Date....M~ __ ;!.-'._..
;!..9..9.Q._.._._
FUNERAL 'RECORD"OF ."
CHECK EACH ITEM AS COMPLETED
. Yearly No.... _.. _.. _. , ....!R...!?.._...
No•... _.. _.. _.. _.._____
Name....... _........ _............Mlnj;_\l....NQr.~....~.n!?ggr.M.~............................................. S~ ...... te.~~~~
Casket
....
Address................................._6.e.;l.J,gl))l!.n........M.~ .!!.!!gP.-.;:.~.............................................................................;.... COunty.....)~~.r.r..Y. ...._...... _.. _...Township......._.._........ _...........................Phone N 0 •.••.......... .•••....•..•.. _ ......... ..... . Where Born............. :w.ashb:u.r.n..... .M!.!'!.li9.JJ1'.1._ ...._...........................Race............~hJ~.~
Date of Birth.......~J;lP..!.~.!!!l?~;:...?.lJ:~
....................
.....~.!H.5.........Age...........•. _(Years) .....~~....... _...._............ _.................._....... (Months) (Days)
How Long Resident in Community..................... l i f.e.t..1me.............................................................................. . Single..S.1nglfLMarried........................Widowed.......................Divorced...................... Child............................ Husband, Wife or Child of..............................................................._........ _............................ _................................. .. Address....... _.... _...... ___.. _..._ .. _...._......_........................................................ _............................ ___ .... ___ .. __..__ .. _... __ .......... Closest Relative..P.a.U.l ...Q§.l.l!1Q~l.......................................Address .......... .9..~F~~.€;~.!,._.!I!~.E!.s..?.u.:.:l Father's Name......._4.ndaat'.aO.n....SnQ.g,g;r.a.1!.!L_.....Birtl'wace... _............................_........................... Mother's Maiden Name...C.ar.Q~ln.e....M....t.ng.......~)l~di~ace... _...·................................... _................ .
Cause of Death..................................................... ___ .......................Contributory__ ....................................................... . Date of Death..._.._MaY... _l.,.. ...196.0....................................Hour...................................................................... .. Place of DeatMC.C.une."'-B;rQ.Q.k.!'!...B.Q.!!p...'---... ~.Q.!l,r.::t.!Fr~!!ong Ill? ................................................... .. Physician............Dr.......G.e.O.r.g~....w.9.9..g,§ .......................... Address........g.~.r..1;):l.~g.~.l.... :M.:!..S..S.9..\lF.1. Occupation of Deceased....................hg.].!,.!!.!:~.1.J~.~.... _.. _.. _Social Security No............................................ .. Name of Employer........ :.......~ .......................... _... _............................................... :~ ..................................................... . Address ........................................... _............................................................................................. ,............! . . ........... . . : ... . . . Charge to........P.aul... C-armOn .....................:..................... _.Address ........ r.~h ...g,~.~.....~t!!.!!.9.w...~ Order Given By...P.ay.l ...Q.@ .!:l:Q!1.......................................Address .........................~~ .............................. ~'...... . Date of FuneraLMalf.._.} ... _~9.6.Q.......................................Time ............. .3....f..... M........................................... Place of Funeral Service............. ~.eJ..+.g!)).~n.... .?!,!..2~J.§.~.... 9.h.~~h..................................................... _. Clergyman.........B~:v...,..._Ml.:w.rJ;l!lQ.~.... R.~.!:l:IT..................Call for? .............................................................._ Address..........._......("!.~JJg\l!@..... _..¥..1..s..s..~1l..l:'1..... ~._ ~
9. ....
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............... .._... ...................... _............................ _.. _.. _.._.
_
"".a(;!~~.".dr.e.a(~~:;...........:1
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 , ................ .. Cremation ................................................. . Newspaper Notices ................................. . Telephone and Telegraph...................... .. Ambulance ................................................ F uneral Coach ........................................... . Passenger Cars ......................................... . Pall Bearers' Service............................... . Transferring Body................................... . Opening of Grave............................... _.... . Cemetery Charges .................................... Lot ............................................................ .. Misc. Transportation ............................... . Shipping Charges ................................... . Clergyman ................................................ Singers $................Organist $................. . Cash Advanced ......................................... . ....... 1 .... Sale.s ....Tax ................................... .
:::::::=::: \ :::::: ::: :::::: :::::::::::: ::::::::::::::::::::::::::::::::: Total Amount. ................................ .
Remains to be shipped-see reverse for details. Information Given To:
Inoormentat............ ~,al~~.aDL.lleIllE~ter~y....................................................... Lot No ............................................. Section No .....-....~..... _............................ Grave No .............................................. .
Ramarks ................ Bl:u.e....shade.d.... aJ.J:v..\').;r.....!!.• ~!i!.l....!!.~.g.l,.~.r.......................................................
...................... ... B1M"'-... Y.e.1.y.!i!." ....g.gp.~_!!m~;],J....9:1.~!IIg~st....().~Ell:l.......... ....... ........................ .................................WhJ.t.Sl .. __Q.r.~p..(!!.....!n.);.~;:.~.9L __ ..... _.._........ __ .. ________ .. ____ .......... ________ .... ____ . ______ ......... ____ . __ __ ......... ____________ ..~I!.rJngJ..~~.l,.9:.. .9..~.B_1t.~.~.... ¥.:f..~.:.....~.~ .............. __ ......... __________ .. __ ........... ____ ... ____ ... ,.ORM 52315 SUPERIOR FUNERAL
III U P~LY
COJlt .... CLEVELAND. OHIO.
f:;;.;~:::::~g~~ Bearers -
o
o
Death Certificate Payment Arranged
o o
0 Relatives 0 Musicians
Attended To:
o o
Clergyman Singers
Permit Bill Rendered
Insurance..........................................................................................
Date. ......~...4.,.....l.9.6Q......_
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD ·OF
No.........................._ .._ _
Yearly N 0 .............." "••
!e.1..........
Name. ...........................Clar.a .. Dor.o.th;v....S:t1ll..............................................:.... Sex.......... f.ema~e. Addres ..................................J?~
..! .... ~~.~.~ .•....~~.~.~.!?S'.!:1:;:..~..............................................................................
County..................................._.._... Township ....... _.._........_...........................Phone N 0 •.....•...•..•___________ ..• _ •.............. Where Born......................................................................... _ .................................Race............wb.l:t.e ....................
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Date of Birth..........s.e;p..t.emb.er....~ ......;!.a9.3.....Age........_ ..... QQ........................................................... (Years) (Months) (Days) How Long Resident in Community................... __ .__ ................................._._. ___ ._ ..... _................. ____ .. ____ .. ____
0
____ • • • ______ • • • • • •
Single........................Married. ....................... Wldowed.w.1g9.~.~.g.Divorced...................... Child........................... . Husband, Wif. or Child of................................R1r.am ... S.til~ ....(.DeQ.eaa..e.d.L. ................................. Address.............................................................................................................................................................................. Closest Relativ•...Mr.s......Wm...B.eear.o.f:t ....................... .Address...........S.:t;..•....LQ)J.l~ ..... .MQ..,........... Father's Name.......J.o.hn...B.engp.l .e!:l.l........................... .BlrthpIeee............................................................. . Mother's Maiden Name..Car.Ollna ...Unknn.Wn...........Birthplace..: .......................................................... . Cause of Death......... my:O.car.d1.t.l.s..................................Contributory......................................................... . Date of Death .....M.
ot
Casket &.... s.eI'll.1c.e.s ........................ (Style) (No.) Outside Case or Vault.................. _......... _. 1 Embalming Body ................................... . Professional Service ............................... . .......... _. Hair Dresser............................................. . Suit or Dress .S.t.o.le ........................... Shirt, Collar, Tie ............_.... __ .................. _ Shoes $...................... Hose $...................... Underclothes ..... _...................................... Door Spray .................... _...................... _... . Glove. $....................Chairs $................... . Flower. $.................. Palms $.................. Cremation ................................................. _ Newspaper Notices ............................. _._. Telephone and Telegraph........................ Ambulance .............__ ............._.................. . I · Funeral Coach ........................................ _. __ Passenger Cars .......................................... Pall Bearers' Service ............................... . ........ "" Transferring Body.................................. _ Opehing of Grave......................_........ __.. .
~::~~'.~···~~:'.~~::::::::::::::::::::::::::::::::::::1
Deceased.........................................._. ___ ... _......... _Social Security No ......................................_...... .
Name of Employer.......................................... __ •.. _...... _........................... __..~...~ . _:.:. :......... _............__ ........................... .
DaooofFuner'. I........ :Ma.y:... ~" .... :l~b~I....... ........................... crim.e ......... ,........ ... c~.. J~A.J~ •.............. ,
Misc. Transportation .............................. __ Shipping Charges ................................... . Clergyman ...................................... -........ l Singers $................ Organist $.................., Cash Advanced......................................... .
Place of Funeral Sell'Vi':e......!!~.J.l.gIlI.Il.n ... J:!.ap'.1;..lS.l;....\lJIlJ,;tr.J::n:... ,..... c•• ••.••••••••••:
....Sales.. ·.~ax.....................................
Address............... _.................... _.:............................._.............................._........._.. _... _......................... _.............................. . Charge to.................ahildr..e n ....: ..........................................Addres ................................................................... . Order Given By ....................S;lfb~ ..j,g.~,:!i'.n.....................................Addr'>Ss..................................................................... .
Clergyrnan ..... Lar.k1zl".H.e.nr.¥............................................Call for ! ...... :........, I
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Total Amount.................................. Remains to be shipped-see reverse for details.
Inoorment at........... B.a.Y.le.s..a ....c.em.e.:t.e.r.y:...................................................................................................... Lot No ............. _.__................._.......... Section No ......... _.._.. _............................ Grave No .............................__ ............... .
i ...~b..•............................................................
Ramarks ......... G.QP.per.....ahade.d. ...s.11y.e.r.....S.:t.e.el ...
........................rg.~~p..~JK~....g.~~P~ ....~!l~.~.I.'.~'?:I.'=.Il:I;).s..~....:1;~....~~.~.'t.~:1;....~.~ ................. .........................Sp.~.lngn~.;J,..9., ...Q.
Information Given To: 0 Relatives 0 Musicians
o o
Lodges Pall Bearers
o
Death Certificate Payment Arranged
o
Attended To:
Insurance.,
....................\\
o o o o
Clergyman Singers
Permit Bill Rendered
CHECK EACH ITEM AS COMPLETED No........................_ . _ _
Yearly No......,..........
Casket .......& ...v.aul:t.......................... .. (Styl.) (No.)
4!.b ...
...
N ame........................................I,.e.~ha....M£I,y..:..!!~.Y.!'!.Y.................................................... Sex. ... .r~.~:J,.~....~. Addr..s ............................................. .6.y,~:t.~.r.fJ.!'!.lg• .... M.~.~ .~.9..~E.*.............................................................
l'-arrx.......................Township..................................................Phone
COunty.....
No .............................................
Whore Born. ..........B.ut:t.e.r.f1.e.ld4 ....M1.@ .!lgY.,r.1..............................Race.......l'Y.hJ.1;.~ .........................
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Date of Birth.........!:uly:...l!l,~....1.S3.0.......................Age................... (Years)
69......................................................... . (Months) (Days)
How Long R.sident in Community......................... ~1fe. ....t..1JJle....................................................................... Singl•........................Marri.d.~r.:rA!'!.g.Widow.d....................... Divorc.d ......................Child........................... . Husband, Wile or Child of........................llauzo.... E.•... Har.Y.e.y................................................................ . Addr.ss ............................................................... ,....... But.te.t'f..1e.J.d.~....M1sSJ:).ur.1................................... Closest R.lative..............................................................................Address ......................................., ..........................
Outside Case or Vault............................. .
Embalming Body .................................. ..
············1Professional
Service ............................... . ............ Hair Dresser............................................. . Suit or Dress ............................................ Shirt, Collar, Tie..................................... . Sho.s $...................... Hos. $.................... .. Underclothes ........................................... . Door Spr ay ................................................
Glov.s $.................... Chairs $.................. .. Flowers $.................. Palms $................ ..
Cremation .................................................. Newspaper Notices ................................. . Telephone and Telegraph....................... . Father's Nam.······Q·. ····M.'-·..·~·y,r.~!lJ;.:t···················Ki.'f(dfflI'J'lace .................................:............................ ........... . Amliulance ............................................... . Moth.r's Maiden Name... .M.:l..§.!l.~.~ ...fl.!lJl.,.~......: .........Birti?place..... Funeral Coach ........................................... . Cause of D.ath.~.... ...., ../)
r..........:]:....;;....,............................. &r.!...,u.J.;....
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- .....:......
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!t.•....J9.Q.Q..........................................
7.4..(;,...:..........................
Lot ............................................................ ..
Name of Employer..... ____ .__ .________ ......................_... _......_........................................ ___ .................... ____ ... __ ... _._ ... __ ........... .
Misc. Transportation............................... . Shipping Charges .................................... Clergyman ............................................... . Singers $................ Organist $................. . Cash Advanced ..........................................
Address __ ............... _........................ _................................................................................................................................ .
Charg. to............1'am1.ly...........................................................Addr.ss ................................................................. .. Order Given By..............f.amJ),Y. .............................................Address ................................................................. . Date of Fun.raL .... Ma.Y....5......l9.6.Q ...................................Time .........:.....g..:.3..()....~.!.:M: Place of Fun.ral sF ce..._......B:ut.ter.f.ifl~d. ..M.e.thQQ.J.. Q;g..ll,.:rg;g........................................... Cl.rgyman ....A .L......:r.lckll.Q.n~.......La....F.Q.:rg~...........;CaII for? .. c.................... ........ .............................._ ,
..............................
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..Sa.le.fL.Tax ...................................... . Total Amount.. ................................ \
Remains to be shipped-see reverse for details. Information Given To: o Relatives D Musicians
Int.rm.nt at..............Mt...;p..lea.ge.J:lt....Ceme.t.er¥....................................................................................... Lot No ............................................. Section No ............................................Grave No .............................................. .
Ramarks ..................... J.4lS4...black ...... tr.ojan... ahad.e.d ... ,a.1lv.e.r.... a:li.e.e.l ...
! ....c.h ...........
....................................:v.illl.er....~egal ....Bat.1n...and....S.j..ly..!l.r. ...Q~.;I,J§,J.r.:~ ... Q.r.!'!p~L ...... ..................................... p.la.te.d.. .emb.o.aBing"'A\U~Qra ...O'.£l,.§.~.~:t.. Q.9...,.......................................... FORM !l Z315 BUPIUIIOR FUNERAL aUPPLY CORP .. CLEVIEL.AHD, OHIO.
o
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Attended To : Death Certificate Payment Arrang ed
0
I
0 :
o o
Perl Billl
M?J'_.. _~~-'._ .. ~2.~~_.. _
Date.......
.. . .
FUNERAL'RECORi>cOF 'c .. '
-' .
CHECK EACH ITEM AS COMPLETED
a
+..... +.....
Io st' ~......_... . Y.arly No .... _.._.. _.. _........
No•..........._...... _.___ _
Casket ........................................................... IS'. . ......... (Style) (No.) Outside Case or V.'a'''o'''<................................. I............ Embalming Body ...................................... 1............ ..
.. . .
Name. .•...._........ _........ _.._....R1.Q.bAr.g...W.<1.yJ!.~.. JkQl!.1!n~y................................::...Sex:.........~~.*.~
Addrees................... _.. _........_...........p.ur..dY-~ ... Mls..$.Q.1J.r.l............,................._.......................................... :.. ..
County...... Bar.£y......_......_.. _...Township......._............ _........................... Phone No............................ _.............. .
············1Professional
Service .. ·.. · .... ··...... ·...... ······-!-·· ..·.. ·..··.. I.. ·· .. Hair Suit or Dress ............................................. I.............. -!- ... .. Shirt, Collar, Tie ...................................... !.............. ! Shoes $...................... Hose $...................... 1.......... ,... 1 Underclothes ............................................ !............... ! Door Spray ................................................ 1............... 1...... Gloves $.................... Chairs $.................... 1.............. 1 ..... . Flowers $.................. Palms $.................. 1.............. 1..... . Cremation .................................................. 1.....··········1 .. ···· Newspaper Notices .................................. 1............ _.1 ..... . Telephone and Telegraph........................ I.............. I...... Ambulance ................................................ 1..... ·.. ··· .. ·1 .... ··
Where Born.............Monet.t.,...MiB.s.o.ur.1 .... _.. _ ...._........................... Race..................... wnl:te ...........
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Date of Birth...Max....2.•._J 9..6.Q...._............................Ag.........._............................_................................_... g. . (Years) (Months) (Days) How Long Resident in Community...................................................................................__ ........................................
Single........................Married. ....................... Widowed.. ..................... Divorced ...................... ChilL .....G.b.*.;1,.9. .... Husband, Wife or Child ot...................... B-111y....Gou.tne;? .............:............................................................ Address............. _........_.. _...._................ _............................................................................................................. :.......... . Closest Relative.....B.ill.¥....GQJ.l.t.neX...............................Address ...................................... _.......................... Father's Name....... B.ill.¥_..GQJ.l.t.neY..............:...... _.. _.....Blrthp.1ac...................... :........................................ Mother's Maid.n Name... _Edith ...B.r.eaz.z.ea.l............Birthplace..._:·................. _..................................... Cause of
Death.~ ..4.~....~. ...Contributory...~ ....................
Date of Death..._May._.l.l• ....19.6.Q.....................................Hour......................................................................_ Place of Death....Q:1i..•....Y..ID.gJ~!l1!..'.§ ... g§Qp.J
..............How Long
Ill? ...... ~~.L .. ................... ..
Physician· .......!);r>... ... -G-lasS ..................................................... Address ....... MDn et.t .• ....Misso.ur.i ...... . Occupation of Deceased. ........ h .Q.1J.Sew.lf..e........................ Social Security No ............................................. . Name of Employer................ __ ......................... _........... _...............................:.::.'.......................................................... .
Address..............................................................................................................................................................................
~::::eG::~~··::..~i.ti;i~.~~~~.~.!?;~y.::::::::::::::::::::::::::::.~~:::::::::::::::::::::::::::::::::::::::::::::::::::::::: : ::: : : : : :
Date of FuneraL .. May.....12.•....~9.6Q..................................Time .....................
J .. J~ .•.M.,...............................
+.....
Funeral Coach············································I···_.......... 1..... . Passenger Cars··········································I···_··· ....... 1..... . ............ Pall Bearers' Service ................................ I.............. I.... .. ............ Tr.nsferring B",O),do·y..................................... I............... I .... .. Opening of c:-ur.•v" ....................................... Cemetery Lot Misc. ,]" .•. Shipping Charges .......... ........................... 1. .............. 1..... . Clergyman Singers $................ Organist S~·................... I.............. I... .. _.......... C.shA ·d.vaIlcecL ..........................................
+.............+....
+. . . . . . .I......
PI.ce of Funeral Service..._....P.ilant ....aeme.:tar.Y-..............~ ...................................................................._. Clergyman......Re¥··.·· .. G~.. ·F-·.·..·S1ler............................... Call for? ..................................................._........Address..._......_.. _....Ca.s.s.v..ille, .... Miasa.w:l..........-....._:.... :.:...................... _............................_.:_.. _.._.
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==::=::: \ ............................................................... ''';;,;:,1.;;;;;; Totsl An'ount ............................~
Remains to be shipped-see reverse for details.
Interment at....... _.....l'ilant
...C.em.e.t.er.Y.......................................................... _...........................................
Lot No ......................... _..................Section No ............................................ Grave No .............................................. .
.wh.i.t .e ...na.t ....t.op ... d o.e .. :.................................................................................. . ..............................w.g.H!?....§AH.!),....~:?!_~J},.f.:....~::~~.~.~:r:.~.():r................................................... ............ ......................................B.en."Wal...C.a.sk.e .t.... Q.Q_............... _............................................................................ Ramarks ................... a .L
,..ORM 15 2311 SUPRR IOR FUNERAL SUPPLY CORP .. CLI:VEUAHD, OHIO.
o
Lodges D Pall Bearers
Information Given To: Relatives D Musicians
D Death Certificate D Payment Arranged
o
Attended To:
o o o o
Clergyman Singers
Pennit Bill Rendered
Insurance ......................................................................................... .
(Boone) 1..9.6.Q....._
.
Date. ..Ma.y.. .l2. •....
.
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No........•..•..........•._ .._ _
I£..':/......
. Yearl; No ................
Nam"'...•..•......................•....... Mar.ge.r.Y-... Gr.ah.a.m ..................................................... SO%. ..
f.e.maJ..e........
Address...............................••...•....•..•.*B&Zm&..F-a1r:v.1elll.•....Mi.ssou.r.l........................................ County...............................•..•..•...Township.......•........•...•...........................Phon. No............................•...............
Where
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Born.............•..••..•Xan.s.aS............•..........•.. _ ...............................Rac•..................l'Ilh.it.e. ..............
Date of Birth. ..S~p.t... J..1.J...~~.1.6............................ Ag•.........••....!±.} ......................................................... . (Years) (Months) (Days) How Long Resident in Community.......................................................................... ____......___ ....................................... Singl•........................Married.mar.rie.dWidowed.......................Divorced...................... Child ............................ Husband, Wife or Child of.........................Max... Gr.aham.................::............................................................ . Address .............•........•..•..••..•....•..•..•....................F.airv.le.lV.•....MiS.s.Ql.lr..l ........................................... Closest R.lativ•.....h.usband................................................. .Address......................................• .......................... Father's Name......._........_.................................................. _.._.... .Birthplace ... _........................................................ .
Mother's Maiden Name..._.......................................................... _.Birthplace __ ._ ............~............................................ Cause of Death...................._. __._ .....................................................Contributory......................................................... . Dat. of Deatb ...•...... May.....12 •....~9.6.Q
............................'.Hour........................................................................
Place of Deatb...........................................•...................................How Long Ill ? ..................................................... Physician ........... _._ ..................................._..................................... _.Address ..... _...._............... :...................................... . Occupation of Deceased. ...... scho.o.l. ...t.ea.che:r............Social Security No ............................................. . ~
...~,;
Name of Employer......... __ ... _............................ _... _........................................ :........................................................... . Address ............................................................................................................................................................................. . Charge to ................................. _.............................................. _..... _Address .................................................. -................ Order Giv.n By..............................................................................Address .................•............................................... Dat. of Funeral... ......•MaY-..•
l5•.....l9..69...........................Time........:..:.? ...~.,..M.,.........................................
Plac. of Funeral S.rvic•...•........•.Fa1;r;o:v.1ew...l44Jl11ho.di.s.t
Casket ........................................................ $.................. (Style). (No.) Outside Case or Vault................_............. .................... Embalming Body .................................... ._................. _ .. .......-... ] Professional Service .................................................... Hair Dresser................................................. _............. .. Suit or Dress ............................................................... . Shirt, Collar, Tie ......................................................... . Shoes $...................... Hose $...................... ................... . Underclothes .......................................................... ..... . Door Spray ........................................................,. ......... .. Gloves $.................... Chairs $.................... .................. . Flowers $..................Palms $..................................... . Cremation ..................................................... _.............. . Newspaper Notices .................................. ... _...... _...... . Telephone and Telegraph......... _................................ .. Ambulance ................................... _............................... . Funeral Coach ............................................... _............. .. Passenger Cars ............................................................ .. Pall Bearers' Service ................................ ..........._. .... .. Transferring Body ....................................................... . Opening of Grave....................................... _.................. Cemetery Chargcs .................................... .................... Lot ................................................................................. . Misc. Transportation .................................................... Shipping Chat'ges .................................... ................... . Clergyman .............................................................. ..... . Singers $................ Organist $............ _................... .... .. Cash Advanced ............................................................. .
...Chur.ch............................................•.
Clergyman ......... _... __....__................ __..... _..._.............................__ ...... C&II f,?r? ._ ... _.......................................................... Address... _.................................... _...................... _ .......................... _.. _.............................._............................ _......_.. _.
(
D
-····1 ················································...................... - - . Total Amount. ................................. - - - - -
Remains to be shipped-see reverse for details.
Interment at.......•....•..•..•....•..D.i.c.e...O-eme.t.e.r.y ............................................................................................ Lot No ............................................. Section No ............................................Grave No .............................................. . Ramarks .......................• hr.onz.e... Sp.r.ay..ed..hdw:.•........8p.fl.d ...c.a.ek.e.t. ....C.Q. .,. ...........................
Information Given To: Relatives Mus icians
o
Lodges Pall Bearers
o
Death Certificate Payment Arranged
o
o
o o
Attended To:
o
o o o
Cl.rgyman Singers
Permit Bill Rendered
Insurance .......................................................................................... FORM 8 238 S UPERIOR P'UNERAL SUPPLY CORP •• CLa,YI:LAHD, OHIO.
Date. ...Mal'..
(Boone)
_.l4....._l-.9..QQ._.._ FUNERAL
CHECK EACH ITEM AS COMPLETED
RECORD 'OF
!e..~.._...
No•......._...•......_._.___
Nam........_........ _............_.. W.e.al.e~....W.•....Sa.unde.r.s..........::.................................... sex. .............!!!f.',J.!L. Address....... _........................_......Ro.c.k.y....COmf.OrtT....Mis.s.ouri....:..................................................... COunty..........................._......_.. _ ..ToWllShip......._.. _.... _..._...._......................Phone No•........................... _...............
Where Born.............. _..__ ..__....... _.... _................ _.......... _.. _ .... _........ _...~ ........ :.-.. __ Race................................... _.. ___ ... ___. Date of BirtlL.................. _.._.... _............_.......................... .. Age..............1.?.._.................._............................_....... (Years) (Months) (Days)
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Casket ........................................................ $..................
Yearly No •... _...........
How Long Resident in COmmunity...........................;~._ ......... ____...............:::....:.:......................................................... . Singl •........................Married. .......................Widowed ....................... Divorced...................... Child ........................... . Hu.band, Wife or Child of........................................................._...._............:.............................................................. Addr•••............. _.._...._.._...__........ _......_......................................................................................................................... Clo.est R.lative._...._............................................................... :.....Address ......................................" ..........................
Father's Name....... _...._...._.. _............................................ _.._~:~·~ .il.'thpl~ce_·_ :_ ............................_........................... Mother's Maiden Name..._............................................................Birthplaee... _~ ....................................................... . Cause of Death................................. _...................... :..... :...............ContrifiutOry.......................................................... Date of Death... _........Ma¥-... l~., ....l'il.6.Q............ :: ...............HoUr... :::.. :.:..::...:: .................................................... Place of Death............._.........home.............................,.............How Long Ill? ..................................................... Physician ........... _............................................................................. Address.................................................................. Occupation of Deceased............................................. _.............. _SociaI Security No ............................................. . Name of Employer........................................... _... _...... _.................................. ::.......................................................... .. Address ............................................................................................................................................................................ .. Charge to..........................................................................................Address ............................................._................... . Order Giv.n By..............................................................................Address .......................•..................• _..................... Date of Funeral......... _..May._.16,....1.9.6.0..........................Time ...........; ...P..•M.•...........................................
Ca!~~;·~ault.
~~~:>.
. . . . . . . . . ... .........
Outside ....... Emba1ming Body ....................................................... . ............ / Professional Service ................................ ................... . Hair Dresser................................................................ .. Suit or Dress .............................................................. .. Shirt, Collar, Tie ........................................................ .. Shoes $...................... Hose $.......................................... Underclothes ............................................ .............. ..... . Door Spray ................................................ .................. .. Gloves $....................Chairs $............................... _...... . Flowers $.................. Palms $..................................... . Cremation ..................................................... _......... .... .. Newspaper Notices .................................. ... _......... ...... Telephone and Telegraph............................................ Ambulance ................................................ ................... . Funeral Coach ............................................ ... _......... .... .. Passenger Cars ............................................. _............. .. Pall Bearers' Service ..........................................._....... Transferring Body........................................................ Opening of Grave............................... _......................... Cemetery Charges ........................................................ Lot ..................................................................... _........... Misc. Transportation.................................................... Shipping Charges ....................................................... . Clergyman .................................................................. .. Singers $................ Organist $...................................... Cash Advanced ............................................................ ..
Place of Funeral Servic•..._..Ro.o.k~ ....c.om.f.or.t._Me:th.o.d1s.t....QllJ.u·.c.n ...................................._. Clergyman ..........RelT..•.. ..E.'l.rl...D_•...1ang......................Call for ?: ....................:.:....................................._ AddresB..._...................................._.... _................_ .. _...... _.........;.. :._...:::..:.:....~ .................. _............................_.._.._..__
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...................................................................... - - - -Total Amount.................................. - - - __
Remains to be shipped-see reverse for details.
Interment at....... __.. _ .._.. ..Mun.c.ey.._ChBJ).e .l ...0.eine.:!i.e.I'Y:..:.:....................._.....:.<•.............•....•..............• Lot No ................................_........... Section No ............... _............................ Grave·- No ............................................... Ramarks ......................._.................................................................................................................................................. ..
................................................................................ _............................ ......... .......,........................................................... .. ~
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Information Given To: Rela tives Musicians
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Attended To: D Permit D Bill Rendered
Insurance......................................................................................... . FORM 112311 S U PERIOR FUNERAL SUPPLY CORP .. C:LKY,U,.:AND. OHIO.
Date.....May__ ~~...
(Boone)
_19..6.Q._.. _
CHECK EACH ITEM AS COMPLETED
FUNERAL · RECORD OF
-'l..a_.!e.~
No•....... _.._......_. ______
C.sket ........................................................ $. ............... .. (Style) (No.) Outside Case or Vault................................................. . Embalming Body ....................................................... . Professional Service ................................................... . Hair Dresser ................................................................. . Suit or Dress ................................................................ Shirt, Collar, Tie ...................................... ................... . Shoes $...................... Hos. $...................... .................. .. Underclothes ............................................................... . Door Spray .................................................................... Gloves $.................... Ch.irs $............................... _. .... .. Flowers $..................Palms $.................................... .. Cremation ..................................................... _.............. . Newspaper Notices ..................................... .;. ............... Telephone and Telegraph............... _.........._......... ...... Ambulance ................................................ ................... . Funeral Coach ............................................... _............... Passenger Cars ............................................. _.............. . Pall Bearers' Service ..........................................._. ...... Transferring Body.................................... .................... Opening of Grave............................... _........ _............... Cemetery Charges ....................................................... . Lot ............................................................................ .... .. Misc. Transportation ................................ .................... Shipping Charges ....................................................... . Clergyman ................................................................... . Singers $................ Organist $..................................... . Cash Advanced ............................................................. .
Yearly No ...._.....
Name. ......_...................... _.........._Qg.1.e.... I.IJ.l!;.l~......... _.. _................................................. Sex. ....f..~.!!1!!,1.~....... Address......................._........ _........ _.. ,J..9..P.JJI!.......M.~.~.~!?.!:\r.A
..............................................................,........ ..
County..........................._......_.. _...Town.hip....... _.._........ _.......................... .Phone No ............................ _............. .. Where Born............. _..._ .. _........ _.... _............................ _.. _ ... __........ ___ .______ .__ .....Race. __ .............................................
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Data of Birth......................._.... _............_............................Age........._............................ _................................ _....... (Years) (Months) (Days) How Long Resident in Community............................................... ___.... __.__________ ._ .. __________ ...... __ .. _..................... __ .. ____ ... . Single........... _.......... .Married........................ Widowed ....................... Divorced...................... Child .......................... .. Husband, Wife or Child of......................................................... _.... _........ _............................_................................. .. Address......._.... _............ _...._........ _............................................................................................................................... .. Closest Relative......._...................................................................:.Address ......................................." ......................... Father's N ame............._.._.... _............................................_.._... _Birthplace... _...............; ........................................ . Mother's Maiden Name... _............................................................Birthplace... _.................. _.................................... . Cause of Death......................................................... :.....................Contributory.......................................................... Date of Death... _.. _Ma.y. ....lg..... ~9..6.Q. ............................... .Hour........................................................................ Place of Death........J-O-pl.-1n. ....M1,s..so.uri ...................How Long Ill? ................................................... .. Physician ....... _........ _....................................................................... Address................................................................. . Occupation of Deceased. ............................................................_Social Security No ............................................. . Name of Employer........................................... _........... _............................................................................................... Address ........................................... _................................................................................................................................ . Charge to ....................................................................................... _.Address ................................................................... O,'der Given By...............................,.................. ",... "" ................. .Address................. _............................................. .. Date of FuneraL. ...... MaY. ...2Q. .....19..6.9..............................Tim . ...................................................................... .. Place of Funeral Serviee..._........MoQ,l,W.e.R..-Cha.p.eJ. ................................................................................. _. Clergyman ......... _.............. __................ _.........................................Call
fo~? .. ~.......................................................... _
Address..._...... _.. _........................ _.... _................ _ .. _...... _.............. ;... _._........................... _................................ _.. _.._.
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Remains to be shipped-see reverse for
:::::::=:::\ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: =::::: ...... Total Amount.................................. - - - -_
detail~.
Intarment at... .... _........ _....Map:lewood...C~e.ter¥."'E.xe.ter. ............... _........................................... Lot No ............................................. Section No ...............•............................ Grave No •.............................................. Ramarks ....................... _.. _............................................................................................................................................... .
Information Given To: Relatives o Musicians
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Clergym.n Singers
Permit Bill Rendered
Insurance.......................................................................................... FORM 152315 B U PERIOR F U NERAL SUPPLY CORP •• CL.VII:LoAND, OHIO.
CHECK EACH ITEM AS COMPLETED No........ _.........._.. _. ___
Casket ........................................................ $.................. (Style) (No.) Outside Case or Vault.................. ___ .______ .. _. __.......... _____ .
Name....... _........ _............ __ .._...Ma;r.~.g, ...~uy.~p..~rt;h ...!:U.g.!!gn........................Se>:.........r~.~!i..~.~...
Embalming Body ........................_......... __ _... ____ .._.. _ .___..
Address......................._........ _.................._... Rut.t.er.f.ield •.... M1.fl.s.o.u.r.1................................................ COunty........],1.~.r.IT_.......... _.. _...Town.hip.......-.·.......·-... - ........................... Phone NO ............................ _....:........ .. Where Born............. _E1.1~ter.i:.1.a1d.T ... .M.1.s.ao.ur.l........................... Race.................. ..Ylp..i.:t.e.............
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~:~es~~e::~r~e.r~~.c: ::::: ::::::::::::::::::::::::::
::::::::::::/ :::::::::::::: ::::: ..........._, Suit or Dress .......... _._ ..__ ... __ .................... ___________ ._... ..... .
Date of Birth........F.e.brua.rY. ...l!4...~Sg.Q.......... Ag.................... j'!:9_ .. _....... _................................ _....... (Years) (Months) (Days)
Shirt, Collar, Tie .................. __ .................. ___ ........ _....... _
Shoes $...................... Hose $.......................................... Underclothes ............................ ___ ......... _________________ ..... _.
How Long Resident in COmmunity.............................................. _.................... _..._~_._.. __ ............. _............__ ........ ___ .... .
Single....................... .Marri."-..._...................Widow.j'I.;9.:<;>.!'!.~9.:.Divorced...................... Child ............................ Husband, Wife or Child ot._................8.par.11n.. H1ns.on_.....D.e~.e.afled ............................................
D001"
Spray _..... _........................_.......... __ .___ .......... ____ ..... .
Gloves $.................... Chairs $.................... .............. ..... . Flowers $..................Palms $...................................... Address............. _........_.. _.... _.._........_.. _......................................................................................................................... Cremation ..................................................... _............... Newspaper Notic............................. _._ .......__ .............. Closest Relative._...._.Mr.s.. ...B .•...D.. ....McQ.ue.en ....:...:Address....... _.... :M:.l.e.aj;9..n •..,..M1.~.§.9..\!,;r..1. Father's Nam..........'N.11liam ... Lo.w.e....................._.. _.....Birthi>lac.... _~ ..................... ,............... _.................. Telephone and T.l.graph........................._._ ....._........ _ Moth.r's Maid.n Name....Gath.e.r.lne.... Q.at.~.!L.......~.Birthpl~c"---- .... --.... ,.....,._..................................... ............ Ambulance ............................... -................................... . /\ '- 1-: . - - D - .... . ~ a - .-'-- . f"-"~..f'_....' cjon "'tri'b ut ory__ ~ "n. . ___~ . ... -....---- Funeral Coach ..................................... __ . ____ ... _......... .... _- , .. ___ ........___ Cau se 0 f Death .~. u "" 211 lo6.Q - - . -- . --- --- -- . --12 "15 P M - ......... Pass.nger Cars .......................................... ......- .......... . Date of Death... _._ ......__. ~. ... -J'. .. ................................. .Honr__ .......... _.... __ ....._..... ... -.... '-.............. -............P II B ' S .
:~::ic;:n~.~~.·~·.·ji~~~~.p.~~1~.~.~.·: .~ ~~~0~,~.~~,:·~:,.~~:~:~,¥.~~~i~~:: ::~~:s.:s.:9.~f.I:~::::
:::::::::::.
;ansf::~:: B:;;::::::::::::::::::::::::::::::::: :::::::::::::: :::::: Opening of Grave.............. ___ ......... __ .......... ___________________ .
Occupation of Decease"-........_.hQ.u.s.e~.1f.fL.._ ................ Social Security No ............................................. .
Cemetery Charges ................ __ .. ________________ ..........____ ......
Name of Employer ____________. _____ .. _______ .__________ ..... _... _........................................... _.:... __ .. _..... _........................................... .
Lot ............................................................ _................... ..
Address ................._................. _. _______________ .. _.............._..... __._.... _.............. __ ....... _____.. _... __ ._ ... _.._.............. _.............._. __ .. _..._.. .
Misc. Transportation_ ............... __ .............. ___________ ... ..... . Shipping Charges ...... ___ .__ .__ .......____ . _____ ..__ ...._..... _.. __ ._... Clergyman ......................__.._______ .._.... __ .. ____ __ ............ .... ..
Charge to........ _....... __ .............. __.. _.. __ :_ .. _:___ ... _._._ .. _........... _............. _...Address ........ __.. _.__ .... _..............................................
Ord.r Given By.......Ed1th...Mc.Qu.e.an........................_..:Address.................................................................. Date of FuneraL ....MaY.....23.,. ....l9.6.Q ................................Time........... ;......... M.,................................. Plac. of Funeral Service... _......McQ.u.e.en._Chap.a1..................................... _.............................................. _.
Singers $................ Organist $.................. ............_..... ..
?J'.•.
Cash Advanced ...................................... _... _______ .............
CI.rgyman.. _.LaI'lX'enUe ... H.enrY......... _............................. Call for 1....................... _._ ...................................... Address......._.._..........8.e] , grn lin, ....M1.s.ao.ur.1.__ ...........:..::.::.::.:....._________..._.. ___ ... _____ ... _____ ..__ .. ___ .___ ..________.
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............................_.. -.... - - -
Remains to be shipped-see reverse for details.
Interm.nt at.............Mt.....:2.le.as.e nt ....C.alllEl.t.e.r.y. .................................................................................... Lot No •........ _._ .. _..... _.... _..... _.....______ Section No................ ............................Gr.ave No. _______ .____................................. . Ramarks ..............Qr.chi.d ...ahB.de.d....~.~J..Y.'.~.;r.....!!.~.1!_.;!,~~...................................................................... .
................................. _\!h.:.~.~.~ ...~.~~.P.~ ....~~.~.~:r..~.o..r.::::~.r..(}.ll:.~.~....~~~".~~ ... ~.l:'1.~ .......................... ................................... S.lu~_1!1g.n.e.l.Q. ...g.a.~.~!1.~ .._~f.g.:_..Qg..,......... _................................................... FORM &288 SUPERIOR FUNERA l.. SUPPl..Y CORP. , Cl..ICVIIL.A""O , OHIO.
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To: Relatives Musicians
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o Permit _0 Bill Rendered
Insurance._ .... _...... _... ___ ............................................. __.. __.... _.. ____ .__ .....
Date. ...Ma¥.... 2~~.....l9.6.Q....._
. . . ...• ...
CHECK EACH ITEM AS COMPLETED
FUNERAL 'RECORD OF
Y.arly No .................... ..
No..........................._ .._
!.e.? ...
N ame. ........................ F.l.Qy..~LF.........!::g,~DJL ...........................................:..................~ .... Sex. ...... IJ.l.l>:~~ .......... Address. ........................... Q.aIH!Y..Ul.e.~...M.".!H~9.~J........::............................................................................ county..........Bar.r,y..................Town.hip .................................................. Phone No ........................................... ..
aa..r.;r.y....9..QJm.:t;.Y.:~.....¥.'"'~§..~~~ .....................Race................lYb.".1;.e................. Date of Birth. ....~.~..P.:!!.~I)!Q!il,.;:....g9.A.....~~9.!±..........Ag..............§~............................................................ .. .. (Years) (Months) (Days) Where Born.................
How Long Resident in COmmunity....__ ................... :.................~~ ... :...... _.................._... __ ......................................... . Single. ...................... .Marri.dlIa;r..:r.1e.g.. Widow~d ........................Div;rced ...................... Child........................... .
Husband, Wife or Child of........................The.lma ... JS.ulaJ ... E.d ens..................................................... .. Addres ...........................................................................C.aS.8.v.l].le. 4 ... JUIl..!l.Q.I!.;r.'-'....................................... Closest Relativ...........SUl.a...Ed.enB...........:..................:.. ~Address.:..........Q.a.!!.~.y.;!,J,1.~ ......!@.:l? .~2.~r 1 Father's N ame..... C-nJ.l.unbuB ....W.alk.e.r.... Edan..........Birthplace...........................:...... :.......................... .
..
............
Mother's Maid.n Name...... T.eJA).le:Il.lHl.~....Y..@.~.~9:1:.~~~ ~.-:I ~ Cause of Death~:.l>{.~.C;~tributory.....~.~ .... l.9 'M~ ".. •. '~""
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"~,,.,Io '960 . .. ... ... .. Date of Death... _.~_ .. .c.~f .......&.. .............:.::::.n:::.::.m....:..:~~Ur.. h
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Place of Death........... hQDle...........................,.".":.'." .......:.'.""..........l!9W J,Qng III 1.....................................................
. .. ..
Physician.............D:r..•....R._... R_ .... DonaleY....................... Address .......J!!9.~~.~.~.l.. .. ¥~f:I.s..C>.u.::r.~.... .. Occupation of Deceased. ...........far.m.e.r................................. Social Security No .. .'f:.ll.~ .:: ..t..
• •••••• . •.• • ____ •••••.....•• _•••.•.•••.. ____ .... __ •• Address ................. ____. ___...................... __ ..................._._._ .. __ ...................................................... ____ ....... __.. _._ ... _____. __ ....... __ .. Charge to .........W.'-.9,.QW............................................................... ...Addre~s ......·.. ~....................................................... .. Order Given By.............w.ldQw................................................ .Address................................................................. . Date of Funeral.. .... May. ...26..... ~96.0.................................Tim •.........:........
?.. J'....M.!....................................
.s..a:!,e. .~L.Tax ....................................... ··.... ··.... ··· ..···.... ··..·...... ·....···········..·.... ·· .. ··..···1
Place of Funeral Service..........Q.o.r.lntb.....Chur.9h ........,............ ,.,.·.:..:..................cc.................................... . Clergyman ..........Ab... Edlf\~QhaJ;'L,....Y.@[email protected],:t;.....:.Call for 1: ...''' .........................................................
Address.........................C.a..s.sl(ille.. ....Mis.aQl.lX'.1.:....::::.~.:::::.~ ..................................................................
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Remains to be shipped-1!ee revers. for details.
Casket ...~ ....e.e.IT.+.C.eJL ................... (Style) (No.) Outside Case or Vault............................. . Embalming Body .................................... Professional Service ... :........................... . Hair Dresser............................................. . Suit or Dress ............................................ Shirt, ~ Tie ....1.!n.Il!l.;r.w.e.a:r.&.. Shoes $......................Hose $.................... .. Underclothes ........................................... . Door Spray ............................................... . Gloves $.................... Chairs $................... . Flowers $.................. Palms $................. . Cremation ................................................. . Newspaper Notices ................................. . Telephone and Telegraph....................... . Ambulance ............................................... . Funeral Coach ............................................ ' Passenger Cars ............................... ,......... . P all Bearers' Service ............................... . Transferring Body.................................. . Opening of Grave ......................... ,........... . Cemetery Charges ................................... . Lot ............................................................ .. Misc. Transportation ................................ Shipping Charges ................................... . Clergyman ............................................... . Singers $................ Organist $................. . Cash Advanced ......................................... .
.
Interment at................C-or..1nth ... C.eme.nel'f.................................................................................................. Lot No •.__ ......................................... Section No ...........·...._............................ Grave No .............................................. . Ramarks ............#2.6..0....c.O.p.p.e.r. ... ah.a9,~.d....Q;r.QD.~.~.: ..p..~ .r.:f..~s:.:t;.~9.l}....§:ll:.~.4!:~...................
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Insuranc,
,.ORM 15 238 SUPERI O R FUNERAL 8 U PPLY CORP., CLEV_LAND, OH I O. . .
.
.. ...........
..\
(Boone)
Date. ....................................._._..__..__ _
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No... _._._ .. __.._... _...__ ....__._
_61..... _...... _
Casket ........................................................ $................ .. (Style) (No.)
Yearly No ... _..._..._..._.._...
Name. .._.. _.. _......_.............................. _Rar.ac.e. .. Rigg.s. .............. _.............. _.. _.. _...._............ Sex...........mals .... .. Address......_.._.. _...._...._.._......_............................_...._........ _.... _...._.............._....................................................................... .. County...................... __ ..._. __.__..__..Township......._.._... __ ... _....... __... ____..........Phone No. ___ ........................ _....... __ ......
Outside Case or Vault................................................. .
:__:·__:··_····1 : : : /::~:~:!:~I B;!i~~·:::::::::::::::::::::::::::::::: :::::::::::::: :::::: Hair Dresser......... __ ..................... _............. .............. ...... Suit or Dr ess ........... __ .__ ............................ ................... . Shirt, Collar, Tie_ ........................................ __ .. __ .......... . Shoes $...................... Hose $........................................ .. Undl~rclothes ............................................................ _... Door Spray ................................................................. _..
Where Born. ...... _.... _...._.._........ _......................_.......... _.. _ .............. _............ _____ Race ___ ... __ .__ ... ___............................... Date of Birth.........................................................................Age................................................................................. . (Years) (Months) (Days) How Long Resident in Community................................................................................. _.......................................... . Single ....................... .Married. ........__ .. ___ ........ Widowed ..................._... Divorced, ..................... Child................_..... _... _.
Husband, Wife or Child of........................................................................................................................................... . Addres .............................................................................................................................................................................. . Clo.est Relativ...............................................................................Address ......................................., ........................ .. Father's Name..............................................................................:.Birthplace............................................................. . Mother's Maiden Name... _...._...................................................._.Birthplace... _........................................................ .
Gloves $....................Chairs $...................................... .. Flowers $.................. Palms $.................................... .. Cren1ation ...................... ____ ................... __ .__ ._____ ............ . Notices ............................. - .............. _.... _.
.. .. · .. · .... 1 Newspaper
: : : : : : /!~:~:::ea~~ ~.el.e~.a.:.~:::::::::::::::::::::::: :::~::::::::: ..
::::::
Occupation of Deceased. ............ _... _............................................. Social Security No ... __._ ....... _...............................
Funeral Coach. __ .............................. _............. _............. .. Passenger Cars... _... _.......................... __.. __ ................ .... .. Pall Bear ers' Service ............. __ ................................... .. Transferring Body............................ _............. __ .. _....... .. Opening of Grave ..... _..... _................... _........ _............. .. Cemeter y Charges .............. ____ ........ _................. __.__..... ..
Name of Employer.......................... __ ............... _........................................................................_...................... _...... ____ ..
Lot .............................................................. .............. .... ..
Address ................. _....................................................................................................................................................... _.. .
Misc. Transporta tion .................__ .... _.......... _._ ............... Shipping Charges ...... _.. _............. _. ___ ..... _.......... __ .......... Clergyman ............................. _............. _._ ..... _............... . Singers $.. _..... _.......Organist $........... _..... _.................. .. Cash Advanced ............................. __ ___ ._______ ................. ..
Cause of Death.................................. _.................................. _........Contributory... _................................................. _...
Date of Death................................................................................ .Hour........................................................................ Place of Death................................................................................How Long III ? ................................................... .. Physician ..........._......................................................................... __ .. Address ................................................................. .
Charge to..........................................................................................Address ................................................................. .. Order Given By..............................................................................Addres .................................................................. . Date of Funeral... ... M!l.Y.....?7.~.....;!,9.Q.Q.................................Time ...................................................................... .. P lace of Funeral Service............._.................. _... _......_.. _......................................................__ ........................ _....... _. Clergyman._._ ..... _.......... __ .. _............................................................. Call for? ................ _.. _. ____ ...... _.... _.................. _......_
Address................................................................._ .............................._ ..........................................................................
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===::: I :::::::::::::::: ::::::::::::::::::=:::::::::::::::::::::::::::: ::::::= == Total Amount......................... _........ - - -,_
Remains to be shipped-see reverse for details.
Interment at................................ Q.Qng.Q};'g... Q.!;l.!!!~.1;.!').r.y. ............................................................................... ..
o
Lot No .... __ .......................................Section No..........__ .................. _. __ ._._ ...... Grave No .......................................__ ..... .
D P all Bearers
Ramarks ....................... _.. _.............................................................................. _....... _.. __ ........... _........................................ .
o o
Lodges
Information Given To: Relatives Mus icians
Death Certificat.e Payment Arran ged
o o
Attended To:
o o o o
Clergyman Singers
Permit Bill Rendered
Insurance __ ............. ___.......................................... __ ............... __ .........._ FORM 1523:5 8 UPERIOR FUNERAL SUPPLY CORP .. CLEVEI..ANO, OH IO .
Date..~.._2~·r···19.6.(L_.._
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF
7...9._...
No•......._•._...... _.. _ . _ _
Casket ........................................................ , ................. . (Style) (No.) Outside Case or Vault................................................. . Embalming Body ....................................................... . Professional Service ....................................................
Yearly No •..._...... _..•....
Name......._......................_......H-a.r.ry....Duane ....8t.ewar.d........................................ Sex. ...........!l!a.l.e...... Address ....................9-lJ...T.b..1r.d ... S:tr.ee.t.d.mne.t.:t..,. ....M1.s.s.Q.u,;r..1................................................ County..... l?!?:.r.~:y............... _.._...Township ....... _........................................Phone No ........................................... . Where Born. ...........M1nne.so_ta ................ _.............. _ .... _.:......_........ :........Raee..........~g.~:t..E:l
......................
(
Date of Birth..... N.Q.y.~!1J.~!lr....?.Q~_..1~S.o. How Long Resident in Community............. l
..........Age......... _.l'(Years) ?........................................................ _....... (Months) (Days)
...y.r. ....................,......... _...................................................................
Single........................Married....marr.ie.'Widowed ....................... Divorced ...................... ChiId........................... . Husband, Wife or Child of...........................Nancy... .B.t .e.WB.r.d. .. _................................................................. Address ......._.... _........ _.. _...._.._........_.. _...................m~~;;.! M'O'.I?:E:l.:t..~.l ....M.1..fl.~I:l1J..~.~ .................
...
Closest Relativ•......._...........•...... _................ _............................. ~ddress ........................................ _........................ Father's Name...unkno.wn..........................................._.._.....Birthplace......................,.......... _...........................
.
~:=:r~ ~:::~ ~~:.:~:::::::~::=~:::~;:::. : . : : : ..: : : :.:.: : : : .: : . .: : :. . :.: : . : :
Date of Death ... _......MaY.....25.•....l9..6.9. ...............................Hour............... ~.:.!±5.
....A.'.....!VI.~.. _.....................
Place of Death......... h~e'jJ: ... ~.................... lIOW Long Ill? ....... ?2:ba........................... Physician· .........Dr.·v... E. Ill. ~..................... Address .......C.a§J?.Y.;\..ll.e...... M~.QlJ.:r.~. Occupation ot Deceased ____ .. __ .___ .........-..... ___........______________.. ___ .... Social Security No ........ __ .......................__ ...........
7...
Name of Employer. ___ .. __.......... ____ ..____ ....__ ... ___ ... _...... ___ ....... ___ ......................... ___.. __ .__ ........... _......................................... .
Address ................. _.......................................................................................................................................................... . Charge to.................i.nsurana.e.........................................._Address ................................................................... Order Given By...............v~1do.w: ..............................................Address ... ,............................................................. .
~:~e ::::r~··~:::::t::~:::~::::::::.~:::::~:~::: : : : : : : : : : :::::~::~:
::::::::::::\
~~: o~r~~::~::::::::::::::::::: : : :::::::::::::::::::: :::::::::::::: ::::::
Shirt, Collar, Tie ......................................................... . Shoes $......................Hose $...................... .............. ...... Underclothes ............................................ .............. ..... . Do'!)r Spray .............................................................. ..... . Gloves $.................... Chairs $....................................... . Flowers $..................Palms $................................ ...... Cremation ............................................................. _...... . ............ ) Newspaper Notices ..................................... _.............. . ..._ ....... Telephone and Telegraph ............................................ Ambulance ................................................................... . Funeral Coach ............................................................... . Passenger Cars ............................................................. . Pall Bearers' Service ................................................... . Transferring Body........................................................ Opening of Grave......................................... _......... ...... Cemetery Charges ........................................................ Lot .................................................................................. Misc. Transportation ................................................... . Shipping Charges ...................................................... .. Clergyman ................................................................... . Singers $................ Organist $.................................... .. Cash Advanced ............................................................ .
................................................................... ··1·········_··· ......
00:
Clergyman ......... _.............. _.................._........................................•Call for? ............................................................._
Address. ................................................................_ ..........................•..._........................................................................ _.
D
Total Amount.................................. - - - -_
Remains to be shipped-see reverse for details.
Interment at.........
~.......~...........................................................................
Lot No .... _.......................................Section No ....... :: ................. ~ .................Grave No .............................................. . Ramarks ......................._.. _.... _......................................................._.................................................................................
FOR M 52SS SUPERIOR FUNERAL SUPPLY COR .... CLIIVI!:LAND, OHIO.
o
Lodges D Pall Bearers
Information Given To: D Relatives D Musicians
D Death Cert ificate o PaYlI1e·-L A -~. .. .... ...... r1
Attended To:
o o o
Clergyman Singers
Permit I n Bill Rendered
7lip I CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No........................_ ...._
Yearly No ................
Af1:...lL.....
I
Casket .,..vau1.t",.aer.v.1c.e.a...... (Style) (No.) Outside Case or Vault... _. __ ..............____ ... .
Name. .......................................Y.ia.l.t.e.:r....Eng.J..and.c ..................................................... sex. .....ma.l.e.......... ..
Embalming Body .......... __ .. __ .__ ..... __ ........ __ Professional Service ................. _____. __ .... _.. Hair Dresser......................__ ..........__ ._____ .. __ . Suit or Dress ........................_... _.............. . Shirt, Collar, Tie. __ .__ ............................... . Shoes $...................... Hose $.................... ..
Address .................................................S..e.llgman......Ml!:!.§.Q.Wr..l...........:......................................................... County.....Bar.r.y.......................Township ..................................................Phone No ............................................ . Where Born. ........... Exe.t.er.,.. ...M.1.!!.S.9.l.lr.l ......... _ ................................. Race....m1ta ........................... Date of Birth..J.\l.ly.... 2:t:.......189~ ............................ Age.......................6.6...................................................... (Years) (Months) (Days)
z.!...
How Long Resident in Community............. X.~gr.JL.................................................................................... . .:.1m . D'Ivorce d...................... Ch'Id a rr1edw·d SI'ngle........................Marne~ ..."'................. I owe d....................... I ................... ....... ..
Underclothes ........................................... . Door Spray ................................__ . _______ .... __
Husband, Wife or Child of........................ B.?:!;.1;J,~ [email protected]@£L....................................................................
~:oves
Addr.ss ............._........ _.................. _......_................... !?~1Jg~@., ...M.j,..El.El~.ll.I'J ........;............................... Closest R.lative....R.a:t1;J•.~....)i;ng!~ng, ........................... .Address.......$..~.;q,g!P.:@...M~.El.§.Q.w...+...... Father's Name...l'lalker._Engglnd .........:.........._........ .Birthplace................................._...........................
$................ c;~rs $$................ ..
$..
Cr::7~on ..::::::::::::::::...:.~.s.....::::::::::::::::::
Newspaper Notices ............................. _.. . Telephone and Telegraph ...................... ..
Mother's Maiden Name ___.An.rl.a...H1gg.a........ ____ ........... ___ ...Birthplace... _.............................___.___ ..__ ..............___
--------.. -- Ambulance .....--........... ---............. --.------.----
Address ..... ___ ... __ ... ___....... __ .____ ._____ .____.__ ...................... _...... _.............................................................................................. .
Misc. Transportation ................................ Shipping Charges ................................... . Clergyman ............................................... .
Cause of Death.....Me.tas.t at1!l ....C.a .... _tQ....lung.~l!8;tJt08.r. ... !l:~.?.~~~.:.p.!..~mal ...!.!.....pro bab-l-y.. Funeral Coach ............................................ ,,2' 45 A M rena _......... Passenger Cars ........................................ .. Date of Death ..·-May·-2<>-......19..,.O......................................Hour...........:,.... .... .................................. -....... . , .1 ......... _-- P a II Bearer~.. ' Servlce ......... ____ .... _.............. _ Place of Death .. .M:t .•. _Jlernon....s.an ........................... .How Long Ill? ..................................................... .. .......... Transferring Body................................... . Physician .......C.....E .....H.e.llwag...M .....D........................Address .. M:t ......V.er.nQn.~ ... MQ................. Opening of Grave .................................... .. Occupation of Deceased. ....ho.sp.ital.. at.t.endantBocial Security No ........ 4.!h4"'}(bBS),9-.. Cemetery Charges .................................. .. Name of Employer......................................................................................................................................................... Lot .............................................................. Charge to............Hat.t.1e.... En&lan.d............................. ...Address ................... $..e.AJ,gm.a.n.....Ml-..$.!?..9url Order Given By........!!....................!!......................................... _...Address................................ 11... _................... 11..... .
Cash Advanced ......................................... .
Place of Funeral Service..._.. G-u-l¥
..13.e.1.e.s....Tax.·· ...... ·...................... ··· .. ··1
llan Z and tm .. umum ... uuCall tor L
Clergyman.mRe.Vu.mCh
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Singers $................ Organist $................. .
Date of FuneraL.... .May.... 2$l.r ....19.6.Q................................Time .....................2.:.;3'O' ...P.• M...................... ..
D
..................................... ...... :: ..........;: ....... _
..................-.- ......
~
Remains to be shipped-see reverse for details.
Intermenta~ .. _............I~~~ ...~.~J"~ .. ~'e!ae.~~)~~
Information Given To:
.................................................................:
Lot No ............................................. Section No ............................................ Grave "o ....................... Ramarks .................... a.Ll¥er. ... shaded ...gunmet.e.1. ... a:te.e.L.IIl ..
=.................'c..'"
i ...ch......................................
........................................ slly.er..... aa:t.i.n .... int.er.19.:r..................................................................................
..........................................8p..~Il.Y..e..9. .. M .w..,....... J?P..r.+.p..g,f.J~J.g, .. Q§t.I?~E'J..~ ..M:r.g..,.. .Q9...,............. FORM 15 235 SUPERIOR FUNERAL SUPPLY CORP .. CLEVELAND, OHIO.
o o D Death Certificate
o
Payment An-anged
Relatives Musicians
Attended To:
D D D
~I
DB
.
nate. .._..Ma¥_.. 27-.,._.. L9.60_.._
CHECK EACH ITEM AS COMPLEI'ED
FUNERAL RECORD OF No........ _......_...... _
:.1J-..-
Casket
Yearly No .... _...... _. . . . . . . .
(Style) (No.) Outside Case or Vault............................. . Embalming Body ....................................
Name. ......_......................I:ll.all... F..•....Re..e.d ...................._................................................. Sex. ..m.!l,;!,~ ............. . Address..............................K:ls;e..~.!l.r.,._ ..M!.~.~.9.~~J............................................................................................ County......Bar.r.y.............._.._...Town.hip......._............ _...................._..... Phone No ............................ _............... Wh.re Born.............M.1.s.aQJJrl_................. _.......... _.. _ ...._........................... Race...............w.h.;!..t~...................
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. .4 Date of Birth. .....Q.C.tQ..be.r.... ~5.•.. _~8.8.5...............Ag•....................l.................... _............................_....... (Years)
(Months)
(Days)
How Long Resident in Community.................................................................... __ ... ____.___ ..............................._____ ....... .
Singl•........................Married. .......................WidowedW".g,9.~.!l.g,Divorced ...................... Child........................... . Husband, Wife or Child of......................... O.11:
::::::::::::
or Dress ........ Q.le.anJ.Og ........ .
Shirt, ~ Tic ..................................... .
Shoes $......................Hose $..................... . Underclothes ..~....~.Q.~ ......................... . Door Spray ................................................ Gloves $.................... Chairs $................... . Flowers $..................Palms $................. . Cremation ................................................. . Newspaper Notices .................................. ............ , Telephone and Telegraph ....................... . ............
::~:~n~:a~h::~~~:::::::::::::~::::::::::::::::::::::::: : Passenger Cars ......................................... . Pall Bearers' Service ............................... . Transferring Body..._.............................. . Opening of Grave............................... _.... . Cemetery Charges .................................... Lot ............................................................. .
Occupation of Deceased ........i".arme.r................. _......... ____ ... Social Security No ............................................. . Name of Employel' ........................................... _... _...................................................................................................... . Address ............................................................................................................................................................................. . Charge to ..........lns.ur.anc.e ... & ... e.a.ta.te......................Address .................................................. ,............... .
D
~:~es~~e::~r~.e~~ic~.::::::::::::::::::::::::::::::: I
············1 Suit
Date of Death........May....2.7.T.... ~9.6.Q ..................................Hour.~...'....!-l:.~J6 ...P. .•M.•................................... Plac. of Death... Q.at.e.Q.);lath.1c. ... HQ.II11.1:!;.aJ.............How Long Ii! ? ............ ),.Q ... 9..
Order Given By.....br.o.th.er. ...and ... sl.s.t.el'.............. .Address ................................................................. . Date of Funeral ......... JIJ!.aY. .._G.9.•.... J..9.6.Q............................Time ............3.:..3..Q ... :E'..•.M.,................................ Place of Funeral Service..._Cllly.e.r..!.13.._~hap.e~ ........................................................................................ . Clergyman ........ Rev:.v...-G-y-..F..•....S-l,ls,t'............................Call for? ................................................................
.&....s .e.r.y.lc.e.a,...c._box ...
Misc. Transportation ............................... . Shipping Charges ................................... . Clergyman ............................................... .
............ Singers $................ Organist $.................. ' Cash Advanced ......................................... .
..SaJ..es....'1'ax ...................................... .
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::1 Total Amount.................................. 1
Remains to be shipped-see reverse for details. Information Given To:
Interment Lot No .............................................Section No ...............•..................... :...... Grave No .............................................. . Ramarks .................. b-l"e-nZ.e ....shaded ... c.opp.er.....t.One ....s.tee~ .. :~ ...ch.~...................................
....................... .............r.O.S.s.... tan ...or.e.p.e....lnt..e.r..t.9.P .............................. ................. ..................... .......... .......................... 9.p..r.aY.e..t1... P...Q.l'1.., .....~lP.r.~!:lKf.J~.H...g.§,.S.~.e..1;....lll.f.g.. ~.o...,........... ............. FORM 1:12315 SUPER I OR FUNERAL SUPPLY CORP •• C L EVELAND, OHIO. "
o
Pall Bearers
o
Death Certificate
o
Payment Arranged
o Relatives 0 Musicians
Attended To:
o o o
o
Clergyman Singers
Permit Bill Rendered
(BOONE)
May 211, 1960
Date. ............ __ .._.. _...._.. _....._ .._._
FUNERAL RECORD No•......._.........._.._
OF
CHECK EACH ITEM AS COMPLETED
::?a-
Casket ........................................................ ; .. _.............. (Style) (No.)
. Yearly No •... _......_.._.........._• .
Name. ......_...................... _....D.l~~y.....~Q~.~~.~....:........................................................... Sex................ t~.~ll,le Addres8 ........................................Wb.~§,j;.Q.!l~.....M.~~.~!?.\!:r..!........................................................ COunty...... E.ar.~y.......... _.._.. _...ToWD.hip....... _.._.... _... _...........................Phone No ............................................. 00 •••••••••••••• • ••••• •
Where BOl1l.............. _••.. _•• _•....... _...._•........•.................. _.•_ ...._......................... __ Race.................................... ____ ........
(
Date of
............ j
:::::::: :::\ : : o~r~~::~.::::::::::::::::::::::::: ::::: :::::::::::::: ::::::::::::: :::::: Shirt, Collar, Tie...................................... ................... .
Birth. ........_.... _._.. _...._....._....._._.........................Age............._............................_............................_.......
(Years)
(Months)
(Days)
Shoes $......................Hose $.......................................... Underclothes .......................................................... .... .. Door Spray ................................................ .................. ..
How Long Resident in Community..................____ ..................... _.................. :............................................ _................
Single.....Slng.laMarried........................ Widowed.......................Divorced....................... Child ............................ Husband, Wite or Clilld of..............................................................._............................................................ ~.............. Address ............. _............ _..__.. _............ _.......................,................................................_............................................... Closest Relative......._.................. _.... _...........................................Address.......~ .:....................................._................. Father's Name............._.._...._........_.................................._.._.....Birthplace... _............................ _...........................
Gloves $.................... Chairs $.................... .................... Flowers $..................Palms $...................................... Cremation .................................................. .............. ..... . Newspaper Notices ..... _.............................................. . Telephone and Telegraph...........................___.....__ ...... Ambulance ................................................ .................... Funeral Coach ............................................... _............. .. Passenger Cars ............................................................. . Pall Bearers' Service.............................................. ..... . Transferring Body.................................... .................... Opening of Grave............................... _...............__........ Cemetel'Y Charges ........................................................
Mother's Maiden Name..._............................ ___.....__ .__ ...................Birthplace... _.........................................................
~:~:eo;fD~:::.:~::~M~Y.::::g~~:::I9.~:g::::::::: ::::::::::::::::::::::::~:::i~~.t~~~::jf:;:iQ:::f.:~:~~::::::~:: ::::::::::::::::::: Place of Death.......Neo.!>ho,.....M1s.s.o.uri.....................How Long Ill? ..................................................... Physician ....... _.............................................................. _................. Address ................................................................. .
Occupation of Deceased.............. ach'o.o.l....J;.e.a~!:\.e.r.... Social Security No ..............................................
Lot .............................................................. ......._...........
Name of Employer........................................... _... _...... _.............................................................................................. .
Misc. Transport ation.................................................. .. Shipping Charges ....................................................... . Clergyman .................................................................. .. Singers $................ Ol'ganist $...................................... Cash Advanced ....................................... _.. .................. ..
Address ............................................................................................................................................................................. . Charge to......................................................................................._Address .................................................................. .
Order Given By........................................................................._...Address................. _........................ _..................... Date of F'un.ral... ...... _.May:.. _)~ •....19.6.Q...........................Time .......................? ...~..,.M.,............................... Place of Funeral Service.............I.'lh~g.J;.9.);LgY.!!.L ........................................................................................ _. C1ergyman .........Re.v..•....I .....l..•....Beld.en.......................Call for? ............................................................ __ Address..._ .._............Wh.e.at'on •.... Mls..f.! .Q.1J.r..L..................._............................................................_......_.._. (
D
Outside Case or Vault................................................. . Embalming Body ...................................................... .. Professional Service .................................................. ..
...................................................................... !.................... -_.......! .......................................................................................... _..._... ! .....................................................................- Total Amount.. ................................ - - - - -
Remains to be shipped-see reverse for details.
Interment at................._...l.tlll.Q.n... Q.e.m~.t.e£y. .................................................................................................. Lot No •............................................ Section No .... ~...................................~ ... Grave No ...............................................
Ramarks ...................... B1ue...18....ga.•....at.e.e.l ...... p.r.e.fec.t.l'on...shr.1ne................................. ·······································b·lu&···-sa·t.11'l····lntel'·1o.r.··....................·....·....·· ...................................................... ..........................................Sp.r..1llg.f1eld...Gask.et...Mt'.g.•....C.Q.•.......................................................... FO RM 62 3 8 S UPI!:RIOR FUNERAL SUPPLY COR P .. CI.EVELAND, OHIO.
o Lodges
Information Given To : Relatives Musicians
o
Pall Bearers
o
Death Certificate Payment Arranged
o
o o
Attended To:
o Clergyman o Singers o Permit o Bill Rendered
Insurance .................................................................................__.......
Date. ...•. .May_ ..Jl.~_..19.Q9_.. _
.
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF No•........... _.. _.. _.._..___
y;""'ly No •... _.._.._........
.7..i...
Name. ...... _.........:............G.Q.llUll.Q.t;l.9.r.~ .. JL.... f.~Mm................................................Sex. ......~!l:.J,.El........... Address ......._.............. _........ ..cas.ay..1l.1B~....M.1.S.B.Q.l!.);'1.......................................................................... _... County...... Bar.ry......_......_.._...Township....... _........•... _........................... Phone No ............................................ . Where Born.............J;l~r;r.Y.....Qg.lID.1;x.•....M.~,~.§.9Jd.r.J
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.........................Race...............v.r~.;.~~ .................
.•....188.l........................Age.................I.9....................._........_...........................
Date of Birth. .....J.uJs_..~l±
(Years)
(Months)
(Days)
How Long Resident in Community................................................................................. _.......................................... . Single ....................... .Married. .......................Widowed ....W.,t~.Q.\'H!tl.ivorced ...................... Child............................ Husband, Wife or Child of..............................................................._..............~ ......................._.................................. . Addres •............. _........_.. _..._ .. _............ _.................................................................._.................................................... . Clo.est Relative......._Qra...P.ur..do.m. ....................................Address .......... f.l,l,;r.Q,y.•.....M~.~.~.l,l.;r..*....... Father's Name....... W.illiam. ..l'.ur.do.m................ _.. _.. ,:.:Birthplace..:.............................. _........................... Mother's Maiden Name..E.l1z.ab.e.t.P.. ... J..QD.e.!)..............~~~~~cde- ........................................................ . Cau.e of Death...Arter.1oso~ero.t.lc ... Hea.r.t. ....Contributory......................................................... . Date of Death... _...Ma.y....Jl.~....19.6.0..................................Ho,;........................................................................ Place of Death.Ml.•....Y..e.);'!l9JL.S§.nJ..!............................How Long Ill? .................................................... . Physician .... ___...................... __ ... __ .. __ .................................................. Address ....~.. ~.... ;...~ ................................................ . Occupation of Deceased. .............................................................. Social Security No ............................................. . Name of Employer ........................................... _............................................. :............................................................. . Address ........................................... _.................................................................................................................................
Charge to ........................B.B.tate...............................................Address .................................................................. . Order Given By............ tam.l.ly.........................................._...Address ................................................................. . Date of F uneral. .... J.\.l.l'I~... .J~
.....l9-6.Q.................................Time.............21}Q... P..•.M.•..............................
Place of Funeral Service..._.... Mll~ ...S.tl'.e.e.t. ...Q..4.\l,;r.QtL..Q.t'....9.fJ,;r.J.!).:t;........................................... Clergyman ...... Ev.Q..•....,Q..:!,,1,n....S11!!!!p..f..L.........................Call for? ..............................................................•.
Casket ..&....S.e.;r.v..".Q.e..~ ...................... (Style) (No.) Outside Case or Vault.............................. . Embalming Body .................................... . Professional Service ................................ j ............ ' Hair Dresser.............................................. . Suit 01' Dress ............................................ . Shirt, Collar, Tie...................................... . Shoes $......................Hos. $...................... , Underclothes ............................................ . I Door Spray ................................................ . Gloves $.................... Chairs $.................... I Flower. $..................Palms $................. . Cremation ................................................. . ............ [ Newspaper Notices ................................. . Telephone and Telegraph............... _...... . Ambulance ............................................... . Funeral Coach .......................................... .. Passenger Cars ......................................... . _._....... Pall Bearers' Service .............................. .. ............ Transferring Body.................................. .. Opening of Grave............................... _.... . Cemetery Charges .................................... Lot ............................................................. . Misc. Transportation ................................ Shipping Charges ................................... . Clergyman .............................................. .. Singers $................ Organist $................. . Cash Advanced........................................ ..
.sale.a ...Tax ....................................... .
:::=::~:::I: : : : : : : : : ::: : : : : : : : ::: :: : : : ::: : : :: : : : Total Amount................................. .
( Intermentat........ _......... ~.~~~... ~.~m~.L,~,.~............ ,
o
Information Given To: Relatives Musicians
o o
o
Lot No •............................................ Section No ............................................ Grave No ................................... ~ ...........
Lodge. D Pan Bearers
:~:~.r~.s:::::::::::::::::::::::~:::::::Ji£~~!.:::~~!t~:.!t:.t.~~::::~~:ip.~~l;;:~~:~~i.:: ::~~~i:: : : ·: : : : :
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................................................p.la.t.e.d ....elllbQ.s.s.,t~g~.A1!;r.Q.r.~...Q.~.~.~§l..t..Qg ..• ............................
Insurance ................................................................. ..
FORM !S lUUI SUPERIOR FUNERAL S U PPLY C O RP •• CLEVEL AND, OHI O .
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Attended To: Death Certificat e Payment Arranged
OPe OBi
11.·
