:~g~Xl~~s!n___ ~:r.~~~p.y.:~t"'e~~:~~~~ ___ ~~~J~~_~!'.E~_1.~~~~~'._~.~!. ____!M~o. Lot No ............................................. Section No...............•............................ Grave No .............................................. . Ramarks __ _._____ ___________________ log ___ ffiO_ld. __,~_._l::b._._CQ_PP_~.r:!;_QnJ!___
4_4.3-___
__""_.___..
Jl/l?r..9..!1;';JL _____._.________ .
_____ __ ________________ .___R9._§_~_t_P..n. ___ F.r.~_!:lQl:l___g!.:_e.p._~ ____~_Il:~~!._~()E_ ._. ___ ._____.____ .. ___________ .__.. ______ _
_________________________________________________M<1.JR_r. ___Q_!l. _§k;_~_~__ J22._,__________________________________._________________ ._________ .________.________
Information Given To: o Relatives o Musicians
o o
Lodges Pall Bearers
o o
Death Certificete Payment Arranged
Attended To:
o
o o
o
Clergyman Singers
Permit Bill Rendered
Insurance .......................................................................................... FORM
!!Ia~1S
SU P ERI OR F UN ERAL S U PP1.Y CORP ., C1. EY E1.AN D . O HI O.
261 Date. ...•.. F..eQr-',,~.r.L.~....
J,25 9
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORIioF N 0 .................... _
Yearly N0 .... _ ••.•• .2.9.......... _...........
......... _ _
Name. ......_...................Charls.a...T.•....i'I!lll.1.am.s.on..................:.......................... Sex.......... ID.
(
Date of Birth..........
.. ..........
Ma¥....2.Q.•....J$9.2........................Age ...........•. _......9..9............................ _.................. _....... (Years)
(Months)
(Days)
How Long Resident in Community................................................................................................._____ ....................... Singl•........................Married..mar.rie.dwidowed .................._... Divorced ......................Child ............................ Husband, Wife or Child of.......•..•.............................................. _.... _........ _................................................................ . AddresB ......................._ ....... _ .......................................................................................................................................... Closest Rel.tiv....Y.fl;r..
DeathI!;.!!l.P.hY..Il.§'.!!!.*.~....\'I..*.~.....ClX.~~.~ ...........Contributory..........................................................
Date of Death......F.ebTI1a;rY.....
l:! •.....;!,9.5.9.........................Hour........................................................................
Place of Death.....Y..,....A.,....BQ.IlP.±.1!.~J:::!.'.~~.~.~.~.y.~JJ. tl.4nglHi'f..~ ................................................. Physician......................__.___ ......................... _____ .__ ............................. Address ................................................................. .
Occupation of Deceased. ........... ..!~fI,.r.~.l?:~ .............................. Soeial Security No ............................................. . Name of Employer .........................................................................................................................................................
•........... ............ .. .......... ............ ............
Address ............................................................................. _.............................................................................................. . Charge to...........W~............................................................ _Address ................................................................... Order Given By................Y!.,tgQ!!..............................................Address........................................... _.................... . Date of FuneraL. ......F.eblma.:rY..... J..2..•....
J.9..5.9...............Time ..........................;J,.9....!I:.~ ....}A..~.....................
Place of Funeral Service...... C.ll.1Y.fl.l::.!..a ... iihabl.e.;J" ..................................................................................... _. Clergyman......B.Il.Y..,.....Q..+.Y.g.Il....MQ.Q9.!.IIl.~g.~.................Ca11 for ? .................... ,
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Casket ........................................................ (Style) (No.) Outside Case or Vault............................. . Embalming Body ................................... . Professional Service .............................. .. Hair Dresser............................................. . Suit or Dress ........................................... . Shirt, Collar, Tie ..........._......................... 1 Shoes $......................Hose ; ...................... 1 Underclothes .......................................... .. Door Spray ............................................... . Gloves $.................... Chairs $.................... Flowers $.................. Palms $.................. Cremation ................................................. . Newspaper Notices ............................. _.. . Telephone and Telegraph ....................... . Ambulance ............................................... . Funeral Coach........................................... . Passenger Cars ......................................... . Pall Bearers' Service............................... . Transferring Body.................................. .. Opening of Grave .................................... .. Cemetery Charges .................................. .. Lot .............................................................. Misc. Transportation .............................. .. Shipping Charges .................................. .. Clergyman ................................................ Singers $................ Organist $................. .
==I~~~-
Total Amount.................................. !
-~- , _
Remains to be shipped-see reverse for details.
Interment at. ...........Na.t..1.QD.aLQ.eme..t .e.;rY.~.SJ).r.Jngf.J.Il.;),g... MJ!?.~g.~.!.J.............................. Lot No ............................................. Section No ............................................ Grave No.............................................. .
l .gh..•..................................................
Ramarks ................... gray..... sha.de.d ...g:Unme.t.aJ.....•. t.f!!:lJ. ...
.......................................Illh.it.e.....sa.t..1.n...;)..nt.e.;rJ.9.r...................................................................................... ......................................Sp.rJJAgJ.~~)Q.....g.!?:.s..~.~..~ ...M.:r.g.:....9..()..~.......................................................... FORM " 2315 S U PER IOR FUNERAL SUPPLY CORP •• CLEVELAND, OHIO.
Information Given To! o Relatives o Musicians
o
Lodges Pall Bearers
o
Death Certificate Payment Arranged
o
o
Attended To:
o o o o
Clergyman Singers
Permit Bill Rendered
262 Date. ....F-6-br.uar.I{-.. S,.. _J.%.9
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No•....... _.. _...... _._____
Yearly NO•..._.. _.._..?;\, ......_...... _...
Casket ........................................................ , ................ _ (Style) (No.) Outside Case or Vault. ........................................... ..... . Embalming Body ...................................................... .. Professional Service .................................................. .. Hai:r Dresser.................................................................. Suit or Dress ............................................................... . Shirt, Collar, Tie .................................................... ..... . Shoes $...................... Hose $......................................... . Underclothes .......................................................... ..... . Door Spray __ .............................................. .. Gloves $.................... Chairs $................... . Flowers $..................Palms $................. . Cremation .................................................. Newspaper Notices ................................ .. Telephone and Telegraph ........................ , Ambulance .............................................. .. Funeral Coach ........................................... . Passenger Cars .......................................... i Pall Bearers' Service ................................ I Transferring Body................................... . Opening of Grave............................... _... .. Cemetery Charges .................................... Lot ............................................................. . Misc. Tra nsportation .............................. .. Shipping Charges .................................... Clergyman .......................................... ...... , Singers $................Organist $.................. . Cash Advanced .......................................... ,
Name. ...... _........ _.......Ini:nat....son... o.t_.. Ghar.le.s... N.i.c.ko.lB...................... Sex.............................. Address...................................U~.§..§.Il.~.~..J.UJJ~.... M.±§..~Q.1!:;:~ ................ _............................................... County.... _.................._...................TOWl1Ship....... _........ _... _...........•............... Phone N 0 .......... __ ................ _...............
Where Bom. ...................... _............ __ ................ _.........__.. _ ...._........ _................. Race.................................. ____ ..... __ ... Date of Birth......................._.................._............................Ag•......................................................................... _...... . (Years) (Months) (Days) How Long Resident in COmmunity.... __ .... __.__ ...___ .................................................. _.....____.......... __ ............_. ______ ._._ ... _._ .. Single....................... .Married. ....................... Widowed....................... Divorced ...................... Child ........................... . Husband, Wife or Cilild of............................................................... _...................................... _.................................. . Address ............. _.. _.... _.. _...._........ _................................................................................................................................ . Closest Relativ•. _...._.................._................................................ .Address ......................................r
..• . •. ...... ........•••..•
Father's Name. ............_.._.... _...................... _.................... _.._.....Birthplace... _...... :..................... _.......................... . Mother's Maiden Name.................................................................Birthplace... _.................._..................................... Cause of Death............. _.................. _............................................Contributory.......................................................... Date of Death..._.._......_................................................................Hour........................................................................ Place of Death ............................................................................... .How Long Dl? ............................................... _.... Physician .......................................................................................... Address ................................................................. . Occupation of Deceased. ............................................ _................ Social Security No ............................................. . Name of Employer........................................... _... _...................................................................................................... . Address ..................................................................... _...................................................................................................... . Charge to................................. _.................................................... _.Address ................................................................. .. Order Given By......................................................................... _...Address ........................................... _............... :..... Date of FuneraL. ......F.e.br.J.lli.r.Y. ... ~l.•...•;\,959...............Tim•.......................... Place of Funeral S.rvic•............. _.Mj;..,....~.;!&~.§.~.n:t
J....;j.Q ...~..,.M..,.................
.. 9..~.!ll.E.l.~.~ r..Y.......................................................... _.
Clergyman ......... E e:v.•....Har.r.y....Mo.or.e..........................Call for? ............................................................. _
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.............................................................. , Total Amount.................................. '1
Remains to be shipped-see reverse for details.
Interment at............... M:t...P..leas.eJllt ....C.e.m.e.t.er.;y:..................................................................................... Lot No ................................_........... Section No............................................Grave No ............................................. .. Ramarks ....................... _...................__.............................................................................................................................. .
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Lodges D Pall Bearers
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Information Given To: o Relatives o Musicians
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Of
Attended To: Death Certificate Payment Arranged
DP. \ Bill
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Insurance ...................................................................... . FORM sa.s1S SUPERIOR FUNERAL SUPPLY CORP .. CLEVELAND, OHIO.
Date. ..F.e.br.uar.Y. ....1Q~_.1..95 9
CHECK EACH ITEM AS COMPLET
FUNERAL· RECORD OF Yearly No .................... Z.2..............
No...................._ ..... _ _
Name. ..........................:Ml!s_...Mar.tha ....T.ay.lor........................................................ SO%......... f.emale.. Addres ......................................7.2l±....G.1.l'l.t....Ay..e..,....$.J.;J,.Y.~r.....!?p..r.*.!'),K\!.I.....M§..r..Y..:),AA.4. ............. . COunty............................................ Town.hip ..................................................Phone No.............................................
Ca.k.t ........................................................ I (Styl.) (No.) I Outside Case or Vault............................__ .. .......... Embalming Body ................................... . .. ______.... Professional Service .______ ....__ .__ ............... .
···········.1 Ha.ir
Dresser............................................. . Suit or Dress ........................................... . Shirt, Collar, Tie ..................................... . Shoes $......................I-Iose $..................... . Underclothes ........................................... . DOQr Spray ................................................ Gloves $....................Chairs $................... . Flowers $..................Palms $.................. Crema.tion ................................................. . Newspaper Notices ............................. _.. . Telephone and Telegraph ........................ Ambulance ............................................... . Funeral Coach ........................................... . Passenger Cars ......................................... . Pall Bearers' Service ............................... .
'Wh.ere Born.............____._ .._........ _.................................. _.._ ..... __................ __........Race ... _....................__ .. _._ .................
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Date of Birth.. ..!.une....12......1S.75............................. Age....................$3. ........................................................ (Years) (Months) (Days) How Long Resident in Community.................................................................... _..... _..................................................
Single........................Married........................Widowed ... Y'{J4.9.~.~.flivorced...................... Child........................... . Husband, Wife or Child of.............. Jl.1.r.gil... H. •....Tay..la.r. ........................................................................ Addre.s ........................................................9&Q.!?§..~.~.C!,........................................................................................... . Clo.est R.lative.......~f\......Ma;r.J...~....~., ....tl§,r..: rJ..~ .....Address ....... !?~):y..!?!:....;?.l?..r.tm;.\!.I.....Mg,.· Father's Name. ......A.mo.s...MD.r.land..................................Birthplace............................................................. . Mother's Maiden Name.....LUy..1na....~.a.:).ID.QIL ...............Birthplace............................................................. . Caus. of Death......l?n.e.1JJ\lQD.1.IL..........................................Contributory......................................................... .
6.•.....l.9.5.9...............Hour........................................................................
Date of Death ..............Fe.p.:r.JJ.«x.Y.....
Place of Death...Qak...Hay..e n ...NlJ.r.fJ.1ng.. HQ1!).!L ...How Long Ill ? .................................................... . Physician....... D.r..•....aeruch ... T..•....K.1.lllQl~.................. Addre •• 9..~.9....1i'.\l.: r.@,Jp.g... p..r..~y..~ .... $. .• S • Occupation of Deceased. ........ __.hous.ewif.e ..................... Social Security No .......................................... __ ..
Date of Funeral.. .. F.eb.r.u.ar.Y. ....10.,.....195.9...................Tim•......................... l
Cemetery Charges ................................... . Lot ............................................................. . Misc. Transportation............................... . Shipping Charges ................................... . Clergyman ............................................... . Singers $................ Organist $................. . _.......... Cash Advanced ..........................................
Plac. of Funeral
_.........
Nama of Employer ..... __.... __.. __ .......................... _........................................................................................................... . Address ............................................................... _................................... __ ....__ ....._.............. ___ ._ ............ _............................
Charge to...... Mr.s.•....Marie...T.•....Har.r.l.B...................Address ................................................................... Order Given By.....MrS._... .Mar.le....T..•.... H.ar.r.1.e.........Address ................................................................. .
... P..•.M. .............................. Service...........Cu,l,..e.r..Le....Chap.el...................................................................................
Clergyman........ ~ .•... Cha.$ .•....lla.llLl'.andt.................. CaIl
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~~~~~~~~ ~:::::;r;;~r~:~~:::::::: ::::::::::::::: :::::::::::::
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~.~.e.:!;Jn ....til'.aln~.Q)lap.e.l"' ..... .
::::::=:::\ ~:~~~::::~:=:::~~~~'~~~::::::::::::::: Total Amount................................ ..
Remains to be shipped-see reverse for details.
Interment at..............~JJ3.QaIlL.I;(.!llm.~~J;..e.l~Y:~W~.:r::!?,!,~!.I.....!l~r.!!';.('!,p.~l..a...!l.......•~.~~
Lot No ..... ___ .. ____ ......__.......................Section No ............................................Grave No ...................................... __ . ___ .. _ Ramarks ........ ___ ............_... __ ..... _______. ____ .____ .__ ...... __ ............. _.. ___ ..... _....__ ........................................ __ .................................... .
Information Given To: 0 Relative. 0 Musicians
o
Lodge. Pall Bearers
o
Death Certificz.te Payment Arranged
o
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Attended To:
0 0
OPe Bil
o
Insurance ................................................................... . FORM !llI..:5e SU P ERI OR FUNERA L S U PPLY CORP., Ct..VEUND, OHIO.
D8te. ..... E!l.'pJ~JJ.~ .:rY.._.2._ ..1259FUNERAL'
CHECK EACH ITEM AS COMPLET
RECORD OF Yearly No ............ _...•?.3....._...... _...
No•....... _.._..........___ .._ _
Name. ...... _......................Loy..d ....{L9..t'kJ...F;r.Q.~.t........................................................ Sex...... Il?:~J:~
...........
Address ..................................OIl.e..§.Y.HJ.e.•.....M~.fl.flQJJ.rJ. ............................................................................. County..Earry....._...................Township....... _........_..._...........................Phone No ............................_.............. .
..e.........................
Where Born. ........K.a.n.a.6.a.... _.... _............................_.. _ ...._...........................Race........!ll:lJ~
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Dat. of Birth......
AP.J'..U .....L.'1.::::../3..1.31................. Ag •..........._....1:1:5..................................................._....... (Years)
(Months)
(Days)
How Long Resident in Community........ __ .................................................... _........... __ .................... __________ .................. . Single................_...... .Married. ....................... Widowed....................... Divorced~U..Y.9.;r..9..~ild... ......................... Husband, Wile or Child of....._.............................._____ .__................ _...................................... _.................. _.............. . Address ....._._ ..._...__ .._..____ ._._.._.._._....__................. _ ............................................................................................. . Closest Relative._.. Mr.S.•.._.Le.QXi....EMJ.9..nQ.J!.9.Jl...........Address ....Q§..§.§.y.f.:.~.~.~.I.....M9. ..~ ................. Father's Name....... Q.~J'.J... r.r.9..!!.!i.....,...................................Birthplace .....•........................................................ Mother's Maiden Name........ MQ.1J,.~.!L .M.!lY..........................Birthplace .............................................................. Cause of D.ath .......p..!I1\p..~.!i.~.!! ....M~.:);l;!,~y..§..................Contributory......................................................... . Date of Death..... E.e..p.:r.JJl1\py ...
9..•....J95.2........................Hour.............:L.:t,.;.3..()....A..~....~.:.........................
Place of DeathB.r.u.C.e....Re.s.:t....H.9..!ll.e................................How Long Ill ? .................................................... . Physician ........Dr.•.... E. •....E.•... MC.nanle.~ ....................... Address ....... Q.a.!?!?Y.J)..d..!l.•....MQ ................ Occupation of Deceased... __. ___ ....................................._................ Social Security N 0 •......... .......•.....................••. __ ..
Name of Employer ................................ _______ ...._.........................................................................__ .... ,.. __... __.................. . Address ..............______ . ___ . __________ .... __ ................. ______..... _...... ___ ..................__ ... __ . __ .......... _.. __ ................. _... __........................... . Charge to.................hro.thers ...& ...sls.te1's............ _.Address ................................................................... Order Given By........ hr.o.the1'...& ...Sis.ter.6. ........._.. .Addr.ss ................................................................. .
19.59..................Time.........................2. ...P ..N..,............................
Date of Funeral. ....... F.ebruar,y:J.2. •.....
Suit or Dress ................................................ 1
Shirt, Collar, TlEl ••••..••••.••••••••••••••• .••.•..••••..• 1 Shoes $......................Hose •...................... 1 Underclothes Door Spray .................................................. 1 Gloves $.................... Chairs •..................... 1 Flowers $...............__ .Palms Cremation ....................................................1 Newspaper Notices ................. ................... 1 ______ ______ / Telephone and
............ Ambulance ................................................... 1 ......... _-. Funeral "oacrl................................................ 1 _.... __ .... Passenger v ars ........................................... 1 . .. _. __ .... Pall Bearers' ;;e:rvj"e ................................ 1 .__ ...... __ . Transferring "oay.................................... 1 ............ Opening of uc,...,....................................... 1 Cemetery Lot ............................................................. . Misc. Transportation.....____....................... Shipping Charges _____ ................... _... __ ._ ..__ Clergyman __ .............__ ... __ .___ ...... _.............. _........... Singers $................Organist $................. . Cash fdvarlc!"j..:...: ................................... .
P lace of Funeral Servic•............... Q.u.llT..e.t:_!.S.._Cha.p.e.l ........... . Clergyman.....E,~.y..., ....
g.:g...~.§..:.... y..~Jl.&P.,9,t....................Ca11 fOl
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Address................. C.aIHW..Ulfl.•....MJ..s.1l_Q!JPJ...................._...:...
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Total Amount. ................................ .
Remains to be shipped-see reverse for details.
Interment at.....................HQ.rJ)..eI'....Q.~!)).~.Y.Sl.:rY............................._: Lot No ............................................. Section No............... _.......................... .!
c.al
Ramarks ......................... CQ:p.per.t.One ....st.e.e.l...h.1nge ....
iges l Bearers
Information Given To: 0 Relatives 0 Musicians Attended To:
0 0
o P.,
..... .. ...................................~9..~.e.t.an....sa.t.,tn... lny..(l.r.~Q.r.
Ith Certificate 'ment Arranged
........ ..................................~l?z.:.~.~.g:f..~.~;J,.Cl.....g.~.§~.~.E.. _.~:f..(Ii..:..
nce .....................................................................
FOR M .:52 3l5 SUP ER IOR FUNERA L S UPPLY C O R P •• CLEVELA N D, OHIO .
.Jl
O Bit
1L_.!9 59
Date. .....F.elt:r1!Il.:r.y.....
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF Yearly No ...................?~
.............
Name. ......................... J.ahn ...lY..•... P..e.r.ryman ...............,............................................ sex......male............ AddresB··· .. ·.··········.··.............Cas-s¥.ll.le•.... Missour.1 ............................................................................... County.. B;.r..J::'y .........................TownBhip.................................................Phone No•............................................ Where Born........ J}.a.:r.IT....9.Q.1J.~!'.~~
....~.1.§.§.9.),l.F.:!............................. Race.....!v.lJ,.1..~.~ ...........................
Date of Birtb .........Q.9.~QP~.~...
3..•..J&7J. ...............Age.........§.2.................................................................. (Years)
(Months)
(Days)
How Long Resident in COmmunity.... __ ............................................................................... ____________ .... ______..... __ ........... Single ................•.......Married.....~~:r:.!:;t.!e.%idowed ....................... Divorced ...................... Child.......................... .. Husband, Wife or Child of............................ N.ora.. May.... Laa1t.er... Perryman............................. .
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AddreBs··········:··········· .. ··.. ····_·_· · ··_;·.;:.-···;;;~arHlY..UJ.l:l .•....M1-i~·'iI$;r·b···Univerg1ty-···· Closest Relative.....llilQf!.:r...........!L.=.Y................................Address .......Bpringfifll.d•....M o.•........ Father's Name.......A;J,J~Jl..P..~r.!:Y..!!!!¥.L........................ .Birthplace................................. _.......................... . Mother's Maiden Name..... li:lJ.~.aP..ll.!;l:?.....$hg.:r:.~............Birthplace............................................................. . Cause of Death............. __ .................. ___ .__ .......................................Contributory...............................___ ... _... _............... . Date of Death .....F.e.b.l'wa:r.y..... l..l .•....195.9......................Hour ........................................................................ Place of Death....~:I:.~.~.~::~.~.~.~.~.~.l.:
....~.~.~~~....C..~Sfo~ t;!Rill?J? ....................................................
Physician....... _................................................................................. Address ................................................................. . Occupation of Deceased. ..... Real...£s..ta:tfl ..................._Social Security No•............................................. Name of Employer..........................................._... _...................................................................................................... . Address ................. _.................................................. _...................................................................................................... . Charge to.......In.sUr.anC.e ... and...ch11dl'e.u ........ _.Address .................................................................. . Order Given By........l'lido.lll... an!i ...ch1.1il:r.l:lJ:L .... _.. .Address ........................................... _.................... . Date of FuneraL ........_F~hr.ua.ry ...~5
•.... ~95.9............Time............ 3... P...•. M.............................................
Place of Funeral service.........c.UlY..er_!..a.J:fu.a.p.e.l.l;;.;.;;:ii".~~=-y. .................................................... Clergyman .........8.l'9..•....Q.l.tnll..JlandQ.Q.~ ...::~ ... :u~ii it;;?-:: ...:......................................................._ Address............ _.. _................................................_ .. _............................ .
D
Remains to be shipped-see reverse for details.
i
Interment at...........Map.lflJll.Q.o.!i ...C.el!l.e.t .e.r:Y......................, Lot No .... _.............. _....................... Section No............................................ Grave No .............................................. . Rarnarks ...........................................................__.............................._............................................................................... .
,.ORM :5235 S UPERIOR FUNERA1. SUPP1.Y CORP., CLEVELA ND, OHIO.
Casket ..::'!'....~...... _........................ . . (Style) .; (~.) , I OutSIde Case or Vault. ............. Embalming;1 Body .............................. ;: .... 1 ProfessionaC'Service ............................... . ............ Hair Dresser ............................................. . Suit or Dress .......................................... .. Shirt, Collar, Tie .................................... .. Shoes $...................... HoBe $..................... . Underclothes ............................................ \ Door Spray ................................................ Gloves $.................... Chair. $.................... Flowers $.................. Palms $.................. . Cremation .................................................. J Newspaper Notices .................................. . Telephone and Telegraph ........................ . Ambulance ..._........................................... .~ Funeral Coach ............................................ Passenger Cars ........................................ .. Pall Bearers' Service .............................. .. ............ Transferring Body................................... . .. .......... Opening of Grave..................................... . Cemotery Charges.................................... Lot .............................................................. Misc. Transportation .............................. .. Shipping Charges ................................... .
1i.........,.,..
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=:.:::::.:
~~:i~~I::~~·~~··:·:·~~·~~~;:~:~··:.·:.·:· • •. • ·! ~.j-~ ~
:.: /.+..:.~~.. .: : ': : : : : : :: : : :
~ ..,'k,J. ...................................... '!'otal Amount................................. .
Lodges ...... Pall Bearers
Information Given To : o Relatives o Musicians
Death Certificate Payment Arranged
Attended To:
o o
2\l9 CHECK EACH ITEM AS COMPLETED
G5..... _...... _...
No........ _.._......_._. _ _
Yearly N o.... _.._.. _....
N ame. ....__...................... _.MQ.Q:r.Q.(:l....~;J,.~g.K................_.........._..................................... Sex.............II!§:.:l..~..... Address........._......................_..~.~.. .J!~.I!!I!!g.L.~!.~ .~ .s.g.1,l;:.~........................ _............................................... COunty............................................Township....... _........ _..._...........................Phone No ............................................ .
Where Born. .........__ ........... _................................................_ ............... __.... __. _______ ..Race ____ ............................. __ ............ .
(
Date of Birth......... Augll.s.:t....12.•.._19.Q.6...............Ag•.............5.G ............................................................... (Year s) (Months) (Days)
How Long Resident in COmmunity....................................... ____............. _............... ____...... __ ........................................ Single........................Marri.d. ....ma.:r.r.~~*idowed ....................... Divorc.d...................... Child ............................ Husband, Wife or Child of.............................ijg.g.¥.l,~ ....~~1.!
...~.:),§gJ~:................... _.................._...............
Addr.ss ....... _.... _........ _.. _...__.. _...._...... _.................................................................................................................._..... Closest R.lative._._.._.....................................................................Address .................................................................. Father's Name. ......J .4_ ..E.r.ad...Blaak..................._.._.....Birthplace............................................................. . Mother's Maiden Name..._G!'l.I'.t.le. ........................................Birthplace... _...................................... _........ _.......
Cause of Death...............................................................................Contrihutory..................................................... _.. .
1959..................Hour ... _...................................................................
Dat. of Death..._...F-ehruar.y. ... ll •.....
Place of Death ....Bj;.•....L.1.lke..I..a~.K .,....Q..,.... M !?..•............How Long Ill? ...................................................._ Occupation of Deceased. .............................................................. Social Security Name of En'ploy,.r.............................................._....................................................................... . Charge cu... ................................. _. ...................................................... _."'c~r'ess................................ : Order Given By......................................................................... _...Address ..................................................................
.F.abrnar.y.....15.,.....19.5.9............Tim •..........:L.;J.Q... :E'..•.M..,..................................
Date of Funeral... ........
Place of Funeral Service............._....C.J).lv..e.;r.!..~.. _F.lJn(:l.r./l,J....!iQm.(:l......................................................_. Clergyman ..Re.v.. Ra;y:mond...Ela.ck ...........................Call for? .............................................................._ Addr.ss._._ ...... _...........g./l,.!l.!l.y..t..:LJ~.~.....M.+§J!!?.w.::,1,............ _.............................._............................ _...... _..__ y
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•••••••••••• 1 Casket
........................................_.................................. (Style~ (No.) ············1Outside Case or auIt................................................ .. Embalming Body ....................................................... . Professional Service .............................................. ...... Hair Dresser.................................................................. ············1 Suit or Dress ............................................ ................... . ············1 Shirt, Collar, Tie .................................................... ...... Shoes $......................Hose $.......................................... Underclothes ............................................ ................... . Door Spray ................................................ .............. ..... . ············ 1 Gloves $....................Chairs $.................... ................... . Flow.rs $..................P.lms $..................................... . ••••••••••.•. 1 Cremation ................................................................ .... .. • •••••••••.•. r Newspaper Notices ...................................................... • •• _ •••• • •• 1 Telephone and Telegraph............................................ . . .......... r Ambulance ................................................................... . Funeral Coach .............................................................. .. 'as:,.n.g.r Cars ................................................. _..... ..... . Bearers' Service ................................ .............. .... .. Transferring Body...................................................... .. Opening of Grave .................................... .. Cemetcl'y Charges.................................. .. Lot ............................................................. . · • ••• ··· •• •• 1 Misc. Transportation ............................................. . Shipping Charges .................................... ................... . •••••••••••• 1 Clergyman .............................................................. ...... Singers $................ Organist $.................. .................... _........ I Cash Advanced .......................................... ....................
..........................................................................._.... 1.. ......
•••
- ·_··· 1···············································....................... _ - Total Amount.................................. - - - __
Rem3ins to be shipped-see reverse for details.
Interment at ..................Qak...H1.l1...C.e.ma.t.er.y ............................................................................................ Lot No ............................................. Section No ............................................ Grave No ............................................. .. Ramarks ....................... _................................................................................................................................................... .
I nformation Given TQ: Relatives Musicians
o o
Lodges Pall Bearers
o o
Death Certificate Payment Arranged
o o
Attended 1'0:
o o o o
Clergyman Singers
Permit Bill Rend.r.d
Insurance .......................................................................................... ,..ORM 523 5 IfUPEA I OR FUNERAL SUPP L Y CORP., CLEVE L AN D , OHIO .
2E
Date..F..e.Qrn.
CHECK EACH ITEM AS COMPLET.
FUNERAL ·RECORD OF
26
Outside
Address............................Exet.er. •... .M1IHI.Q.u~.1..................................................... . ............ ............................
Embalming Body ....................................
C M1 1 h 1t Wh.re Born. .......$..!;..9.t!i..I? .... ~.~I.l ........... I?..~.?..~;:._.................................. Race ................~: .......... ~................
············1 ············1
Date of Birth.......!:!g.Y.~..~.!?~E
....?!......~.~I2............. Ag•......... _..........~.?....................................................... (Years)
(Months)
'''llli
Husband, Wife or Child of...........................I1.
'"
Mother's
Door Spray .................... __ ................ ___ ...... .
Gloves $....................Chairs $.................... FI $ P I $ lla.s e.
am ...£ ..........a•...e.r...........................................................
M.M..
Service ................................ aIr resser......................................... ____ _ Suit or Dress ........................................... .
············1 Underclothes ........................................... .
C "'t
Address....... _.......................................... _.....................Exfl.t.e.r.•... J41.§J?.Q.\J,;r."................................................. Closest R.lativ•......Mr.s_ ... Eff.1e.... F.u.t;r..e~;L...........Addres •.........!\¥..!'!.:!!.~.r.•.... ~9.~.?;:,l,...... Father's Nam•.........'l'hQ.mae....EJ..lJ&j;.:!!..............._.. _.....Birthplace.............................................................
~~fesDsional
Shirt, Collar, Tie ..................................... . Shoes $...................... Hose $......................
(Days)
How Long Resident in COmmnnity............................................................................................................................. . d marri.e ...··dowe d....................... D·Ivorce d...................... Ch·ld . '-'WI I ........... ................. SI·ngl e........................Marne..
::::::: :::::
Cr:::~on ..::::::::::::::::...:.~.s..... ::f.~.s.:~.~
............ 1 Newspaper
Notice ................................... Telephone and Telegraph ....................... .
MII:ai~~d:eDQ~d~~~~~~~~!i~;:;~::t.~~~:~:.•;;:.. e~;:;:;~~;g:b.r11;p:J.:~~~.= .::.:::.:::I Ambulance ................................................ Funeral Coach ............................. ________ ...... .
Cause of D Date of
Place of Death....Hnme.............................................................1Iow Long Ill? .....................................................
-.·········1 Passenger Cars ......................................... . •............ 1 Pall Bearers' Service................................ Transferring Body................................... .
Physician···J)r-·...···E·. ····E·.··.McDaniel............................. Address .........C.as..$.y..tll..e.•....MJ.§.!l.9J,,;r.i Occupation of Deceased. ... hQllS.e.1111f.e.............................. Social Security No.............................................. Name of Employer.............................................................................................. :..........................................................
Opening of Grave ..................................... . Cemetery Charges ................................... . Lot ............................................................. .
Address...................................................................................................................................................................... Charge
Misc. Transportation ............................... . Shipping Charges ................................... . Clergyman ............................................... . Singers $................ Organist $................ . Cash Advanced ......................................... .
Giivv:en:~~:::~F.~;b.:~~i~i'~J:~1~~:i~~59.~.:~~:::~~~~~::~'~~~~~]~~~~:~.~~~~~~~~~~~~~~
Orderof F Date
Place of Funeral Selm('e................J./.\~d, .g:£:..~' ...\1f..;~j,!.!1.,~ ........................................................................... . Clergyman ..........fi.ey ......C.lJ'Jl.e... ,Mg.Q.Q.:r.m.J9.f.............Call
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C.J.~?;e~ault........ (.~".:)............
Nam....................... EJ.o.r..enc.a..J.ane.t.... Qar.t.e.r.................................................... Sex........f.!'!.!!!!?,l!'!.... COunty... Jl~.r.rx. ........................Township.........~~~.!!!F.........................Phon. N0.............................................
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Casket&<.. JHl.:r..y.19&!L ........................
Yearly No............................_...........
No...................._ ._.___
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..Salfl.s....TalI...................................... . _ ..·······1············································ ......................... . _·····..···1···········································........................... Total Amount................................. .
Remains to be shipped-see rev.rse for details.
Interment at............ li...plewo.o.d...C-eme.t.er.y .............................................................................................. Lot No ............................................. Section No ............... _............................ Grave No .............................................. .
l ..c!::h ................................................
Ramarks ........................... lr.1.s. ... shaded ... s i lv.er.....s.t.e.el....
........................................fle.ah ....c.r.e.p.e....1n:\&r.~Q.r.............. ................................................................. .............................................. C.o.nner.sv.lll.e....C.aak.e.:t.....Q.Q.•.................................................................... ,.ORM 6 238 SUPERIOR FUNERAL SUPPLY CORP. , CL.VELAND, OHIO.
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Information Given To:
Lodges
D Pall Bearers D Death Certificate Payment Arranged
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0 Relatives
0
D Musicians
0
Attended To:
OPel D Bill
Insurance .....................................................................
26S Date. ...Eebnl8.l'¥_.. ~~ ....
J.35 9
CHECK EACH ITElII AS COMPLETED
FUNERAL RECORD OF
Father's Nam •.......J.e.aa.e_..T.a~b.e.l'.t.................... _.._.....Bi'1hpl.ce... _.........................................................
Casket .. §<. ...YIl;1,l.J,.~................................ (Style) (No.) I ............ 1Outside Case or Vault ............................. . ••··•··•·· •• 1 Emb.lming Body .................................... I Professional Service ............................... . Hair Dresser ............................................. . ············1 Suit or Dress .............C.le.an.1.ng ..... ••••• •••••.• 1 Shirt, ColIar, Tie ..................................... . Shoes $...................... Hose $..................... . Underclothes ........................................... . Door Spray ..:............................................. .···········1 Gloves $.................... Chairs $.................... Flowers $..................Palms $.................. 1 Cremation ................................................. . ·······.···· 1Newspaper Notices ............................._... . ••• _ ••••••• 1 Telephone and Telegraph........................ .
AlJ.g.!':. ....r~.a.1;h.~r..!!.1;g.!1 .....Birthplace..............................................................
············1 Ambulance ··· .... ··.. ·.. ·······.. ············ .. ····· .. ···· 1
No•....... _.._.......... _ ._•. _ _
Yearly No •... _..
_.2.7. .......... _...... _...
Name.....•._...................ll..f.r.ed ...T.alb.e.r.t ................. _................................................. Sex.......mah........... Address................... _.............Ex.e.tel'+....lVJ.&l?.9.l.!.:r."........................................................:................................ COunty...B.a.l:'.r.Y..........................Township..................... _.............. _........... Phone No ............................ _.............. . Wh.r. Born. ........Bar.~ ... Q.O.\Ul:ty..•....Ml.\l.ElQl.!X.L Date of Birth..........Aug.ua:L.7.•....
......._.................Race.............. .l~l1J.~~ .................
Ut8}........... _....Ag•......... _ ..75.... _............................_.................. _....... (Years)
(Months)
(Days)
How Long Resident in COmmunity.............._............~...... _... ____ .~................................ __ .. __ ...................................._..... SingJ •........................ MarriecLmarr.iedWidowed ....................... Divorc.d...................... Child............................ Husb.nd, Wit. or Child of....................•... D.elJ..a. ...Add1ngt.Qn ...Tal.b.e.l':t... _................................... Address............. _.._.... _.._...._.._..................................~~.~.!i.:r.J.....~:l:.!l.!l.'?~~.1............................................... Closest R.lative.....D..e.J..:),.
._ ••. •.• .....••••••••••••
Cause of Death...C.Ql'.Q.Ual'Y.... Tl:ll:'.Q.mP..Q.1;!.1.!!...............Contributory......................................................... .
14.•....195.9.........................Hour ................7....F..,..M.•......................................
D.te of Death..Eebr.Ui<>rY.....
Place of Death ............. n9.me......................................................How Long Ill ? .................................................... . Physician ...........Dr.•._.Qna.B.•.... B..•....p..:r.j&.~.....................Address ....~.~.1;.€!.r. •.....M~.§.!?g.1,\r..*...........
'fKk ...:3..':I:. ...:.. fe.1..3/
Occupation of Dece.secL ..... groC.e.r.y....Q~r............... SOci.1 Security No ...
Name of Employer. ___............................... __ . ___.. _... _...... _.............................................................................................. . Address ..................................................................... _...... _.............................................................................................. . Charge to...............w.•
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............................................................ .. _.aa.oress................................................................. ",
Order Given l!y.................... iJ(.J..~l.v.,y.....j;jd!\J,••• s"".~~.+..y.!
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Funer.l Coach ............................................ Cars ......................................... . Pan Bearers' Service............................... . ··......····1 Transferring Body..................... __ ............. . •••••••••••• 1 Opening of Grave..................................... . ••••••••••• • 1 Cemetery Charges............... :....__ ... __ ..... __ ._ ....... ... I Lot .............................................................. Misc. Transportation.. __ ............. __ ...... __ ..... I Shipping Charges ......................... ____ ...... . Clergyman ............................. __ ................ . Singers $................ Organist $........... __ ... .. Cash Advanced ........................... __ ............ Sa.le.~ ... Tax··········· ....·· ..... ·................ •••. •....... 1
_ .. ..... ... 1 Passenger
Clergyman ..Chaa.•...Mc.Nabh"'CJ..y.d.e....MoQ.O.r.lllaWiII
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~··-···I · ······· ·· ··············· · ····· ·········· · ····...................• ~
Remains to be shipped-see r everse for details.
Interment at........ -."Ma,~,tew'I~ I~.·~·,~me·1;e;pY:···· · ··· ·· ··· ........................................: Lot No •............................................ Section No ...............•............................ Grave
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Total Amount............................ .
"1.Y\..vVI/L.,zLALl Lodges Pall Bearers
Information Given To: 0 Relatives 0 Musicians
Death Certificate Attended To: Payment Arranged
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Insurance .......................................................... .
•......................................................................../
Date.F.ebruar.if.... lg·T··..~
... FUNERAL RECORD OF
CHECK EACH ITEM AS COMPLE'I
~........................
... . . . ... ...
Yearly No ...............z.~
No................................__
C• • ket i ..
(Style)
N am.......................................Margar.e.t....Ann ...S.t.ephens.................................... Sex....... f..e J:l1ale. .... Addre.s...............................................!IlGUiliburn.,....M1s.a.o.UI'.1..................................................................... COunty......Bar.r.y......................Town.hip ..........
Aen...............................Phone
No............................................ .
Where Born.............M-1.G-
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How Long Re.ident In Community............................................................................................................................ . Single........................Married........................ Widowed....w.l9,.Q.Vle.Divor ced...................... Child............................ Husband, Wite or Child of...........••.............Dan1el.. J ..•....~Stephens................................... "................ . Address ..............................__...........................................d.ec.eas.ed. ................................................................... . Closest Relative ......Em.l.l¥....P-r..lv.e.:t.!!.............................. .Addre ••........w."'.I3.t\J?.Y:!:p..I.....Iv!.:I..I3.I3.<:l!:1.r..:I.. Father'. Name. ...... Henr.y....P.endergr.a .t'.1:..................Birthplace.............................................................. Mother 's Maiden Name..Ang~),J.ne. ....lJ..~p..C?.!f.P.: ...........Birthplace............................................................. .
(No.)
Outside Case or Vault .............................. Embalming Body .................................... Professional Service .............................. .. Hair Dresser............................................ .. Suit or Dress ... :f..l~ Shirt, Collar, Tie ..................................... . Shoes $...................... Hose $..................... . Underclothes ............................................ Door Spray ................................................
Gloves $....................Chairs $.................... Flowers $..................Palms $.................. ............ , Cremation ................................................. . Newspaper Notices ................................ ..
Telephone and Telegraph ........................
Occupation of Deceased. ..... ho.us.elZlife ........................... Socia\ Security No ............................................. .
Ambulance ................................................ Funeral Coach ........................................... . Passenger Cars ......................................... . Pall Bearers' Service ................................ Transferring Body ................................... . Opening of Grave...................................... Cemetery Charges ................................... .
Name of Employer ... ____ .............................__ ..... __...__ ..................................................................................................... .
Lot ............................................................. .
Cause of Death................................................... ___... __.______......... __ ..Cont ributor y .....................................___ ..................
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Date of Death ..E.eb.r.u.a.O.... l.S.•.....l.95.9. ........................Hour.................. li!.:..................... Place of Death............. hOlll6.....................................................How Long III ?..................................................... Physician .... Dr..•....iY.•.......Q.•....Eg,Y.?a.~g,.~........................... Address ..............~Qg.~.!:.Iil.I.....fI.:t.'.k...! ............. .
Address ....................................................................._........................................................................................ .
Charge to...........I.naur-an.:-& ... an4 ... Ch11dr.er:l....... .Address ................................................................... Order Given By.........ch.1ldr.en ...........................................Address .................................................................. Date of Fun.ral.. ...... Eebr.uar.y:....22.~ ....J..9.5.9...............Time....................?.t3Q....f ..•. M..,... . Place of Funeral S.rvice............D.•.K.•....Mi.a.alQn...5.ap.t.1J>.t...g.t\J,~.,r.gA ... J '
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Misc. Transportation ............................... .! Shipping Charges ................................... . Clergyman ............................................... . ............ 1 Singers $................ Organist $..................
Clergyman......... B.l.v:.•... Chas .•....l!.anz.andt .................Call for ?.i Address.....................Ca·8-&"',j.·1 J.s.•.... JU.s.,s.o.Ur.,1.............................
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Remains to be shipped-see reverse for details.
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Interment at. ...........WGUilibur.n,....p.r.a.ir.1e... C.emet.e.r.Y. ......, Lot No ................................ _........... Section No ............................................ Gravt: .. ,,,_.........
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Ramark ............................... #4.5.5 ... H.Q.r.J.!I.Q.n. ..l?),ll.§! ... ~J},y..ElJ:' . ..l3.t\g.~~~....
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........................................... p.!,!g:h&~.~.... Q.r..El.2~....~..r.~J~.~~!:'i.r..El..S..S.....~.e.:l.l.e..~.l................................. ............................... Jlp..~,t.!lKO,e.JQ,. ...Q.§!,.!.l~.El.)i....!¥.g.,.....9..()..~......................................... ........... FO R M 52315 SU P !UtIOR FU NER A L S UPPLY C O R P .. CL RV ELAN D . OH IO.
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Lodges P all Bearers
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Death Certificate Payment Arranged
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0 Relatives 0 Musicians
Attended To:
OPe Bil
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Date. .... F.e.Q.:r.~...!:y.....~lJ:~
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CHECK E ACH ITEM AS COIllPLET
FUNERAL RECORD ·OF ·
No................................_ _
29
Yearly No.........................................
Name. ................................V-ern1e ... Rey.ndal. .. D.av.1dB.Cll:l..................................sex. .... male ............ Address .......................................!!:aJ.!:Y:.~~Y[•.....M~!?.~9.!:!.:r.t ........................................................................... . county .....N~Y!..t.9.rL ..................Township................. _... _...........................Phone No ............................................. Where Born. .............M1.as.Q.ur..1................................._ ................................. Race..........Y.-:hJ.~~
...................... of Birth........Ap.r.l1....3.D....19..QJ......................Age.........._....55.............................................................
Date
(Years)
(Months)
(Days )
How Long Resident in Community............1.ife....t.1me .................................................................................... Single........................ Marrie~rie.d.Widowed ....................... Divorced ...................... Child...................:........ Husband, Wife or Child of........................P.ear.l....Tr.a.c.BY. ... D.ay.ldsQu .............................._............... Address ..............._.............._ .._.........._............................F..a.1.:r.:v..l.~.lV........
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Closest R.lativ •.......p.ea~1....'r.r.ac.ey....D.ay.1dB.o.n.. .Address......................................:'-; ...... ~.~ Father's Nam• ......NQ.ah ...D.a1f.ids.~n ................................Birthplace...............................JJ).rJ~ohlk . ~;~.. Nanc "v................... Earl ~v...................·····r .BI·rrthplace ,"'-,.. Mother's Mal·d. n Name................ vF .........................L!:'......... ................... Cause of
Casket :!....~.. ---.. __ ._........_.................. _. (Style) (No.) Outside Case or Vault............................. . Embalming Body ........................... _..___ ... . . __. __..... J Professional Service -_ ......................... __ .. . Hair Dresser. _____ ........... __ ........................... Suit or Dress .. :~..~.P-"--"",, Shll't, Collar, TIe. _______.................. __.... __. __ _ Shoes $...................... Hose $...................... Underclothes ........................................... . Door Spray ................................................ Gloves $....................Chairs $.................... Flowers $.................. Palms $................. . Cr emation .................................................. Newsp.per Notices ................................. . Telephon. and Telegraph ....................... . ,. ... ........ Ambulance ................................................
Death~....~ ........ ..... . ...... .~~nb,iliutory.. ~~.&&~...!!-C~,-dv.,~ ... '" b 2".1 "'9 l.Q 015 A M. .Jf _ •••... ...•
Date of Death···.. ···· .... e· r.uar.y.... .....,.... .
",.................Hour.................. . ..•. +' H ..-..... I
....
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•... ............•••.
Place of Death .. O.aBB.V.~11.e....Q.a.t .e.Qp-a.y.a.1.c........ 9__ Long III ?.....................................................
Funer.1 Co.ch.......................................... .. P assenger Cars .......................................... P II B 'S· ............ a earers erVlce................................ ............ Transferring Body ....................................
Physician ... Dr.~...H.o.\![ell......................................................Address .............. Occupation of Deceased. ....AP..R..:U.~.n9..!!!....g&~J..~.:r....... Social Security No..
J'.1J...:gy.•....MJ.§J?Qw.;:.l...
Opening of Grave...................................... Cemetery Charges ................................... .
Name of E mployer.........................................................................................................................................................
Lot ............................................................. . Misc. Transport ation................................ Shipp ing Charges ................................... . Clergyman ......................._...................... . _.......... Singers $................ Organist $................ .. Cash Advanced ...........................:............. .
5..9.9.::-.9.5.:::i:+.:l,5.9..........
Address ........................................... _................................................................................................................................ . Charge t o.........ln.s.uZ'.u;J.ce ... and...Ohiadr.eu...... _.Address .................................................................. . Order Given By...... W.idow...and ....ch1ldr.eu............Address .................................................................. Date of F uneral... ....F-eb.r.u.w;v....2.7.•....1.9.~9................Time ..................................2 ...P.•.M.•...................
,#;.~..~....................................
Place of Funeral Service......... ·Ch\,l;l?~ ...ct ... :~e.... Sre.th.er.n ..1n...Fair.."Il.iew...................... Clergyman ....HGUs:l;Q.Jl,...!]).t'aGS:;t-Poy.le...X.r.aCe\Yk1l f~r? ........................:
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Total Amount .................................. , Remains to be shipped-see reverse for details.
Interment at.......J:j-iee....G~tePy.....................................................................................................................
Lot No ............................................. Seetion No............................................ Grave No .............................................. . R.marks .....................d.ark...c.app.e.r..t.Onfl....ah.a.d.~.9... .. )J,g4..1;...9..9.11.P..~;r..~ ....!?:1;.~.~J...
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........................................r.Q.ae.:tan... f.lat.1D. ....in.t.e.r..tg.!: .............................................................................
............ ......................... ~P..r.:l.:!l!l;.P:~.~.~ ...Q.a.-.~.~~~.~.....1vI~. ~. :.... g.~.:.......................................................... ,,"ORM
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SUPERIOR FUN E RAL SUPPLY COR .... CLEVELAND , OHIO.
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Lodges Pall Bearers
I nformation Given To: 0 Re1atives 0 Musicians
Death Certificate Payment Arr ang-ec
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Attended To:
OPe: Bil
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271 Date.Eal;lr.JJ.a ...Y..... 25.~._.;J,9.59
CHECK EACH ITEM AS
CO~~~;"''ED
FUNERAL RECORD OF No........_.. _...... _ .__.__
Y.arly No .... _..
I
.3..9............. _......_...
Casket ........................................................ . (Style) (No.) I
Name. ...... _.......................Ka.thryn... N.e.y.ada... B1.sh.QP ......................................... sex. .......:t:.eroa.l.e... Addr•••.............................................c.aas.y.l.1.1a...... M1~.§!il.\l.r.;l, .................................................................... COunty....B..a.r.r.Y.........................ToWDship ...... }A.~.~_~.~§:~....~.~P..¥.J..i!lbni~o ............................ _.............. . Where Born..............Qb.1.Q..........__ ............................ _.. _ ...._........ _.................Race.............\1Ih.:1.1;.~ ................... Date of Birth··.. ·....-AlJ.S'\,l~t. ...2+,.-~.6.~ ............Ag···········-·(~~~sf·········(Mo;;tb;;)············(·Days)" How Long Re.ident in Community...................}{.. ..if.~a........... _................................................................... Singlo..........._...........Marri.d. .......................Widowed ..w.lao:w.eCbivorced...................... Child........................... . Husband, Wife or Child of.......................La!ix.e.nc.e....B..1shlpJD..eQ.e.a.§.e9....L................ _............... Addr.s •............. _........_.. _...._.. _...................................................................................................................................... . Closest R.lative...._Mra~... .E.a.tA1... B.ae.e.Q.n ............... .Address ..... Q.!l.];!.f?y.JJ1.~.•..)A:9..•................ Father's Nam•.........'l11111am....Map.le. .................._.. _.....Birthplace..._.........................................................
Outside Case or Vault............_................_
Embalming Body .................................... Professional Service ................................ ............ Hair Dresser............................................. . Suit or Dress .......................................... _. Shirt, Collar, Tie ..................................... . Shoes $....... _............. Hose $..................... . Underclothes __ .............................._..... _. ___ . Door Spray .... _......................................_... .
Gloves $....................Chairs $.................... Flowers $.................. Palms $.................. Cremat ion ...__ ............. _..._........................... Newspaper Notices ............................. _.. ..
Telephone and Telegraph ....................... .
Mother'. Maiden Name... Aoo§....M~p. .1..~..............................Birthplace... _...... :.................................................. Caus. of Death.ac.u.t....~.~.~ntributory.................:....................................... .
Ambulance ................ __............................. . Funeral Coach........................................... . Passenger Cars........................................ .. Pall Bearers' Service................................ Transferring Body.................................. .. Opening of GI·ave..................................... . Cemetery Char ges ....................................
..•....................... Date of Death ... _.F.ebruar.y.....25..,. ....195.9....................Hour ....................3..UQ....:P...•. M Place of Death ........... hQJl!.lL....................................................1Iow Long Ill ? ..................................................... Physician .........D..r..,.....K•....~.•....M9.P..(!!),.*.~.;!, ...................... Address ........ .9.§:!l..!I.Y.g.:I..~l ....~..•............. Occupation of Deeeased. ............. houae.w.1i'.e. ...................Social Security No ..............................................
~~:C:··T;~~~~·~~~~;~~::: : : : : : : : :::::::::::::j
Name of Employer ___ ...................__ .__ .... __ .___ ...... __ ...__ .... _.............__ ........ ___ ......__ .....................................__ ... ___ ................. . Addl'ess .............. __._______.__ ..................._..................__......................._..........._...................................................................... .
1
Shipping Charges ................................... Clergyman ......................................_........ Singers $................ Organist $._.............. . - .. ,
Charge to...............\Ih.ildr.en .............................................. _.Address .................................................................. . Order Given By.............chi1dr.en.................................. _...Address ........................................... _..................... Date of Funeral... ...... _..F.ebruar,v.... 2S •....1.9.5.9..........Time ................. 2...1'..•. M.•.............................. Place of Funeral Service..........Qul.v..e.r..!..a.._Chap.e.l ................... Clergyman....~.,.. ~ Call : Addres •... _................~,... ~..,..... _.. _...... _......................_
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.............
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Remains to be shipped-see reverse for details.
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Interment at................. _...O'ak ... Rldg.e. ... a~e.te.I',l[............... Lot No .......................__ ... __ ._. __ .. _....... Section No .................................._....... _._._ . _ • . _...................._... __ ___ ... .
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....... ................... ~...~.~ ..Q.J1l.,... _,............................................ ................... ............ FOR M ea3 e SUPERIOR F U NERAL SUPPLY CORP .. CLI!YI!L!AND, OHIO.
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Attended To: Death Certificate Payment Arranged
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Permit
Bill Rendered
Insurance ............................................................... __ ........... ___........._.
27 2 Date..F..e.'Q~]Jal;~L.~~...._J.25 9
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CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF Y.arly No •...r ...... _}l......... _......_...
No•......._.. _......_.._._.__
Name......._.................. _.._...... .M1rlrda...Lual.la..Jlsx.~lJ:! ..................................... Sex..... J.~.~.:),.~...... Address.......................................... Q.
.!l.!?.9.)gJ......................................................................
County.....BaI'.r.Y. ....................... Township ........... _........ _...........................Phone No............................_.............. . Where Born............N.gY{Ji.9I\...Q.Q.1m.1;y .•....M.~.:'?.~.Q1:\:r::.j,........................Race... ...I!~.1.:~ :'l.............. ..
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Date of Birt!l. ....Mar.ch._l~.~ ....1882L.................. ..Age...................IQ............................_.................. _....... (Years) (Months) (Days )
How Long Resident in Community...................... __ ......................... ____ ...... ____ ..................................___........................ . Sing le....9.1ng.l.e..Marri.d. .......................Widowed.......................Divor ced......................ChiId........................... . Husband, Wife or Child of.......•.....................................................•._...................................... _.................. _............... Address ............._........_.._................................................................................................................................................ .
Closest Re1ativ•.... ~.J'.~ .,....NgJfl:....MQ9..r.~ .........................Addresf:c:l€i.E;.~~.l....A~~.~.S.~.s.
...............
Father's Nam• ......Bar.ane.t .:ti...W.•....Har.:r.A!!....._.. _.....Birthplace..._........................................................ . Mother's Maiden Nam.Rache.l ... E .•....Br.QiVn ...............Birthplace........................,.................................... . Cause of Death ..............................____..............____ ....... __....... ___ ........Contributory .... __ ................ __....__ .. ____ ....__........ __...... Dat. of D.ath ..._..Ee.b.r.uar.y....2.el.•... J35.9....................Hour ......................................................................•. P lace of Death ...ga;V.v.y. ...C{).W'l:ty.., ....R est ...Home .. .How Lon g Ill? ..................................................... P hysician ...... .Dr..•....Mar.Y-...N.e.wman................................... Address ............Q.~.(!.!l.Y.:t..+.JJh ...M9...,......... Occupation of Deceased. ........d.l.sabl.e.d.......... _......_.._....Social Security No.............................................. Name of E mployer.....................___................... _...... __.............................................___. ~ _ .. ______.. _____ .... _.. _..............._.__.__ ... _ Address. __ ............................. __ ........ ___......_____ .......__...... _____....... __.....................__ ...........___.. ______ ................__........ _....._____ ...... .
Char ge to.........lnBur..ance ... .&... Mr.s. .•... Moor.e. ......_Address ................................................................... Order Given By.......No-la,. ...Moo.t'.e..................................-...Address ................._ROg Date of F uneral....Ma.r.ch...l
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•....19.59................................Time .........................Z..;.}9....P.,J!!.,...................
Casket
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(Styl.) (No.) I Outside Case or Vault ............................. . Embalming Body .................................... Pr ofessional Service ............................... . Hair Dresser............................................. . Suit or Dress ........................................... . Shirt, Collar, Tie..................................... . Shoes ; ......._.............Hose $...................... Under clothes ........................................... . Door Spray ............................................... . Gloves $....................Chairs $.................... F lowers $..................P alms $.................. Cr emation .................................................. I Newspaper Notices .................................. / Telephone and Telegraph ........................ Ambulance ............................................... . Funeral Coach ........................................... . P assenger Cars ......................................... . ............ Pall Bearers' Service ............................... . ............ Transfer ring Body................................... . ............ Opening of Grave ..................................... . Cemetery Char ges .................................... Lot ............................................................. . 1 Misc. Trnnspor tation .............................. .. Shipping Charges .................................... Clergyman ................................................ Sing ers $................ Or ganist $................. Cash Advanced ........................................ .
Place of Funer al Servic• ........C.u.ly.e.r..!..!l_•. Qh.a.P..el.................................................................................... _. Clergyman ...........R41.v ..•...C.•.... F.•.._Slle.r.........................Call for? ............................ ................................._
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Remains to be shipped-s ee reverse for details.
Interment at .......... O.ak...Hl11_.C.em.e.t .s.X'Y.................................................................................................... Lot No....... __ ......... __ .......................__Section No............................................Grave No .............................................. . Ramarks ..:...............'l'1b..j,._t.e....A.j,.ng.e....Q.~p......1;!:!;.~.~J ....@.!;l,.q~iJ,...g ().:l..cl......................................... .... .
....... ............. ....... ....l'i'hl,.t .!'L..§~.1;J.n . .J!}:t!.~.r):9. .r.......... . ....... ......... ................... .. . .. . .... .... . ....... . .......... . .............................. ~p.I'J.nKr.J.~1~....g.":s..~~:t.... M.f.~..~.....c..()..~....................................................... " ORM 15 233 e U PER IOR FUN ERA L SU P PLY CO ftP . , cl...VE 1..AN D; O HIO .
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Lodges P all Bearers
Information Given To : 0 Relatives 0 Musicians
Dea th Certificate . n Pa vment Ar ran ged
Attended To :
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Cler gyman Singers
Permit Bill Render ed
