... FUNERAL SUPPLY COR .... CLBVELAHD, O HIO. Page 3 of 6. 105-110 Funeral Records September 1959.pdf. 105-110 Funeral R
345 Date.....B.ep.t.emb.e.r.....9+._.l9.59
.
.. . .
CHECK EACH ITEM AS COMPLETED
FUNERAL RECORD OF
No•....... _.._.. _.. ______
Yearly
,. ' N :...._. _. _..l~5..._......_...
Name. ...... _....................Alfr..e.d ...RaY..ffi2J19. ...QhaP.!!!/!,!1 ........................................ Sex. ....!llEi,.1..\'L ........ .. Address................................._........_Exa:t.e;r.......M.l.!l.f.!.9.1l;r.~ ............................................................................. county........Earr.y_.. _......_.._...Townahip..... ~~.~~T~X .......................Phone No ............................................ . Whore Born........... E.r.i u. ....QU.a.b.2ID.a........._.. _ ...._........ _.................Race....................!Y.t\ .l,.~.~........... .. Date of Birth........ AllgUs.t.. 2.lJ:.,....~95iL
(
.............Age........................... .3........................................... _....... (Years) (Months) (Days)
How Long Resident in Community..........................................._........... _......................._.......................................... . Single ........................Married. ....................... Widowed ....................... Divorced...................... Child ......... .c.P.:l),Si.. . Husband, Wife or Child of..................Ii.lf.r.e.d... ChaJlljuuL........................................................................... Address................................._ .............................E;1l;~.1;.~.r.......M~!?..!?g.~F..~................:....................................... .. Closest Relative._....Alf.r.ed...Ghapman .........................Address................................................................ .. Father's Name.....Alf.t:e.d...Ch.ap.!!!an.............................Birthplace..............,............................................... Mother's Maiden Name......Ma;t?y.....M. •... Nunn.~irthPla~:.. ~.~ ..... . Cause of Deatb?2u.l.a~~~..................con~utory....8.:.2rj ... Date of Death.....J~J~p.J!.~!!!!?.~E.... Hour.................~.:.?2 ~ Place of Death.................. D.Q!!!tL ..............................................How Long Ill ?.................................................... . Physician .......J2r.:.:.....9.g~.§ ~ ~ ~:r:.~.~.~ Address ............g.a.§.il.Y..1.l..l~ .......M.1..!Hl.Q.\!.ri Occupation of D.ceased............Qh..tld. ................................... Social Security No ............................................ .. Name of Employer................ __ .... __................... _..._........................................~................................................... :.......... . Address ............................................................................................................................................................................. . Charge to................................. _.................................................... _.A.ddress .................................................................. . Order Given By...............................................................................Address........................................... _.................... . Date of FuneraL ......-S.ep.temher. ...ll......19.59..........Time ........................2.. J'....M.?........................... .. Pl.ce of Funeral Service..._........ _.... -C.ul :lr.e.I!.!.s ....Ghap.e.L ....................................................................._. Clergyman....... Rev......Hugh...HiggB................................ Call for? ............................................................._
I:;--:M............................. ... ..:...:..:..........................
9..L.J9.5..2...................
..:.... .. ....
I
D
......................
....·....·......·· .... ·· ..·..···· ..........·......·· ....·..........···1·............· ...... .......... ·· .... ··.... ··.. ··.. ···............................·.. ··· .. ·1- - - 1
Total AmounL ............................... - - - -_ Remains to be shipped-see reverse for details.
Interment at................Mapl.el'.lQOd...c:~meter.,jL .........................................................................................
~:~:r:~:::::::::: : : : ::::;;:~;::::~;::.o~:;.:::;:~.;:~:::i:·.~h:~·:::::.~~~~.e ~~:::::::::::::::: : :: : : : : : : :: : : : : : ...
...................................... lIIh1:t..e....Q.r.flJ;l.e.... J.nt..!l.r.;l,9.r.:::.~~¥~KY.~.1..".,, ~ ......tr.im......................
............ .........................~.~.!?:=F.~.~ ...g..~.!!.~.~.~ ....Q.C?..:.......................................................................................... FOR M
Casket ........................................................ , .._............ _ (Style) (No.) Outside Case or Vault................................................. . Embalming Body .................................................. ..... . Professional Service .................................................... ············1Hair Dresser ............................................................ ...... Suit or Dress ............................................ ................... . Shirt, Collar, Tie ......................................................... . Shoes $....... _............. Hose $........................................ .. Underclothes ............................................................... . Door Spray .............................................................. ...... Gloves , .................... Chairs $...................................... .. Flowers $.................. P.lms $.................................... .. Cremation ..................................................... _............... Newspaper Notices .................................. ..._............ _. Telephone and Telegraph............................................ Ambulance .............................................................. ..... . Funeral Coach ............................................ ... _.............. . Passenger Cars .......................................... ... _.............. . Pall Bearers' Service ........................................... _....... Transferring Body.................................................. ..... . Opening of Grave............................... _........ _............... Cemetery Charges ........................................................ Lot ............................................................................ .... .. Misc. Transportation.................................................... Shipping Charges .................................... .................. .. Clergyman .................................................................. .. Singers $................ Organist $.................................... .. Cash Advanced ..............................................................
sass
S UPERIOR FUNERAL SUPPLY CORP • • CLI:VEUHD, OHIO.
Information Given To: Relatives Musicians
o
Lodges Pall Bearers
o
Dea th Certificate Payment Arranged
o
o
o o
Attended To:
o o o o
Clergyman Singers
Permit Bill Rendered
Insurance........................................................................................ ..
346
.. ....;!,~...lJ 59
Date.....~.~p..!~ ~.!?'? ~
..
CHECK EACH ITEM AS COMPLETED
FUNERAL · RECORD OF Yearly No...............l
.Q.6................. Nam............................................j~J1?~.r.~....M..~.... f.!'!.~~;!,.~..........................................Sex....... IOl.Ill.El.~ ......... Addr..s ............................................r.!lg..'?~.!-.~ .I. ....~~~.9..~ ............................................................................. No........................_ .._
COunty............................................Township..................................................Phone No ............................................ . Wh.re Born. ...... Eag~ ..Jl,Q.Q.!l;.~....M.*.§.!:lQy,T.J.._ .................................Race............~:9.:l,~..~....................
( )
Date of Birth...... .J.a.n.uar.Jc..2.l.~...l
8.S.1..............Age.............1 ;;;.............................................................. (Years)
(Months)
(Days)
How Long Resident in Community........................................ __ ._ ........... _.................................................................. . Singl .........................Marri.d. ....................... Widowed ....................... Divorced.9J,Y..Q.r.Q.ltli\ild ........................... . Husband, Wife or Child of........................................................................................................................................... . Address ..................................................._ ....................................................................................................................... . Closest Relative......Mr.s._ ...F.r.ank.... F.Q~.......................Address.....~!?,gJ.~....R.Q.Q.K•....M~~u?.Q.~.r. i Father's Namea.J-~.;k.1Y1..c-.n.~ . 1r!
