178-187 Funeral Records April 1961.pdf - Google Drive

Date. ....Al?;r.l-J...•:j,.,•.. J9..Q .l .....

CHECK EACiI ITElII AS COMPLETED

FUNERAL RECORD OF No ........•..................• ......_

Y.arly No ............

?!?.......................

Nam. ...................... N.e.y..e l.. J2;;).1.Jl~.... L.~.l2r..~n9.~....................................................... Sex........ll1~;J,.~........ .. Address ...............................Y{§,.§hp..\lr..n .....MJ .§..~9.~r..~..................................................................................... County....Barr.y.........................Township ...........A.§h .............................. Phone No .....................................:...... . Where Born. ............ B-o,,.LT.Y. ... 'O.O.Un.ty.. .... Mis..SQ.JJ.:r.J........................... Race ............ :\'!p..J:t~....................

(

,I

Dat. of Birth. .....J

8.1. ... J ..$.. .... )..9.19........................... Age........................5.g...~...:J,g.................:J,3................. (Years)

How Long Resident in Community............l.lf.e....

(Months)

(Days)

t..i./ll..e...................... ..............................................................

Singl. ........................Married. ....................... Widowed....................... Divorced ..c1J.Y9..:r.g.Ebtild.......................... .. Husband, Wife or Child oL ....................................................................................................................................... .. Address ............. _........_.. _.... _........_...... _........................ _......................__ ........ _. __.............................................. ____ ._....... .

Closest Relative...... Mr.B.. ....C.l£lY.8.... L.awr.eJlQ.!L.......Address ..... W§..§l}.1?!:!r..!l,.. )~tS..S..o.gE.i.... Father's Nam..........S.amuel ...J~L .... La).v.r.arW.e..............Birthplace............................................................. . Mother's Maiden Nam.......Dle.v.a ... Bo..l.e.s. .......................Birthplace..............................................................

Cause of Death ..~...................................ContributorY.~••~~. Date of Death...... ~.r.11 ...l

......12.6.1.................................Hour....... ~ .....:?!:. ..:_;;r.:. ...

I?.:...........;

Place of Death ....... h.Ql!le .......................................................... .How Long III ?................................................... .. Physician ..... Day.le....JY.illi.al!lSQn.. .... Q.9J:'9)).e.r. ... Address ..Q§..§.§.YJ1J~. >. .. Jvtl·..~..~.y..!-!:r.:l: ...

Casket ..& ...s.e=.iO.B.8. ..................... 1 (Style) (No.) Outside Case or Vault...... _...................... . Embalming Body ................................... . Professional Service ............................... . Hair Dresser..................... _......... ___ .......... _. Suit or Dress ........ _....................._._..... __... . Shirt. ~. Tie ....UO.d.e.rUZ.e"'U!.... . Shoes $... ___ ._ ... _._ ....... Hose $.__ ... _. _.... _...... __ Underclothes _.... _........ _.. __ ...... ____ .__....___ ___ ._ Door Spray _... _...... __ ..._. __ .......... __.......... _._ .. . Gloves $.................... Chairs $.................. .. Flowers $..................Palms $.................. Cremation ...................... ___ .....___ .. _............. . Newspaper Notices .... __ .____ .. _.. _.. _......... _.. _ Telephone and Telegraph ...................... .. Ambulance ............................................... . Funeral Co.ch ........................, ................. .. ........... . - Passenger car . ..............." ......................... r Pall Bearers' . Service ................................ . Tr~nsferring . BOdY.................._... _............ _! Opening of Grave.. __ ._. __ .____ .. _.....______ ._ ....... .

Occupation of ' Deceased.... -1j'.a,Dffi