The URL can be used to link to this page

Home My WebLink AboutFuneral Register (2) 1923-1936 Mirrofilmed by North Carolina Bepartment of Archives and History Division of Archives and Manwscripts Kaleigh, North Carolina IREDE aro COUNLY . BONN tay ae — = on) Yuu) vs = a PN eee tALCon RSV oe Ko i ; / i Soe ee RECORD AND BILL OF ITEMS rly No. Yearly FOR THE FUNERAL OF Tota/ to date ae elves Residence Lo €21tke ‘ M ‘ . ‘ ~ Place of Death Q WwW. Uo 4 Oe A wa<d_« Date of Birth iGdaan« £4. 4 FAO car (Monit (dD ae ~~ «¢ Wife or Widow of ay IJ Years { Sex Px Con” (Year) (Month) (Day i | Date of ILS +tOU “3 ge: 1a % Ages JO Months § Single 4 —— A) tw. Maiden Name Birth-plac e AoA A HH re omdey / 7 Days | Married — Occupation FP ain imi ia ee ° J ’ : . Name of Father ¢/ @*Ve--bwe 8 thes tev>C His Birth-place << er~-er « « Tec +s . y » 4? r . . 1 . Maiden Name of Mother ¢ LAGE « B. L2F LOCK Her Birth-place 4 4) -< VP tag ~t4 OS La Cause of Death— Primary Cc wcer eg Pee me Gah dave A ] ee ‘i so y (Ce y Pe oan . es Certifying I hysician Ae. f A ee OP nt Cin Residence wl he Lar 14K Yu se . aes q : , Z 1 ‘i e PE as, Place of Burial Funeral Service at LE ze eo Timea Service. > Fh atm Date of Interment df = lS = 2. Size Ya Made by J. W, Lining and Pillow Set No Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flow ers DR. I. dog ae Ca.K SA a —— " es Se 5 heel r hin 7-2-4) a . | 'SBUEO BY prea a — ps a ee ae Casket or Coffin No 4 s.. hs, KS “n oO 60 Candles & ad Cemetery «+? t<-o ee Lot No. > Put in the Diagram one | for every Grave in it Grave No Section Designate site of monume Gloves Bearers or Porters Hearse to Senate LO ££ Removal Automobiles 7 \oo Newspaper Notices Transportation Charges Officiating ¢ lergyman Aatntebilinahtiaiiinmmal iimadiiiale Color or Race LR mark like this And mark this Burial with double dagger thus ent thus: ro Amount of Bill ma 7 Ooo 4 Pp - Goods Ordered by i. W, R rprr.207u0 > 2 / 7 Bill Charged to(2.U/. [Vet reer j | | i PORNTER CASKET CO.. BOBTON MABE. 1018 RECORD AND BILL OF ITEMS Yearly No. Af th— Lan CA etd LE Ly Hn ‘ Koa it~ KO 192, / 6 (Day) Residepte Place of Death Date of Birth eS Ss Date of Death (Yee!) (Month) Maiden Name ~) ite f Birth-place ett <ellét ren Name of Fathe CG c. ) a ¢ Ae ao Ce Occupation His Birth-place 4 & Months § Single | W_.....Days Total to date FOR THE FUNERAL OF JU ct lon Married . “4-9 t wr 271747 12 fie iy, len, Se Dn-£_, ) a Af, f, te ae Viaiden Name of Mother Fe Ze C (40 a Ci + Her Birth-place Z . z c ) . »r ° { e of Death — Primary + on fe 1144. Aree Secondary C1 oe 4 gach ee teevemey horton = b . J es , i Certifving Physician SAT et eer Residence od : | t¢ Be era 6. Mess Place of Burial Lf. « z Cemetery ... ‘ , te : ral Service at - Lot No. Put in the Diagram one mark like this for every Grave And mark ¢/ a ‘ or every Grave in it, And mark (fis of Service L7 71M Grave No. ! e : Seca ; Burial with double dagger thus: { | : J 2 — Date of interment . a Designate mite of monument thus: | et 29 0-E-dpewah TW Of A~4 h Bf 2 Made by DR. /S/- If ny ie igo i He SEER AROROARRE OS TONE OE { andles Gloves Bearers or Porters a . Hearse to 6 rest * / Removal JO\00 Automobiles LE & w- « Newspaper Notice es ‘Transportation Charges | \ ; fi ; | | Officiating Clergyma ¢ sens “rr a] | . | : \ o?¢ Amount of Bill AMADA rine Goods Ordered by Zh of Ge 2-4 Oe i p Leo ie fill ¢ harged to a “ tw 5 on | a iid a siecle Uicesiniaial sled biiasciapicis acacia Cr. eng . ‘ nniiemnant upsmnmseeemnsnensensaneatieieinniemnmenmeninineee ARES CRANE RS aa (SSUEO BY DORNTER CASKET CO, BORTON, MASE. 1016 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Tota! to date Yearly No. Residence ~~ or ee PE Cee ao ef Place of Death so - , A PF yreennd,,.. L Wife or Widow of Aoi a ) A oe Ane Date of Birth 5 ” ate of Hirth ! ih os P ie es [2 Years Sexy * Cee Color or Race Date of Deat y : - ’ ate of Death otto (Meath) ee Age 9 Months Single Ya ae ¢ c Cr tno ‘ | Maiden Namie Days | Married Birth-place Cpa er Occupation fA Jon 7K, tA) one OO ys : . (L€ << te His Birth plac e tC 1a oo Ee. a Name of Father (#2 Maiden Name of Mother Her Birth-place Cause of Death — Primary Cociwele Semritw Secondary Certifying Physician TJ. l. LOW1-2eorn ~~ _~SiéResidence Place of Burial ZB a nl ot Cemetery “uneral. Service i N Funeral. Service at Lot No | Pat in the Diagram one mark like thi Time of Service Crava No J for every Grave init And mark thi Burial with double dagger thu Date of Interment tx ae / < of Section \ oe . Designate site of monument tha { ] Casket or Coflin No aS ¢ iz Candles c > f Size Made tie ceree tte ee Gloves Lining and Pillow Set No Bearers or Porters The arse to 1 } Handles Plate Removal Outside Box or Vault Automobiles Burial Suit nee ‘ Slippers Ne wspapel Notices Embalming : : Washing and Dressing Shaving Services Use of Chairs fransportation ( harges Otheiating ¢ lergyman Church Charges Cemetery Charges Amount of Bill : as : N\ Goods Ordered by 7 < Music | Bill Ch irged to o 7 b ane i r Fl rsowers acta tae NS an eae DR. i | i } | | | | | | } | ' | : | 1SBUED BY COeNTEE CASKET CO... BOBTON. MASS ‘ete RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Total to date . Yearly Ne. FOR THE FUNERAL OF Tota/ to date Yearly No. FCR THE FUNERAL OF i pie JU ClO a e (ae . (Loclee fates. eo A ts ae ) 4{ tee & i GK Residence OO Ee Pr Cree — i de foe — W ife Or W idow of fay Cord LE. 4M. Reside y DE mT — Wife or Widow of ecacel ef Y rtd Place of Death of Plac e of Death Date of Birth le KO ss Ss oS Years Sex ; Color or Race Date of Birth Lf. or x f , a~ z . (Year) (Month (Day) x oa (Year) (Moath (Day “dl Years Sex Ke pros Color or Race ‘ Date of Death 192 é Age ¢ Months § Single Ae Date of Death 19 = sisiatii o ? E c f pal i | 6 i beau’ ts Age 9 Months § Single ‘Z# Cm tno Maiden Name ; J Days \ Married d = Maiden Name Days . Married { A Af P c ; ee ae ci. 7 so : Birth-place ee <1 télL a a pe ~~< +. Occupation wX A247 Birth-place — < pa Ler Occupation Ae) Cua A) omen Or —_— Lc-2 3S - ‘ Cee ae (otel 2 a .) rp Oo iZ Name of Pathe: ar Prvern His Birth-place — ¢ oe ET See ened . = Name of Father S, we F£ Cee he His Birth-place DO hie 7 C : as Ae ; tt Maiden Name of Mother fh LE “e 4 ee Che Her Birth-place Maiden Name of Mother: Her Birth-place Cause of Death — Primary) “4?--<*—<=-€ - r144Amroreem Second ary cA atten. A top Roc CW Cause of Death— Primary Cote le OF enjhwls uses Secondary fr x : ; : F . i Certifying Physician Of «fi AI tee ieee Residence hem bun. eae Le. AS q Certifying Physician ee Ae es OYrL_s~ SCO ers ; : : 7 , * . a st rhe r ; . Di in of Gusial. ea “{ Cemetery : “<1 o Place of Burial <2@#t @eeem eet Cemetery | luneral Service at . ee * hat Tie. Put in the Diagram one mark like this Funeral. Service at Lot No. P he D k like tl i Ree tin the lagram one mar ike this : ‘ TM | for every Grave in it. And mark this a sel : | = : lime of Service oe. — se Grave No. Burial with double dagger thus : } Time of Service Grave No | i fen every Grave in it, And mark this j r S 2 y - ; e : [ Burial with double dagger thus f Date of Interment " ‘ section | Designate site of monument thus: CI Date of Interment 4 - = I " o if Section | Designate site of monument thu f i ae a Se ——— ‘ aiaiaieiail % ‘a ve oo | at ‘ : 8 ne ae ctha No oe - eee O- a F c-e cecal xe Candles Casket or Coflin No AS $2 Candles . : A ~O hy wail. Vade wy ar, WY. ¢ 4 A ~ “3 Gloves 3c Size Made bye Ie W_ Gloves pari Uv = > | : id Pillow Set No. Bearers or Porters See Lining and Pillow Set No Jearers or Porters | | cca = ele cae oo Hearse to .¢ 2 | fo Handles Hearse to | > | Removal Plate | Removal : | ‘ lutside Box or Vault Automobiles | Outside Box or Vault oo. Pan Automobiles Z ; ?-— % |= - ~ ' f Jo = ni = “ = ; ps | Suit a if id JAF e- ee J%O i Burial Suit sO ; ie a wy ; / iV Newspaper Notices Slippers Newspaper Notices n Embalming } } } ny and i | Washing and Dressing | } | | +" 6 5 {i in i Shaving \| | | Services | ( | lransportation Charges Use of Chairs Transportation Charges { Officiating Clergy may flee (Ln, ree { Church Charges Officiating Clergyman et ce | ery ¢ Amount of Bill JO Q oa . . oe. ! Z | Cemetery Charges Amount of Bill we —,. : \I | Goods Ordered by 4/, of FR On } Music Goods Ordered by 7“t. joe w ‘ | : mutes a — ) fe. | { iL se Charged to .... ad ot “FZ cn j i Flowers Bill Charged to <e<~—~— ‘ 7 “gd. 7 ; DR. aia aa CR. DR. CR. i S/- ff Ff) rd Y IN ae oF Be . : T : t ee ane , “dtc ¢< Yo dom fog ~~ | f 7 > | | ~ ' | | |_| | t me f | q | | | | | { ? | | i u i - wee + a oy ARRON comm: wis BOSTON. MAGE. 1810 'S8UED BY DORNTEE CASKET CO., BOSTON, wase., 1918 18BUED BY DORNTEE CABKET CO RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Yearly No. Cs10-< Residence MW. at. Zz anrS/Le« > Ste Lo Z ll a tei fh. LF G Place of Death. 42 2+ Roe +<— Wife or Widow of. Tota! to date... Date of Birth ] : f Years Sex 2448-——— Color or Race (Yea » Day | J - Date of Death 192 ¥ = if Age Months 4 Single ME LE. (Yew Werner (Day) Maiden Name Days Married Birth-place Occupation iba ete Nien His Birth-place Ma N M Her Birth-place } <4 Secondary ‘ Residence | of Bu Cemetery H eral Service at Lot No. | Put in the Diagram one mark like this : Geave M | for every Grave in it. And mark this j pime Of Oervice eye a Burial with double dagger thus : t Date of Interment vee Designate site of monument thus: aie | if pene encom iacieaeianesail cae 7 t or (Coffin No 4 I LLO Candles / |. “Zz : Vie i WW r Q Gloves 5 Bearers or Porters if Hearse to Removal or Vault 0-H Automobiles Reds ; Ay Anh ah. 7 jo Oo Newspaper Notices | | | | | | | i i| | / i] i ; : i | Transportation Charges | ns Officiating Clergyman P { tery | | Amount of Bill i Goods Ordered by Le. - Meta te, | | wers & Bill Charged to ef d, | Pet DR CR. “S35, 4 Ur. eorot 47 _— Lig |’ / . — Esa | | | | | ' | | | | } : | ! | ' | } | | | | | | | 1] : : ‘ : i i Sa RE oe TRE {SSUEO BY CORNTER CASKET CO... BOSTON, MASS... 1918 | | i RECORD AND BILL OF ITEMS FOR THE FUNERAL OF a ee LI Yearly No. Total to date Place of Death ¢ Cee Z. ig or Wife or Widow of Date of Birth SHS dat ( es y ears : (Year) (Moath) (Day Date of Death 9 sf . a (Yee#) (Month) (Day) oo Kesane -_ Color oe Rute Age / f. Months Single apace hy teé ka Maiden Name JK Days Married Birth-place te Al Qte- Grea. Ce 4 Name of Father Reason 7 PO Le V Maiden Name of Mother Occupation His Birth-place Her Birth-place Cause of Death— Primary Secondary Certifying Physician ae a. Crt Residence Place of Burial .~72 Ce —e— oor2. ox... Cemetery Funeral Service at Lot No. Vas in tiie Ola ia aiai Meas Time of Service F #A 3 Jv) Grave No. | for every Grave in it. And mark this Burial with double dagger thus Date of Interment Section ~ sicineesdhasttesbaausanana aii - Casket or Coffin No. A & 2. |... 44J Candles Size I Ag Made by J. lv e Lo Gloves Lining and a. Set No. Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault (2 vy Automobiles Burial Suit Slippers Newspaper Notices Embalming Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman cH tees a at Cemetery Charges Amount of Bill bl ceaeinsauieioa’ aliieteeas Music Goods Ordered by Flowers Bill Charged to Ss b) heme —— — nikal sO Ss CR. Am a ISSUED BY DORNTEE CASKET CO.. BOSTON MASS ‘ere reenact RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS { Total te date. Tota/ to date oi " les Se Color or Race Date of Kirth , ; ; adie = YY Montt (Day) | eae [ a (Year) (Meath) (Day | é s Years dex ‘ M< in @-< Color or Race : i Sinele Date of De: ‘ . mall zt Date of Death 192 an 3 Age Months 4 Single ate of Death 192 3 f Ave } Months 4 Single lw h—-< (Yea?) (Month) (Day) (Tear (Month) (Day) © , i : : se d —— Maiden Name Days Married Maiden Name .c-4+~— #<—— t= of ims... Gl. L t Days | Married 22? . vf A A . " Birth-place Occupation Birth-place i vet i ee Pia, Name of Father His Birth-place L Name of Father ote — His Birth-place / a Maiden Name of Mother Her Birth-place Maiden Name of Mether ya Be) Recor Her Birth-place | Cause of Death — Primary e Secondary Cause of Death Primary Secondary Certifying Physician V. 7 rot Residence Certifying Physician al Jt. tte. hort Residence - ~ : ; : ei ; : Place of Burial Cemetery Place of Burial w< 4 Ng eet A, . .Cemetery i luneral Service at Lot No. | Put in the Diagram one mark like this Funeral Service at I> ~~ mee le OL Ks Cle Lot No. ; j | bf C a Ane kth ' Put in the Diagram one mark like this { : i ake or every Grave init. And mark (/is ‘dei 3 “ ; | Pn vase tices t A sicl snarl tite Pime of Service Grave No. ‘ Burial with double dagger thus: ¢ Time of Service + m ort Grave No. 2 A it * - . a on ; ra ; " : ae urial with double dagger thus Soe ed ee Soe, : D bet of Int — " as ies | Designate site of monument thus: CI Date of Inte ae m : Zé a IE Set Hon i Design ate site of monument th us: os FOCR THE FUNERAL OF f Fie MAF he Residenod. viaty Lars Qhe, } Mn’. e Mey frre Yearly No. Place of Death Wife or Widow of Yearly No. Residence Place of Death Ig 4S é FOR THE FUNERAL OF Zesmeniie- CL <7 > ft oe — , A ee Wife or Widow of 'S8UED BY DORNTER CASKET CO., BOBTON, MASS. 1018 ISSUED BY CORNTER CASKET CO., BOBTON. MASS. 1816 saiaiaaiiaiiiai ee ~ = = : a Se = ee = a a SSEiie cammememmeminaiees ate EE = I = Casket or Coffin No ro. : gop 4 at Candles r Casket or Coffin No ae fae O._« ak § AY A|| J, 50 ee Candles > b/s; M Ys Ul ,¢ Co Gloves | * Size & fe Made hy J. Ww. ais cS : } 7 J oloves é ~ - Nis : : 3 i yi A }— Li id | v Set N | Bearers or Porters |. Lining and Pillow Set No 1 w# at, j r 3 ig Oo Bearers or Porters —T, wa V cai 2 e >i H ~— | Handles : | 147 Hearse to Lesa, , ‘ Ma ’ Removal Plate Removal : a Automobiles | . Outside Box castvemt- Automobiles ss : - | lovee £ ESS 7 00 1 Burial Suit . Newspaper Notices Slippers Newspaper Notices Embalming tti0-3m ps c JS f g sing o| « Washing and Dressing Ce herr tee... Lig “A tera rine C Pee T SC Yo H Shaving | Services Cha Transportation Charges Use of Chairs Transportation Charges i be ‘ 72. } 1 Charge Officiating Clergy man Church Charges Officiating Clergyman C8 oa aieiaiel ; cy | A ‘RD: a , e < { y Charge \mount of Bill 3 7 eo Cemetery Charges Amount of Bill Ce miami f | Zz a 4 ? : Musi | Goods Ordered by &. wv, IAM en Music Goods Ordered by {, a Flower | Bill Charged to Coreen <7 ~ a Flowers .7 Gt-1 LO Bill Charged to Re " a wane a a (+ Seems niles panahiianinn a Sn Samet een ecenNnermeementee suena ‘ DR CR DR CR. : aaa einer. is ieee ia tee sea we i : kW © ed i j pn : { (42) Sve aft tae 7 | : SALAS e IS, of.<ts | | . f | si | f : | | i | & | | } : | | | “| jon + | ~~ | | s | | | ; i |" 3 i! | / | | | | | F | | 1 | | -| | i | ane ae —_|-—~ } | | i i “a ‘ 4 | Be en em 1 ‘ | | | ; | seein i be i A | | li : eal RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date... Yearly No. FOR THE FUNERAL OF Pate? ts idee Viste £2 | Chace Ghrhing dh nae Residence China Era ba ” Residence t on Gg gta r£&2 ; iL c Place of Death. 7” “— or Widow or Place of Death Pee ttn Wife or Widow of Date of Birth ; (Af. Years nie ee z Color or Race Date of Birth L2t — 2. (JIT... Years hs A ihc -~ ey Cnkis sn ae Date of Death gs pas — Age Months 4 Single Wi bo CoFyrack.. Date of Death 92 ‘scca 2 — 2. Months ¢ Single mrtie ae (Year) (Month) (Day) Days | Married L a Maiden Name b Days | tad Birth-place Occupation Birth-place Occupation 4 2 . eo Name of Father 4 LL t< er Le ee €k tye His Birth-place . Name of Father U2 Le.-~+ Con His Birth-place iy. Maiden Name of Mother J Her Birth-place Maiden Name of Mother oo Atta FOO Aare Her Birth-place AEA Cause of Death — Primary Ce <a. ee C08 a Secondary oe Cause of Death— Primar Sf, KA i ore a at : Certifying Physician. Ct - Fete. SL AAA... Residence Certifying Physician | - er. . OCrrrnann. Residence 7 . r Je (ae oto. eet Cemetery r Place of Burial ee ind ite C+ Cemetery Secondary Place of Burial Funeral Service at © Le Lot No. | Putin ate o Funeral Service at 0 lie ctl hence _ Lot No. | Put in the Diagram one mark like this rime of Service ...2/ GEA Grave No. { eselbagee 4 cuits dae eas = Time of Service “Ee foe Vs Grave No eo ee - Date of Interment df - G Sue “ f Section Designate site of monument thus: E> Date of Interment aA a y Section Designate site of monument thus os | : ee 2 et or Coffin Ne a & . Candles . f P Casket or Coffin No ye Oo 0° Candles 643 ade vy ' 4 : - C - ini Gloves z /Fv22— 2. OL? Size Made by Gloves of y oh Pd } a Set Ne : \ Bearers or Porters | Lining and Pillow Set N Bearers or Porters — —- ve { {| _ Hearse to ... é-ece-—n_ 6 | eee Lo Haidles Hearse to Se nieineiete oe. /O Removal - | Plate Removal yp Vau 7 Ie. Ke a Automobiles Outside Box or Vault Automobiles eC #/o3| Lo K r Burial Suit Newspaper Notices Slippers Newspaper Notices | j | | | Embalming { sit } Washing and Dressing i | T Shaving ) | | ‘ ‘ } } Services fi ° ct | lransportation Charges Use of Chairs Transportation Charges | irch Charges | Officiating Clergyman ie ae Church Charges i Officiating Clergyman minairasapcinars anni’ ; Cemetery Charges | Amount of Bill ee Cemetery Charges Tseng / pee 7 a Amount of Bill asilili SO Music Goods Ordered by Music d Goods Ordered by iy | wers Bill { harged to Flowers suil ( harge d to DR. CR. DR. eens; 2 ns ad | # cay bE A MowLe Se aes ie ee A+ ot eo ras 6 3 S ¢ | | | YNSAL AG a ° | | dogs ras % ( B | | ee | | 7 me , af" a | | | | | a | | 7 | aa | | | = | | as i | ! | | | t | | | | | | | | | | = t a ad | ; | | al ; rn aaa UI sccesea sus { i il | | i | a iia L siete ; 1S8UEO BY CORNTRE CASKET CO.. ROBTON, MAS., 1018 ISSUED BY DOANTEE CASKET CO. BOSTON MASS. 1010 ad 10 RECORD AND BILL OF ITEMS Total to date... FOR THE FUNERAL OF 4 A - Yearly No. ber p Lia tA Che. Se cei, aes. A Ps p+ isk Wife bs juan SS 3. 9 ( bf (Year) (Mo Date of Death 194 us fa(7) /&% (Yea J(Mooyf) (Day) Maiden Name Laura ATA os girth place Aanf Name of Father , OM pa Mee Maiden Name of Mother — JO anr44 Place of Death Date of Birth Years Months fg. é Days Occupation ae al Zé. - Single Married - pod His Birth-place Her Birth-place Cause of Death— Primary } <1 Secondary Certifving Physician..¢C « Jet, y Residence MA ee t k es ALCL Pe. c PASE TR " Place of Burial Cemetery . ears Sex ¥ Canon Ke | = Color or Race ‘7 ts ¢ Funeral Service at “ Lot No. | Put in the Diagram one mark like this Ss per C | for every Grave in it. And mark this fine of Service a oD” * prave No. 4 Burial with double dagger thus : ¢ — ; 7 = 2 Ye Cant | Date of Interment e e section, | Designate site of monument thus: Cc) as ae . — flin No nN Candles ; } S Made | Z Gloves S Bearers or Porters I. | — ———yt i y ©} Hearse to Cz. cmuaiiee LO ~? Removal 1 Automobiles | { t | Newspaper Notices { | {| | || | | | | | i 1 in H | | | in | Ao ed Af j 1 f Cha | Transportation Charges Charge Officiating Clergyman | Cemetery Charge | } Amount of Bill i SJ oY Ma “ | Goods Ordered by | | Flowers | Bill Changed | to DR. Cr PAE 26 G- 2- Ly ; | | | baal bd (S8UEO BY DORNTER CASKET CO., BOSTON, wads., 1918 ++ RECORD AND BILL OF ITEMS FOR THE FUNERAL OF a ie ee a ee gene a yp Kraan be Eo 1 Me ore ii Yearly No. Tota/ to date Residence Place of Death Sap tiies JA: hea. 42-4 exJ Wife ox Wedeowo? Date of Birth oe 2a i : ee , 437 (Month (Day | @ ? Years Sex Je—<-*e- Color or Race Date of Death 192. a - Age Months ¢ Single 2 ne. | Married La j Maiden Name aghonmn & <.- A 5 ee L 1g bis o Birth-place ACA ee te é _ Occupation Name of Father ! Lea— a a His Birth-place Maiden Name of Mother .. Ean. Le agre Her Birth-place t Cause of Death— Primary oo Pe pArcbrsseconiary Certifying Physician. —* - moe Cn TO Place of Burial ont Sata Funeral Service at Time of Service RF Residence Cemetery Lot No. Sof? IM. Grave No | Put in the Diagram one mark like this And mark this Burial with double dagger thus: 7 wee Designate site of monument thus [ ] 1 for every Grave in it Section 4 Date of Interment a - 2 ©. Casket or Coffin No. A = eo a ) Ee. "70. Candles Size... MG Made by J: W. ko Gloves f res Lining ead i. Set No Bearers or Porters Handles Hearse to Ch 7 oO ns Plate Removal Outside Box or Vault Antomobiles Burial Suit Slippers Newspaper Notices Embalming Washing and Dressing Shaving } Services Jse of Chairs Transportation Charges Church Charges Officiating Clergyman ine mua) Cemetery Charges Amount of Bill sieighael Siti Music Goods Ordered by Flowers Bill Charged to DR. CR. Scie Pre ay! _|e/ 3.3.2 ty Cnet w/ |e 2 | 4 = eo | | | | | | | : | | - Baba | | On MASE. 1018 1SBUED BY DORNTEE Casnet COo.. 8 ct Yearly No. 12 ' Hesidence ee Place of Death Date of Birth ] (Year) (Monit Date of Deatl 192 ; rr (ve Zs (Day (Dey) Maiden Name Name ot Birth-place eae fect “~_ “Lk Ext ater Lappromnel - of Mother ahiee ee es Certifving Physician bh aut: flee <<Coree_*™ ” | e of Service a Pu Pate of Interment me SO xu xe Maiden Name ( se of Death Pri f PI ‘ of I 1 i'uneral Service at MPA. 2/6 Mad betel Yah .W. ©. & | b | iw and | ! { | ae | . | | lL se of Chairs | \ Cha l i | Cemetery Charge } \ irch Charge Mir-| iv 10 4+ 4 } / i aT . f /'| ae: oa aes St els | ace RD = SN Wife or Widow of ef 7 Years Age § JO Months 4 Single l aa Days Marriec¢ Occupation (tage Cline His Birth-place Her Birth-place Secondary Residence Cemetery (cor, 7 Sex Jian. m Mor Lez. [ RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Canta - se ect Total to date.. a tv ._— ol Lot No. | Grave No. 4 Section | IF Candles Gloves Bearers or Porters Hearse to Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Let1t+1'2 Lapepeaeen » Bill Charged to | nantes 4 |... HO | for every Grave in it. Designate site of monument thu ie Color or Race Put in the Diagram one mark like this And mark this Burial with double dagger thus : ¢ OO CR. eT, 7~ %- 2% (jbo Ae | 28 Panay ty treed Tha jp Wal | S| mi ay (6 * i, 29 2° 3 1-98) $4 | “ow v7 ie | lest 90\ x7! 677 20 57 Ufo g Fo! rn Z25 17 Oli (8BUED BY DORNTEE CASKET CO., BOSTON, MABS., 1918 Aad A - a " | 2Z | : ah {© / Og ia o- oOo 2° 00 a 02 Bo 4-—----- RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Yearly No. firlilin F bse Residence oe aise f~ Ai Place of Death Date of Birth (Year) (Month) (Day Date of Death 19 (Year) (Month) (Day) piriafoan Birth-place C aa hor oe Name of Father ie ar Maiden Name of ther dhe perme Cause of Death— Primary ies cil Wied Certifying Physician oS. a. ici ei fiarwn—~— Maiden Name Place of Burial Funeral Service at a L yin F- >NX- 2 it Time of Service Date of Interment Casket or Cofhn No Size £ 3 Lining and Pillow Set No ae Made by of, lW: . CO) YO Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers | } oe iseuEd SY DORNTER Casket co,, 80 Wife Gr Widow of IP row Months ] Single Ages Days | Married Occupation His Birth-place Her Birth-place ar Meo— Rac Fe ictintico Residence Cemetery Lot No. Grave No } U for é Section Candles Gloves Bearers or Porters Hearse to Removal Antomobiles Newspaper Notices ‘Transportation Charge Officiating Clergyman Amountof Bill Goods Ordered by Bilt Charg red to BS AY Fy 7 he fick. Fr. Co. 4 i Oia + j | " | STON. MASS. 1818 , sae Sa | Put in the every Gr Jesignate sil Tota! to date we init Color or Race UR. Diagram one mark like thi And mark this Rurial with double dagger thu eot monument thus: | ) Sere a 14 : ‘ 4 i } } i ' i ( i \ } L ' | ’ i . 4 a | ‘ } RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF { t fin tor il Total to date... Wife or Widow of Residence Place of Death Date of Birth 1fo 2 +f wy ( 2/4 Years Sex F Rane Color or Race (Year) Month (Way e. Date of Death 192Y¥ ? a Age SO Months Single ttc (Yeas) (Month) - (Day) Maiden Name Lolle e. Ala-~e ; 7 Days Married .....X Birth-place Z Occupation ALnnk RkAf. Secondary eas Cause of Death — Primary Ye scent aliases Certifying Physician liom Se icc Place of Burial jf Mle ce luneral Service at f Lot No. | | | Name of Father His Birth-place Maiden Name of Mother Her Birth-place Residence Cemetery Put in the Diagram one mark like this } for every Grave in it. And mark this Grave No. Burial with double dagger thus : $ lime of Service Section Date of Interment Designate site of monument thus: Fr} Candles f 2A-§ |O 9. Gloves Bearers or Porters } Hearse to Removal Automobiles ° L “NJ Newspaper Notices | = | | el | Transportation Charges Cha Officiating Clergyman j Char Amount of Bill “A / 7 a AY Goods Ordered ry fot F Leake Bill Charged to a ; ne entail at = mare mmeeemeee o—_ | asi sibilant DR ; ra ; CR. } - | i eo | | | | } | a | | | _ _ I; — cae ae se ean ad | l | ISSUED BY DORNTRE CABKET CO., BOSTON, MASS. 1818 See Yearly No. 15 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Total to date AML Residence Place of Death Y Date of Hirth 1 (Year) Date of Death 19 (Year) Maiden Name Birth-place Name of Father Maiden Name of Mother Cause of Death— Primary Certifying Physician Place of Burial Funeral Service at Time of Service Date of Interment ————— Casket or Coffin No. Size Made by Lining and Pillow Set No. Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music f lowers ‘iain Wpean Q, Wife or Widow of DR. (Month) (Day [ Years Sex . er | Color or Race | (Month) (Day) Ase) Months § Single og 4 hike L Days | Married Occupation His Birth-place Her Birth-place Secondary Residence Cemetery { eR Ae eR LU Lot No. : } Pat in the Diagram one mark like this Grave No { tor every Grave init And mark this 4 Burial with double dagger thus Section | Designate site of monut tthu 2 nee = a a aaanrmenpeenane Candles Gloves Bearers or Porters Hearse to Kemoval Automobiles Newspaper Notices Transportation Charges Officiating ¢ lergyman a ES Bre heen Amount of Bill casstititlwidkedeanasse’ SMesrinaat ee - Goods Ordered by ASLAN Cad Bill Charged to > . ee Ef I mlieeeelpnaenemnrmnypioomes sn ‘i ae CR. canteens a eaceenemnnsmnennianapeenia aE ES iSeUEO BY Lol Chak te | polet ve. 35 re i j. 4 oe CORNTER CASKET CO., BOSTON Mase. tere tae ai aan sie elint te aet an inw pits 16 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF + tin Jarl ies Ns C., Place of Death wa Date of Birth ] (Year) (Month (Day) 19 Z37~ Age ee og x e Maiden Name B iden haa ee Name of Father , ie gua Maiden Name of Mother Total to date... Residence Wife or Widow of el Years Months Days l Married Color or Race CG 2 Sex . lan Date of Death Single Occupation His Birth-place Her Birth-place Cause of Death —Primary Secondary ercornietarul Certifying Physician MA ba Tene Residence Place of Burial Ji a ce olen a Cemetery - “ 2 . er T Funeral Service at Lot No. | Put in the Diagram one mark like this ! | for every Grave in it. And mark this Burial with double dagger thus : ¢ Grave No. Time of Service ata Date of Interment f—S-2 J Section Designate site of monument thus: CI ; i ‘ | a a he Ww | = Candles 3 Made b ec. gE. CG i )§ \00 Gat No. | Bearers or Porters Gloves a gd Hearse to Removal » a «or | Automobiles | 4 loo | j ->te-—— i 36 Newspaper Notices | sing | | i | | i I | sis i | Transportation Charges Charge i Officiating Clergyman ery Char i | Amount of Bill | go é a \\ '| Goods Ordered by Mora. Pedarae | | | ers | i Bill C harge d to < rs DR. et nea 8 oS SE c - : . | St - — A G28 -Comk. YS r¢ G | 2 | Legrat | “Mf fo_|eo _| = : = | ee | | i se | i| I! i | | : | | | } } | | os . | | oe ’ i | | om es 'S8UEO BY DORNTRE CASKET co.. BOSTON, mags., 1918 en tn eee Onecene 2» RECORD AND BILL OF ITEMS Yearly No. ty FOR THE FUNERAL OF Va... Residence Total to date A> Fn s } al ead Place of Death Wife or Widow of Date of Birth I 72 t / D f Death oe Y (M = (tay O & Years Sex DPac- | Ci ain ate oO eat f : (Year) (Morth) 2S Age Jf Months < Single 4 tlt ae aspeliagy 2 2— Days | Married & Birth-place Meew. . ‘Go _ i Y. Occupation V3 wort (aaepa< + _— Name of Father AEE den 7 hon poco t Birth-place Mac. Zé. ve Maiden Name of Mothe Chad. ALe ae , Cause of Death Her Birthplace 2 iofacnr_ Co. Wu.C_+ cs Primary a Ry, - Secondary . , d Certifying Physician Lew : Place of Burial Cx Ht AA Ie —--eh * ox e t FO1 Residence (Cemetery Funeral Service at. 7”%2>44.2— — Lot No | Put tn the Dis Pe ki Time of Service a rem : Grave No I for every Gray i A 4 é Burial with double dagge Date of Interment 1@ jf» > ff > % Section / ? -_ - Designate site of monument tl aes Casket or Coffin No. Sh. - o/s 9-Le- Ag © |. Candia Size y sae Made by Sh Gloves mh 4 Sey Lining and’ Pillow Set No Bearers or eta 3 hl ¢ , Handles Hearse SO47.4.b. cs > eh ) Plate Removal : ) ; Outside Box or Vault tt=> - | ~ . OEIGe) Amewsiiin Ag. * Burial Suit oA <_R_ / \or Slippers Ney spa) ‘ ‘ Embalming i— 2 \ | Oo Washing and Dressing Shaving reves. Dervices lrans sportation Church Charges Officiating ii BA eons Clam sis idaacmos Ceffetery rhes «af pu =A 5 3 O Amount of Bill / 3 ene Use of Chairs 4 Music ' Goods Ordered by x ot 6 » | Flowers Bill Charged to | ee oo ee —_— ° | i DR. CR /0[30 f2% 2As oe i] I ] | | | 1} {| | i| H . | Sh 188UED BY OORNTESR CasKET 2O., BOSTON, MABE. 1018 18 Ale Ae a iDance at RECORD AND BILL OF ITEMS Yearly No. Residence . oe Place of Death ihe top Lif 1 Date of Birth (Year) (Month) Date of Death 1S... (Year) (Month) Maiden Name Birth-place Name of Father Maiden Name of Mother Cause of Death— Primary Certifying Physician Place of Burial luneral Service at lime of Service Date of Interment git fy ern €73 Made by.\> Set No. “hairs ireren Charges fpa-4 by. Vault | Cemetery Charges Viusic aie blowers L OF G 2... Years Age Months Days Married4— (Day) si Single Occupation .. His Birth-place Her Birth-place Secondary Residence Cemetery Tota/ to date... j if Wife or Widow ot Leak Vuclls Wright Sex A Color or Race Lot No. | Grave No. E Section Put in the Diagram one mark like this | for every Grave in it. And mark this Burial with double dagger thus : t Designate site of monument thus: | ‘ae GO. Candles Gloves + Bearers or Porters cad | } Hearse S Reuse Removal \{£ O || Newspaper Notices Transportation Charges a ds Qo Officiating ( lergyman ei § 2 Amount of Bill Goods Ordered by Bill ¢ harged ‘oa tue JAM, Nad ee | J\6 0 ui | | + DR. 10. “ 72 oe nom a SA. Cage _ - g iy head’ a ee SO | ny ) 1 | —P | | ¥4__| 4 | @A\CO | \ | A | 4 } ef 9 oO°O | ) , a “| Arh : = —_ a ! i) oe | ad 7 | | } } | i he" wane . it] sl on) | | a. oe | | eS ee “T | os =r rat | | a a | ao . | A | ae “ | | | it Fj 4 4 | a , en .. fe cn ms | s | | C8 oe se =" || oe | cd (S9UEO BY DORNTEE CASKET CO.. BOSTON, WASS., 1918 ecnnennrommseamalips 19 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Total to date Yearly No. Ther t Ma ck, Residence.. oe Place of Deail Wife or Widow of Date of Birth l (Year) (Monih) (Day) Years dex | Color or Rac Date of Death ons se “i ha Sissies S Oued J Maiden Name Days Married Birth-place Occupation Name of Father His Birth-place Maiden Name of Mother... Her Birth-place Cause of Death-- Primary Secondary Certifying Physician Residence Place of Burial Cemetery Funeral Service at Lot No. Peo » mark like th Time of Service Grave No ! noe ace Date of Interment | 2 cee ENS ——— a Casket or Coffin No. Cand] Size Made by FF Claw i f oO Lining and Pillow Set No. Runs NO4_ <1 tI | oo Handles Plate Outside Box or Vault Buriai Suit Slippers Embalming Washing and Dressing Shaving Services n (Charge #49 OB cthing Clocayan o Ld Amount of Bill De al eile Goods Ordered b Use of Chairs Church Charges Cemetery Charge Music Powers Bill Charged t CR. ~ sone aera: «ee ecm | — Vine 20 fey AE PS | | {| | | } =| —— | | erm RNTER CAGKET CO. BOSTON, MAGE.. 1018 198UEO BY DO ' i ¢ } 20 Yearly No. Residence Place of Death Date of Birth Date of Death Maiden Name Birth-place Name of Father / ae 29 Maiden Name of Sister (A euch Cause of Death— Prin Certifying Physician Place of Burial Funeral Service at —e Meth rime of Service 4-_V: f ae. No. Date of Interment Uahton fa 4 ‘fi ey - “ty Section. g and Dr having ervices A Use of Chairs Church Charges Cemetery =p pan ny Yvan Music llowers oo AND BILL OF ITEMS pe Hy bifirn Ae. Ke dederebe _. Wife or Widow of. TV > (G65 - Jon 63 Years 19 7 Tey. é M- Age Z Months Qh kiwlbhe) RC RF Oypepetd~ Days Occupation . His Birth-place Her Birth-place Secondary. ‘ Voces Pe etal, Residence {2 aL loood. L. Cemetery Mad} Lot No. m0 A A yay Wek: lie Canillon G yloves Rar Bearers or Porters Hearse to | Removal < Se VauK | /ao ad || Automobiles |. falog| {po dL. ae. aes / >| Newspaper Notices 7h leo! ssing A_O . i | Roh ary — | La/de-,A Mev ce | /2\0 | j Hi “| / J tT < | Transportation Charges Officiating Clergyman 7 Amount of Bill H Goods Ordered by | Bill Charged to iM aH 1B hoch Tota/ to date... Put in the Diagram ome mark like this | for every Grave in it. And mark this Burial with double dagger thus : t Designate site of monument thus: CI CR. yy. \Erd 'S8UEO BY CORMTER CARKET Co.. BQSTON, maae., 1918 — RECORD AND BILL OF ITEMS / , FOR THE FUNERAL OF 21 Tota/ to date ia ~ A oo“ ; e - \ (4-1 ie = : Dl hy hg eo 7 Residence 7 Ale , it Af ily He, Li ad an a 5 v ya r. / Reef tt4 An Place of Death Ktsdesnes ' Wit wis . - . f Z fe Or idOw O Date of Birth lg OCF if — (Mapth (Day Years Se JA BL £ Date of Death 19 v, MO oa | wen ( “a Bae i (Year) a ma Age Months ¢ Single - Arkh , Maiden Name " plore ? Days Married te on : Birth-place Oud Ley A vy Ce : a bs } ecupation Name of Father , Nhe AA a. my J : Hie Birth-nl Pip gin te hp ia ’ 5 ria pia c i ae: Maiden Name of Mother Sad auingh é r—— Her Bitthalacs. Ie fia “o Cause of Death—-Primary, cae he we: ak QALLE * fy r Certifying Physician ya AAA « beatae Oy 2 7 Place of Burial UD 4: LUO CAE LE} eye Funeral Service at \ HL ee Ld id Lies int No : mis ‘i 42 9 ’ i, Put in the Diagram one mark like this Time of Service pee ry I for ev ave init And mark this / ee Burial with double dagger thus Date of Interment Ne LAL LOK Br lagger th [ Desipnat tm us ea — = gee ot. Casket or Coffin No, oe Size Made by Lining and Pillow Set No. ES ( yO Handles vel C Plate Outside Box or Vault Cortex Burial Suit Slipp« rs Embalming 5 OO Washing « . a8 Shavir ay fi J Servit oO Use f EG ney id, “iy ¢ { Church h ¢ charges tbc eile Cemetery Charg: a edb iy f © ¢ \n nici olaccert ecscagaes Music a J : “ Z Flowees Lt C So O ea saieano ial - enn DR. CR. ~*~ : aa BET | Ceeaen é = 7 = |— sid | mit | j ’ es | Fi } a | fe | | | a | | 188UEO BY OORNTEE CASKET CO.. BOSTON. MASS. 1916 reece i { ; 3 @ ee. ae —_— | i ’ 4 7 s 2 , 4 ' ; 1 i} } ; } k i nf 7% + 22 RECORD AND BILL OF ITEMS Yearly No. FPLLO ANT HAR. Residence Place of Death Date of Birth ] (Year) (Month) Date of Death 19 (Year) (Month) Maiden Name Birth-place Name of Father on Maiden Name of Mother Cause of Death-— Primary Certifying P ysicianr Place of Burial Co Cy of luneral Service at e of Service stot — Wk en Date of Interment " if (Day) (Day) FOR THE FUNERAL OF _,—> ty p42 in fi“ Grave No. Wife or Widow of Years Sex Age Months 4 Single L Days Married Occupation. J Bb His Birth-place er Birth-place H ~, eed se >condary ae : Residence Cemetery WW Lot No. Section Tota/ to date... Color or Race _ Putin the Diagram one mark like this Ee] for every Grave in it. 7 Burial with double dagger thus : 4 And mark this Designate site of monument thus: Cl 6/3 | Noe linclamrents a- /demn1. | il ‘_ narge alanite, Candles | Gloves en Bearers or Porters Hearse to Removal || Automobiles Jb | | = Newspaper Notices J oO | | | | | | 00) - i] 0! Transportation Charges Officiating Clergyman oOo | Amount of Bill | | | ery | Oo Vahaptdne Ai | 2 bw <, Seana inne we ol pte ers = fash Bill Charged gel wobble eta ach ed re (permeate. Lee» |t DR. [ | 4 beaheoLl, , Cally | | ij2fe = Ale eglndnn Me — a | | Au ~~ a Eo | <a wit Bese é LAA Lag - - I 7 77 ae T ¢ A tL ff Ce~2tegy. T | sh? | | | CA tlerce Ste] | + i if ” . Ff nd | aril GLA | for add UMAAL AWE a spe Qe 4 ZO Wy | | | | ae 'S8UED BY DORNTEE CASKET co.. BOSTON, MASS... 1016 23 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF , Tota/ to date oe é Residence. Place of Death . : : \\ ‘ \\ Date of Hirth l (Year) (M Y, Sie Date of Death 19 Color or Race (Year) (Month) Day Ave Ai insisthe Sls 3 i Name } Maiden Nam¢ n, ie Birth-place Occupation Name of Father . His Birth-placc Maiden Name of Mother 3 hvhed Her Birth-ple: ‘ Dap. ce Cause of Death— Primary a Certifying Physician , Rocid 1) A eee Cha Place of Burial o- | a Funeral Service at / <4 - { \ eee 2 x i the Diagram one mark like this Time of Service ‘4 he { | for every Grave in it. And mark this - “ vith double dagger thus Date of Interment “4 fee see see: D> nate site of monument thus { ] a iebesanithieabilaniahceine<ininbiiaiican Casket or Coffin No Size Made by zs c Lining and Pillow Set No. Handles ft - i. Plate Outsid Box or Vault Burial > Slippe rs Embalming Washing and Dressing Shaving Services Use of Chair x Ao 2 Church ¢ harges fat 4 / 6 sialic simnek saints oe ‘ ) Cemeter, Charges a \! ccisuasidacencionaaneid indie Music Flowers Qexan— (is Le ‘ {. |e© DR. CR, - nasmengynniteneneenniniemieannememnenets | e _|| aol < i | Y ‘ | | | i } —~ | | | | | : c | 1 1 nn \ \ — | i . | i | | | | (Ce ' \ : vere i 1@GUED BY DORNTEE CASKET CO.. BOSTON. MASE : ! ; | i Sena eae AIR cea ae el re 24 Yearly No. Residence Place of Death i ciaeaiavalins 2 idow of GZ Wife or ZW f Years Date of Birth l $1 10& mo Sex f wad (Day) a Date of Death 19 e Age 0 Months — (Yea (Month) lg Maiden Name + Birth-place Name of Father Certifying Physician Place of Burial funeral Service at a oe ie of Service ZEM - gy! 8 ff of Interment ip pa “tor ee , 7 Maiden Name of Mothe Cause of Death—I = heed “ / 7 /é 200 | | | | t Occupations oe P His Birth-place Her Birth-place Secondary Residence Cemetery Lot No. Grave No. Section | | | Candles Gloves -4| Bearers or Porter, | Hearse to & evi b ko Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman \mount of Bill | Goods QOfdered by | Bill Pharged to RECORD AND BILL OF ITEMS FOR THE FUNERAL OF os Tota/ to date. . _ peggy hp) Put in the Diagram one mark like this | for every Grave in it. And mark this Burial with double dagger thus : 4 Designate site of monument thus: CJ /|se | | 1Sbe I | rs : eros a seme ccsrensnne_ sommes om | u\/ CR. 4 /\ t N i} i o + \\ v A a \ 7 | 1} | ae | | | i ea | |—— -/] | | | i oa I | | |_| | = i— | ! | i | | | a ae Po oa \| | i} | i | a 3 iit — — one “ . | rs | | = a | 'S8UEO BY DORNTEE CasKaT co... BOSTON, MASS., 1010 geri ii sas in Pca corner, A anh as hate svenensil) ncenemcmnenannsamsnstll Yearly No. Residence Place of — Date of Birth Date of Death Maiden Name Birth-place Name of Father Maiden Name of M Cause of Death Primary Years f Sex ‘ we Age Months Single a 4 | | A omens Occupation i LLY ce *ULLdttiZes 2 ehltucvle Ue His Birth-place Her Birth-place Secondary 2 a é Certifying Physician Ay CAs ee MAL — inten eer. Place of Bundy. DRepee Funeral Service ay Time of Service Date of Interment if Casket Gy Nov A4 4 Sino lo : Made I, Lf Lining and Pillow Set No. Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers DR. | 1SBUED BY DORNTEE CAGKE! CO,, BOSTON MAGE 1818 Total to date olor or Race And mark this thus ‘ta Wy ‘ 10 f Ze Cemetery ~~ ey f . =. fet Mo, | a | Putin the Diagram one mark like this Grave No | es i for every Grave in it. Burial with double dagger thus section oe a Designate site of monument LK, See ~ Samco o “oem srereces 22 aS SRI = UAL Candles ; , i = Pe AA * ie Gloves Bezrers or Porters . f A A be 7 Hearse to m 7 T ‘ Sate. Removal AK Aka. Sete a Se Automobiles - Newspaper Noti > P j Y 1 ~ ‘“ Transportation Charge: Officiating Clergyman Amount of Bill SP | Goods Ordered by XH i Bill Charged to at so nm Sovewee + = 2 hohe weases = L CR : cages —y / ; Cc J [2f3 fC AD PAK OL gt 26 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. , OR THE FUNERAL OF Total to date. : Yearly No. D FOR THE FUNERAL OF Total to date , ¢ (ee ; MV, (LA v x F Ze Residence — oe Ae — Residence ie Le ‘7 fs x Pe : Place of Death Ga rile Wife Guidow- ot MAA tena awd berth Place of Death AA 6 be Wie cotnialaeete? ote # At) Date of Birth 1 t fe a 47 Years {Sex Cibde dCaen Date of Hirth l 84 pt ate 3 ed td cial Date of Death 19 ¥, Mee ei Age 2 i Months 4 Single : — Date of Death + ai | if. an Site ) Single borttnn se Maiden Name Re x @ pool ‘ ie Le Lt, # Maiden Name dy a Ak i 9 Days | eee B.rth-place 4p Occupation . red Ras s8 Sivksocnssensne Birth-place fe UL) VLA Occupation a _ Name of Father G LEG = His Birth-place . Name of Father Us a His Birth-plac« f e // a ar Be Her Birth plac e FLvadelh ad2_—,,.. Birth-place } Sec Maiden Name of Mother Cause of Death— Primary No lope a Cause of Death— Primany Secondary / ; a ,ause é idar ‘ C Ga Te Ayn A : ici iy. : rth Residence (iS: 12 | ecerate sadieaee o Certifying Physician ee Residence ‘ on ha Certifying Physician > 4 MO) 4 f ' Buri vartth iL Ok veh cai sry ae Place of Burigy.. » G& C40 & nian Pe Ce ih thnk af Wig Maiden Name of Mother... Place of Burial f | F Ball ea Cheuveh, . service al £ Veal ; & lesa ervice at o No. Put in the Diagram one mark like this Funeral Service Ap Lot Ne Diss ies She Diawrais ae saa te tit ; i cis el eas oy Bt. 4 ees Gf Ja e- No ' ie i for every Grave init. And mark this ; ii of Gosling kw, hee C 3 J for every Grave in it. And mark this sf Burial with double dagger thus : t ‘ eae €, : ‘i Burial with double dagger thus Date of Interment ML e JO, le 7 Section CI SaLir } e Designate site of monument thus: CI : Date of Interment i ] Designate site of monument thus i j oh P C4 A . T o fa Ob, Thi Candles fy ll. ° Casket or Coffin No. Ma J i , A GH a | j eo de by Lf e) © ‘Co Gloves if LAA Y i BNE ea Sie Made by ve 4ito is | i } ow Set Ne 7 Bearers or P< oe é Lining and Pillow Set No. r Porter sided : ' Hearse to OY 7 <4€i ee L Jv DO Handle to... Abs i | Vide Le Cee, | : anales , a i | Re amiova} } Plat: fs Ren il i} Hi Poe ae j t A | LY“ i Pauli LY A SV) / C210 o| Automobiles Outside Box or Vault % ttomobiles i HX ld | utsi ; ,_ Ke 04. 25 Ch edkacasol/ L Zaft a saa i | i Burial Suit pyre | Ne wspaper Notices Slippers I paper Notices ) 2LS10 0) it { J d Dressing i | 3 | Embalming Washing and Dressing Shaving || | | Services f Chairs i} i} Transportation Charges U f Chai Transportation Charges | | se of Chairs , - ‘ harges lj Officiating Clergyman | Cle } 1} é g Clergyme be : 3. a cs 0 lergyman saliidoiithinseceal emaaiiiaes | Cl} i \ ee oan Church Charges te om ery Charges |] Amount of Bill “re, y= . . ry — & i - SE Cemetery Charges re M an Geta 2 lusic I! ! Goods Ordered by — | s Music ; i wers Bill C harged to 4 j Ch ed to - 2 5 paste DR. CR. ‘ DR. CR. | | |_| /: 3-4-9 | By cheek | ayy) ore es ee eee Ce ee Hnpra | bo Ke |S fee oo ern: = eA ATES NES fod Oo < af 7 | | 5 jefe, oe . | a “ Ooel E f-7- Go- 27 YO = | 4 <4 _ | | a | : I——| | | a | a oo : Il > Dl ot | ; 4 a i _| a | i > | | eo -| | | AT | | | { | i | _| ; ; } | | A | <i _ sd | ; | — . } es |= a | aia . oa _ | & ; | ‘ | | | ao ee : ] ae om | | ; | | | 'S8UEO BY DORNTEE CASKET co... BOSTON, MASS., 1010 1S8UED BY OORNTER CASKET CO.. BOSTON. | | | "eer PNR SMM | me 28 Yearly No. Residence Place of Death” Date of Birth 6 Date of Death Maiden Name.) Birth-place j . f Name of Father z MALL _ 44 Maiden Name of Mother ha a On wy 1 Cause of Death } Certifying Physician .../ Place of Burial Funeral Service at lime of Service Date of Interment £ (Da ) 3 fe Days <7 Occupation ../... Ze ; ey UA ans, RECORD AND BILL OF ITEMS FOR pe FUNERAL OF "f/f Via Hens Ticring : 3 A tsehes Atri nh 7 \en ki eee I ew Abt KO _ ag Meroe 7 <> ; Wife gx Widow of. { q§ Years (Dhy) a 15 Sex hate. Single Mavi docs . Months : aur ay Wha His Birth-place C « econ AB He Her Birth-place Tota/ to date... And mark this or ; } vd es i Chair Be. es Cemetery | harges Music llowers DR. | | i] | a j | 7 Secondary Residence Cemetery fs ys 7 Lot No. J Put in the Diagram one mark like this 3 o, N | oan I for every Grave in it. 4 / ERE 250: Burial with double dagger thus : ¢ / Section | Designate site of monument thus: CI [ es asia i : i) , ad vee a / di Of” ge ; f a | is 2 Mal Candles Heel fAewneyse Bearers or Porters __, Gloves CLUS \. Hearse to | | a || Removal j el “~ Cy a wi G4 Oc 1S8UEO0 SY DORNTRE CASKET CO., BOBTON, Mase. 19016 || ¢ ” } I 7 Automobiles een ee | | | | | | Newspaper Notices i Lo i Oh | i l| | i Transportation Charges H es Officiating Clergyman 6 ayer I oS Amount of Bill Z je I c | Goods Ordered by | ©] I| ¢ | Bill Cha ie d to occa a sense i CR. nliaai iannenaniadainiciaih = : = v[-oli4 Pack O-AM. | 3927 PW | U 1 | ff i Peee | . oe | 1| | / 1} | | | a i ‘ | | = | | | | | f{ | | | | 1] j > Hy j- fe | | ae | | i 1 | | / | | } [ IL | — | cg re Ie- Yearly No. Residence Place of Death Date of Birth Date of Death 19 +7 / i (Year) (Month) Maiden Name Birth-place Name of Father WwW = W oa - Maiden Name of gh ‘ause i Primary : Cause of Death Certifying Physician Place of Burial Funeral Service at . Time of Service Date of Interment Casket or Coffin No. , Handles Plate Outside Box or Vault Burial Suit Slippers ~ Embalming Washing and Dressing Shaving Services Use of Chairs wrtrernen OLA, fo Maul (.emetery C ae Music Flowers DR. | | “ | | | | on | | | 3457. afte ; ; eae daef av A¥o21 st e_ | Grave No | I for eve ini > 4 Burial with double Sic hg -47 Section | ao a Designate site of monument thus [ ] el ange metre NN tc M ide by Size s é Lining and Pillow Set No. oy Sab Yasdau 2 pet RECORD AND BiLL OF ITEMS FOR THE FUNERAL OF W Za or Widow of Years bee - | 4 09 B Months | £ (Day) —_ . Days Occupation His Birth- -place aa Lu, a. we (MEuin (Day Married nae. Her Birth- -place Secondary e. ®, Residence Cemetery Lot No. | Candles 1f OM Gloves Y Gre Bearers or Porters Hearse TY” hMevr CL-0o RP , hemoval mit « . Automobiles ” Zo? L:\FIS| Newspaper No 2d \oo Transportation Chi irges J IPO Officiating Clergyman 7} JO ot Amount of Bill Goods Ordered by Bill ¢ charged to jas fs baa | ay xf 71+} YrV 9 lg. yy a, of Total to date ry Grave in it. 29 Color or Race [ Single lus | { Put in the Diagram one mark like this And mark this dagger hus: 4 @0d 4 O Be § o Ow 2.4 c)-< f oo 1SBUED BY DORNTEE CASKET CO... BOSTON MASS te'8 | ae ‘> > i _|l 4 /{/0 |'3f J oi | ae i | | | | <a | | a | | | | _ | o | | Yrs It- 29 RECORD AND BILL OF ITEMS RECORD AND BiLL OF ITEMS Tota/ to date... ‘ Senet Yearly No. / Me ¢ na woe De FUNERAL OF ; ly No. FOR THE FUNERAL oF oe Pe /f { , Oe ; LN) — Chtetd Lictigsgpe. 54 J a Giese Cae op. “4 - 7 MOD) & i 44 vets 4 Abth eg 0h ke - Lich hegleor-d (bk Ke Residence Residence yi / ‘ Shans of tas ; hi sz Ag, AU BYA i AA... - Wife ha Widow of. hate. Place of Death 317 Wife or Widow of C f Ss aie Date of Bi a af 2 Date of Birt i 1350. Hany fn of Years Sex y ee Pi e capt” Bath ant | & Years Sex F~ Color or Race Od ie Age Us Months § Single eee Date of Death 19 +7 a. 3 J Date of Death = wit . ra Age I g Uy , (Year Pee on Age § 3 Months ¢ Single ; is oe = A4he — | Maiden Name , “7 ij # Ye "7 “Mea haf - : entice Mam: \ 7 Days . Married f } j i yr a : ace _ . Birth-place 7 Lh eo ss . Occupation. \ ; f “i ae i Birth-plac ' LithlLing Hl pi Occupation ‘ thdhtav - Dy: wa t CE “ lnm nf Basic. : Name of Father J Ae oA ‘ Mh Uf Vv EEL he. Daeg Lgl TZ ny AL 2 j Name of Father W - W " _..... His Birth-place (poce LW, ie — i & L Ad} { 2 . : : Maiden Name of Mother M 4 a v ee / Net Her Birth-place ..=- —— he ; eich wena Her Birth-place (B22 to—n ae es : Canes of Dasth—Primery . Secondary ee Cause of Death— Primary 5 “ye - Secondary | Certifying Physician } ' 4 Y UE rf MANN Residence ; Certifying Physician ©. § clvele on — Residence : ferls « : Disne of Nastal C f f' LUDA 4 Cemetery ; i Place of Burial Qatar _ Cemetery } x f oe i, } eat “ t ™> ~ . At-o-~r il ilk IS icaten ° : : Funeral Service at / 4 half Aen . 4 Lot No. r Put in the Dingess one mark like this een * Lot No. Put in the Diagram one mark lik “thi i c ; of 4 ( bp f(r ‘ for every Grave in it. And mark ¢/ = : ; A 7 J 14 4 , a8 i . | for every Grave in it. And mark this a: en i . . ’ est A | ‘ ave > Se ‘e Co or every G e nd n lime of Service } J..E¥% . tr J Grave No. e Burial with double dagger thus: + i Time of Service Grave No L vi ee a = And mark thie Aus r f acet | Date of Interment : Burial with double dagger thus : 3 | te of Interment 1 EA. ‘ f Section Designate site of monument thus: Cc] ke : r i Section ae 5 7“ es Designate site of monument thus: | ] et cea omer Me ~ : anemic ; j = BAS 2 EY So ey Do ERE Fi Af - . ¢ 7 ; J o 0 ] Fa . ' ; : Aa aie earns - SS == a ee map streams el PUPA Neb Candles eas { vans i Casket or Coflin No. Candles | oa ie Sis tS cattery Glevns aK wid | [NS | Size ye Made yy 7 : OM Cloves Y fnr»_— 4 20d i i 0 g ; Set Bearers or ppince aaa | r i Lining and Pillow Set No Bearers or Por A Vb pte oe Whey j y An | 05] P ' i | Hearse to #44 ‘ . | / oO > i Handles Hearse . hun. Ceo AO Se } aA Removal Plate Removal | or Veul : J Automobiles Outside Box or \ ault 9S 2! 3K Automobiles 4 MH. € - ' rd | a } é I | Burial Suit 4 IS sill de 7 v2 3 t | } a / . | Newspaper Notices | Slippe rs J 7s News naper Notices | -| Embalming / 24 |\Oo i | i| | i i : Washing and Dressing i | i i] | Shaving i j : : es | | Services Chai ' Transportation Charges se of Chairs Transportation Charges ee , 4 ves | ox Officiating Clergyman . “ } recta fff fe Vial ff s IPO || Ofici: ating Clergyman i \ : ~ Porc a ; Cemetery Charges || O..o || Amount of Bill Z J. : ey (.emetery Charges yi J 0. Amount of Bill | : j © ep e Music i oy | | Goods Ordered by Music we wtih Goods Ordered by Ie ee : ed | | Flowers | # | ; Bill Charged to : | Flowers i Bill Charged to t eins iiceiiniisiaiieas - macnn einen amentne samitellinas somes aes See a anes rE Eee sce eemseceesereereeanie sesomeneeme DR. CR. DR. oe Sg teres re SS - a sasnneeneennaisimmatiemia Se | | pep pyc O- RM. | 3727 DS oa | | | | | | i ; ree none | | $f -|- re | .“ I} | | . of Ait | - | | P 1} | | + | — | “ a | | | i | | |} | | i i| —> oe | 1 | | | : j | i | LA | | i YA ae | n i : | /| i ; ee #] i} : \j ] | | | } ‘a | || [ Ir | } i eee ; ~ | } | ‘as - ~ — — - = / | a - ins | P | | | iE e a fi ~ —~—|| —_ | | | ! aa oy | | Ld Le | | | | : §'88UE0 BY DORNTEE CASKET CO.. BOBTON, MAGS., 1918 — . eer ene . San ISSUED BY DORNTEE CABKET CO. BOBTON MASS te'8 a 30 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF / f Yearly No. / OA 44 Kh 68 pha LK%/, i td ¥ 7\ a ds ti £4 hither, due oa pslowl ih yidow Or a Date of Birth 1546 / 3 8 Years f Sex Alt Date of Death 194, / So Hf Months ¢ Single (Ye : (Day) | 4 / 7 L Lf Days | Married lL ; é& Ay r ie @ ta 4 ff aut St 4 Residen e Place of Death Maiden Name ie ; A.A i” - hy QUAIL A ptr Occupation ; At ‘# His Birth-place A B rth-plac ‘ Name of Father Maiden Name of Mother Her Birth-place 4 ie ise of Death Primary; t , I r Adpéndary pty ing Physician , Ml , Kesidence.. “""" TL 7 Vieni A bA~4A 5 f i f Burial é , Cemetery funeral Service at x A a No. { | » Service : hime of Serv Burial with dout Gre ive No LY j sechon Date of Inter: Put in the Diagram one mark li | for every Grave in it. Designate site of Total to date. ‘plorver Race ke this And mark thi sle dagger thus: j monument thus: | = ——— = Candles Pe — | f (.10Vves Bearers or Porters ae “yaa ‘ | ficarse to woe } | se ~ 4ll i Ct val { ge Lu bude CRAM AR- fre \J Automobiles Newspaper Notices | { } | { } | { } | | Transportation Charges i | Officiating Clergyman } ig wget Amount of Bill l as is? Good s Ordered by | | Bill Charged to \ } vile — beeen DR CR. ” | 2 a ' t- | } - i | | | | | | | { | | | | | j j } \ j f {| | ui \\ Vv } — i i ees a } j ie a | # | | } | cnegre mores accammanns © naar ‘ 4 1SBUEO BY DORNTRE CABKET CO,., BOSTON, MASS, 1818 weal RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF ~ Gms fer Up. lig v hte halo Sas he we feds itees 70 om! — Wife or Widow of S4y 8 of Years Sex Malt— 19 29 ee 3 Age 4 J. Months | Single i Maiden Name +3 @o. FiLt Wvalig Maiden Name of Mother Hele aes Kk Pr Chueh d Chi thr 3350 PnY a at ‘fy v4 Residence Place of Death Date of Birth Date of Death Days | Married Occupation Saomnts/ His Birth-place Ped reee Co Wey’ a of Birth-place Name of Father Her Birth- pk ace Lateavlle AL Cause of Death Prim Secondary Residence e a cemetery Certifying Physician Plac e of Bur al Funeral Service at Time of Service ‘14 fiers Grave No ao es tee orters rr May vidhsy Date of Interment Casket or Coffin Candles ie aphed oon Jw. gO Lining and Pillow Handles Fae Plate Gloves Bearers or | SG Hearse to Removal Outside Box or Vault Automobiles Burial Suit Votices Slippers Embalming Washing and Dressing Shaving Services Pransportation Charge Use of Chairs Church Charges Officiating Clergyman Cemetery Charges Amount of Bill Ordered by Music (ood Bill Charged to Flowers DR. | | | Lot No } Pirin tae Dh Tota/ to date dagger thu ynument thu POG PS ram one mark hike thi nit And mark ¢/ JV ee 1@eUED BY PORNTEE CASKET CO BOSTON MASE wre 31 33 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Total to date.. Yearly No. FCR THE FUNERAL OF Yearly No. FOR THE FUNERAL OF Tota/ to date ‘ f wo . f Residence 4 oman. H. e. Residence Place of Death hoofs v i - ‘caliei mp " aio a oy Sé b . Wife or Widow of Jate o ‘ears Se Olor ace ate o irt l f : - Dat { Birth | a wa im ears eX oe. 7 ; , pit Pe gaa ¥ & FP Years Sex 4411_- | Color or Race : ge s § Single Jate of Death ‘ J - Date of Death 19 wll 2 Age | Months 4 Single een ee Ga pod \ge) @ Months 9 Single 4U/ JA es ; o . | . ' Maiden Name a Days Married £-—— Maiden Name 2 2 Days | Married W iclou | Fbccupation E e e Birth-place = ec %. W.€ : Occupation as anes guar ere PF _Name of Father 24. Coa His Birthplace Leeoeh Co- H€: ~ >: “e Td ‘ . fe If Her Birth-place Maiden Name of MoMer — hoki A Her Birth-place ae ce Bea Secondary ‘ iia, rth plac e Name of Father if f Maids n Name of ol Paces Cause of Death Primary Secondary . Cause of Death— Primary ; t ie tJ wriitvins Dhvsiatan Residence Certifying Physician er Ua MALL YOFY ctr beesidence { ( . | Place of Burial . ‘ 4, = ~ Cemetery ‘ r Place of Burial Bait Lt “Att < —~ Cemetery i / 5 . . ‘ a, , z 7 ah : Zi lunero. Service at Lot No. Put in the Diagram one mark like thi Funeral Service at fa Leoact<l_- T FUSE LS os No Biot is tha Th 1 j | | Fic lias : d - / > | utin i” lagram one mark like this : ) y Grave init. And mark this ‘ } | ! { : ‘ ge a | S TT sa ssl Le 44 t f < , for every Grave i nul mark the f me of Service rave No. 4 lL Burial with double dagger thus: j Time of Service aK ate. t/f °/e 7 Grave No L aio es ale lig i Aes eee me 0 te? : Burial with double dagger thus H Date af Interment Section es is ki s Date of Interment Section , iv a a 3 Designate site of monument thus Cc] ¢ Vinuiasate cite of saonninann ha CJ Nt1+e0. lan lcod, D oe | j j = at na a en te ~ ~ ss ao | _ —————————————— : = = Se = = SS. — ™ ao RS SS ees os S82 SARS SERNA BE Ta VMN POTEAU Nn ' r Coffin Ne Candles Casket or Coffin No Candles | , Mad Gloves I Size @ ‘ine Made by LW. BID Co Gloves S 4a. Dey k : ; | Y ) Bearers or Porters Lining and Pillow Set No Bearers or Porters | ie ‘ a Hearse to Handles Hearse td parr cal coisas 7a oo | ) | i Removal 1 Plate Removal ? } : } : : o < : ‘J ~ ¥ ' Automobiles Outside Box or Vault C# “@_#€ > IOS Automobiles = . C Burial Suit Ne wspaper Notices | } Slippers Newspaper Notices | Embalming A « 4a Washing and Dressing | | : Shaving || | 4 Services as Chair lransportation Charges NO. | OD j Use of Chairs Transportation Charges Officiating Clergyman | ' Church Charges Off ting Clergyman ee Se | : . ‘“ . LS Charge Amount of Bill | Cemetery Charges 2t+11n¢ VY H+ ale ioe “ OW Amount of Bill cis tee pe Goods Ordered by Music / Goods Ordered by Bill Charged to A | Flowers Bill Charged to D CR. DR. CR i 4, VW ocol ) Ne : 4 /; +f 3/2 eb. A -—\~ O00 ‘ MWY = a J.\cO ; ! ASL UD 4 J-2S | ; ' | ‘ | ; ! A ; y | ile: ; - ] | vd I ; | s | i “ # | ‘ } | | ‘ | | | : Be | | | | | ; | | ee | | il cds cl | i} | se ! | i sai | | | hes | | ” 'S8UEO BY DORNTER CASKET CO., BOSTON, w +. MASS., 1818 ISSUED BY DORNTES. CASKET CO, BOSTON, MASE. te'e } Spm Ne eee cen one Yearly No. f Mi RECORD AND BILL a ITEMS Total to date \ Ad Mteelete ‘ EER PHE FUNERAL j dhe ecg Resid t a Ws LOL ‘be esidence a f J - : ; es ? Ge A lhe. Place of Death (Uf, » (4 C bi Du lid neees Or ife or ag A: yw OF. Ae fst Cele Zoe, ' j Date of Birth § / / Li Lk - Z ms ! Years ot is Ve Date of Death 97 4 7 Ages J Months 4 Single (Ye (Month) (Dey) | , : Maiden Name ‘ 4 L (2... Days | Marries MC1208 siden Ne Cp KM Fs A — : / - A i 4 kL ce ° af Jo f 71 Lg 2 Birth-place j J Occupation Bae. F... —4 | ' pe Sod a 7 Name of Father TALE A C44 ‘ His Birth-place d wt se ar Vs : tt dd hd spoue s Maiden Name of Mother MLK é ‘ Cc “ (OS Her Birth-place LAL =i Cause of Death — Primary Secondary Certifying Physician fy : ite vA nce Place of Burial T/* C vemetery luneral Service at Lot No. Put in the Diagram one mark like thi wa es o | for every Grave in it. And mark / anne pices vis j [~ Burial with double dagger thus : { im eee Y Designate site of monument thus: C] ‘ vt Oo CD! « andle \l Gloves ! Set N | Bearers or Porters aca | oO Hearse of 30 0 Removal | | Automobiles / LIPO de Leted feo e | Newnaner Notic es ee | ‘ Transportation Charges | Ofhciating Clergyman er (thar | /46|2O 8 A A Ui An Uc | Amount of Bill Goods Ordered by [ill ¢ har ved to i a na : “ee hy) o- f Pe i “ 4 ty 56 oO fav rk he Wi : & p: - ti r en oe eam 'S8UEO BY DORNTESR CASKET CO.. BOBTON Mass. tele RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Tota/ to date Aketa an XK ae Residence Place of Death thr 7 ¢ Ae 1~< tT. Date of Kirth or < <> Wife or Widow ot Z#t t Per11 Gace lu A44a ine V f Col | | | Dacha ] < ¥77 a .* a / Years Sex 442 — or gr Race Date of Deatl 19 ' “a 47 “ae ans Ave $ 7 Months ¢ Single Maiden Name : “O Days Married Occupation ee wt < 2 Lbé@Qe A << ~2P-* fr Ri € Birth- -p lace eter + 77: Le Name of Father Jar Pa a0 Kk ob His Birth-place Reewue— a>. ae Maiden Name Mother Prtcsyaty cee ton hated Ber Birth-place a 3 Cause of Death — Primary Secondary Certifying Physician Residence Place of Burial bt pl ki 5" ft f iF >" 7% Lot No. Put the D none mark like thi 2 Grave No Z ? y Ata i \ ’ ; Bu j } ible vert PRG i Ca Cemetery Funeral Service at Time of Service Date of Interment - 2 5 " a . UnceneEeenenEEenNee Casket or Cofiin No Candles Size rt Made by £0 OQ PO Gloves Lining and Pillow Set No Bearers or Porte: Handles Hearse iv, Oe Lt « —<— 7 / oo Plate Removal Outside Box or Vault Automobiles Burial Suit tT Fron 2 Y Ss 7 Slippers Newspaper Notices Embalming PS oo Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman Cemetery Charges Amount of Bill 7 js Music Goods Ordered by Flowers fo oo Bill Charged to DR. CR. ES TT SE ET a, /. RNASE TS mn “ | se AT, +4 Cast— VT) to | / m pee 2 - SJ F Fins A : Le deueo BY DORNTER CASKET CO.. BOSTON. MASS. 1016 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date... Yearly No. FOR THE FUNERAL OF Tota/ to date Jiro, XL ll 4 fbecca fits Rata Mee 4 Residence ALY Y € : Poyt__ ] ; ” Place of Death Wife or Widow of } lace of Death Le a V. Goole “R dA a Eh Wife or W dl ot Uy. Ps Date of Birth igs 7 Auf 3 © 7. Years Sex Color or Race Date of Hirth l . i a | “ ‘Nene chums ries J <= Years Sex | 27 Age 4 J Months § Single a. Date of Death 19 | Age § Months § Single $ | Date of Deatt 19 i 7 jMonb) (Day) | ‘ oS | (Year Bian. (Mont Day i / t Days Married 4— : a Pe ae an & Maiden Nance gah Days | Married 2 ‘ | ish lane j L“r4 ‘Ae ~ *,.: Occupation la : Birth-; dace Occupation 7 Name of Fathe + IE ide CL ack ? His Birth-place e yee ore , Name of Father wah y . & , - eC i ‘ . , ae Jt U Cte Her Birth-place A €. . e Maiden Name of Mother JAA Jeohurcty Her Birth-place pot - Maiden Name of Mother Secondary Secondary feed : : ; econdar) / . Cause of Death— Primary tesidence Color or Race ff (Cause of Death — Primary gf /) r 4 “ : { erifving Physi LL oti mo Momence Residence Ceri:fving Physician -4#? 2 x . Certifying Physician Residence fg Place of Burial /2<-44 ee a a » 2 ee) f . i Place of Burial en f¥< af Forbes Cemetery as : A) AL. i uneral Service at H Cl-Pllew - - Lot No. 3 Put in the Diagram one mark like th Funeral Service at Lot No i F . ‘ i . J : Putin the Diag: one mar ket | mr te 1 _.A2 INN. Grave No y | for every Grave init. And mark 1h ss 3 . =" t © mark ; FUE Ol = - mares < Burial with double dagger thus : Time of Service cf iff: !7/- = 1% ? 7 Grave No . Pfor every ( _ se HG IDAEK 6 rR g2-? insta, | B al with ble dagger thu ; ; , : / : ] ere Designate site of monument thus: [~] Date of Interment x ' Section | | i Designate site of monument th aaa sisudieadeih +3 ; , Candle | pabespe tia ea od Tr aaa — aa ie saa aes ls see f = } j Casket or Cothin Ne FJ2OK xe oo Candles \j | Gloves | Size Made by Gl ‘ seare Ss or Porters | 8 . i Bearer Fort } | Lining and Pillow Set No Bearers or Porter ; | ‘ : earse to | | ui Hea | Handles H aa ‘ 2% Removal Plate Automobiles | | Outside Box or Vault Automobiles . | ? Burial Suit /3? cw paper Notice i Slippers / | : ‘ : i Embalming 24 6-O / | Washing and Dressing 4 Shaving | | | j Services if spp tion Charves | lran portation Charge ie il Ctiates Transpo j Officiating Clergymar | ; lating Clergyman | FFP Church Charges Officiating Clergvman siti acm } - & ¢ mo al A : “ } - \mount of Bill |——_— Cemetery Charges Amount of | : 6 od ds = ed \ | . Ji Z A , Goods Ordered by | | Music snita Cdrvleved his ff. A Viiv. a 'o Bill rargec - . ill ¢ harged to Flowers B Charged t« J Av 1 tA << é f ¢ cate " calceianand i i / rE = ==, pemennence sao an . DR CR. ~ = = semeniinainiinaaeiaealltaiti i aie we) DR. CR. WaAlod Gy OV OV Geckicy D ———_— — : — LY 2h _F Y VW ‘7 OCR AV Ole 2f/)9/ } a ‘ pares (oec : 3 7/n9 |Wanot Pa / } dpbeernnennaremnteasven* sf | t j " ss / f _ I, } ae i . ¥ | i | | | ‘ | + | } | | wal : jj | : ! i ‘ | soi 5 ' | | | e — | | j i | ff | “ Ta i i | 4 1S8UEO BY CORNTEE CASKET CO.. BOSTON, mans. 1910 {S8USD BY DORNTEE CASKET CO., BOSTON MASS. 1818 Yearly No. Residence Place of Death Date of Birth l (Year) Month Date of Death 19 (eer) (Month) Maiden Name Birth-place Name of Father / Maiden Name of Mother Ys Primary Cause of Death Physician Certilying Place of Burial huneral Service at e of Service Date of Interment DR ‘.— Kudtirwec J Ze Wife on Color or Race Occupation ..4 His Birth-p \ Her Birtk-place es prory Be Xe a pence Aeon LP : Cemetery Lot No. Put in the Diagram one mark like thi N | for every Grave in it. And mark his Grave No. Burial with double dagger thus : j i Pree: eiiaisiniaitiing Section Designate site of monument thus: CJ Candles Gloves A . Bearers or Porters | ! & | ~*~ | | Hearse fo $ NN | a Removal e | Automobiles od tp fe ey ” | “ a ilewal Ne wspaper Notices | j | | | | | Transportation Charges | Officiating Clergyman ———— a Amount of Bill es ¢ Se rt Goods Ordered by f - ie Y eo Bill Charged to CR. 4A f4) ! | Bach heed. 7. E. } Jo t--> ) | | | | os | | Al | | | | | i | | | i | j Fc | | 1 i | } | i| | | | | | | att era | oe ae . ma 'S8VUEO BY DORNTEE CasKarT CO., BOBTON, masse . ere - = 39 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF i oe Mg, fi fatwacay Wife or Widow of 2 “4 aah (Day) | Years | Sex ss or “be ane Months 4 Single With tebe overs, Days ii sianaassilliatadad? 7 427 His Birth-place Yearly No. early No. Tota/ to date Residence Place of Death Date of Birth lor or Race Date of Death Maiden Name Birth-place meng Ling. litho Maiden Name of Mother Her Birth-place Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial Cemetery l'uneral Service at Lot No I ? D am one mark like this Time of Service Grave No Vi Gr in And mark th . + Burial with double lagwer th i Date of Interment Section a er Des nonument thus co —eeeeren renee ase —_——e ' ; Casket or Coflin No Cand! Size Made by Glove / 12 Lining and Pillow Set No Bearers or Porters Ze Handles Hearse & ° . Plate Removal Outside Box or Vault Automobiles Burial Suit ef, Oto Y oo Slippers Newspaper Notices Embalming Washing and Dressing Shaving Services Use of Chairs Transportation Char I Church Charges SPLIT ASMA VIR oc Rcsctls te yy ia metery Charges & AO Amount of Bill md icine A : ; : > x Lusic Goods Ordered b 7 oO Flowers Bill Charged to fe... DR. CR. — Se CNRS ALTRI TAO DE Eonar . " a - nea eaee ad 2// X/e = Aa * | é / | ( / | } | | | | | | | 1 | om | | = | j j | | | id 1S8UEO BY OORNTEE CASKET CO... BORTON MAGE 1816 set tesa J ae 40 41 | RECORD AND BILL O a - RECORD AND BILL OF ITEMS j / ota/ to date... ; Yearly No. . Yearly No. FOR THE en OF S y ae FOR THE FUNERAL OF Tota! to date § pe Linen “ aa a , | eK © /ncck — L | of & [. Bhat 10° / , Residence # / ttn. Residenc : =“ : AL _ oar W ife or ¢ idow op/ Mee ae Place of Death Wars 4. Mien i Place of Death om coe: Wife or Widow of f Date of Birth a. fess Lope f 62 Years Sex Bets Date of Birth t ‘ 3 Year) . : hs ~) (Month) (Day ears Sex 4 } Color or Race a : en ae , « Sincle : Date of Death 19 2.9 < f Date of Death 19-4 vy Z Lo - Age f Months ingle gl aD (iemth) ae Ages Months ¢ Single J A laiden Name L 7 Days . Married - Maiden Name i iM ha 1 “ yo 8 arries | | Birth-place reke g a /.. Occupatio Be BZ x Birth-place GLa Lo . H. F . Occupation ne of Pathe EE ff His Birth-place G EL te _ = Ms " Name of Father ju c ie so Bi pee oe. f) ; Name of Father : His Birth-pla € H AZ ( prt AO Cid j . . T c > ‘ : ttt on News of Mather Lthzed- & es Birth-place Maiden Name of Mther acl AX] Her Birth-place “©... aie S ' (cause of Death — Primar ‘yy Secondary +“ Cause of Death— Primary Saniniart ‘ vine Physician ~~ Residence Certifying Physician DQ oa. “ oes Ma Bit Hositence an At Raial ogee wag Cemetery seca Place of Burial. Ce 5 ef, ed a Cemete ‘Of Ly “ q emetery a ee luneral Service at — § oe ‘hol 444 L4KAY Lot No. Put in the Diagram one mark like this Funeral Service at Lot No. Cowen 1 : | for every Grave in it. And mark ¢his es a ‘ t I ne mark liket ol Service ieee ¢ J Burial with double dagger thus : | lime of Service Grave No. : : ’ An k ee e1 date of Interment Section | Designate site of monument thus: Date of Interment Section [ee ” | ee Ted &) — | ee - ial | Casket or Coflig No. Mab - nore, i| Candles . Casket or Coffin No 0 @ my wy eo 7 - go Candles | Sing j Nin pares t v/ \ Gloves | ze Made b y Gloves : Lining and Plow Set i i ’ z Bearers or Porters Lining and Pillow Set No Bearers or Porters a 1; KR AL jf Je 0 | : “ eae / Ha COV EE VUEK K. , ® OO g O Hearse to | Handles Hearse t Aero <= J id t H Ov. VLE . Removal I Plate Removal | i / | ‘ | Ba, so) yr , / Automobiles Outside Box or Vault Automobiles } : Z fs Ly / | } i i Suit es f~ 4 ¥S|00 Burial Suit } / Co 4 k ! « Uk ha vlescal Thad: Lo? | Newspaper Notices | Slippers Newspaper Notice | i mbalming ; 3 i sing Vashing and Dressing | a ; i | a ing i | . | ; if ices i i 1 : | of Chai l'ransportation Charges e of Chairs Transportation Charges t Cl L a a i, Officiating Clergyman . Church Charges Officiating Clereyman . J * WV | " ‘ LUE ges Heal 5 t a ooo ie { ery ( Yveve — Vout Ae § QO | Amount of Bill = s a dc. Cemetery Charges A mount of Bill | es ? * oa ! . in 3 519 oO Goods Ordered by Le Ae ce : / e Lt Musie Goods Ordered by ' 7 | ) is © | Bill Charged to Plowevn Bill Charged to | DR. CR. DR. CR. a 7 ———e a ie a. > . - a prreerae pate EN NT SE —e | \ | 3/1] 2 pe JS ZS |or ec I. Y/2) I, yp He SY Ie } \ i / | / i f | ’ | 2 | Z Cael JG ifs & 4 } | | a | | j > i | ce 7 — h iV | | | A t ; i | a | | f | r » eines | | | | } | ie | | } } } | | | j } | | I | } P i | | | | A | | |-——I ae = i | | y | | | 5 “ j . | \ i ie ui a fia | | | _ | —|—| : "4 hi —|—— J Bis | | 1 ! . . ' Seeman om “ awe we: : ; | | ey 3. 1S8UED BY DORNTER CASKET CO.. BOSTON, mase., 1918 | = 1 _— yaa ISSUED BY DORNTEE CASKET CO, BOBTON MASS. 1910 v 42 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS ase ip@ueDo @Y OORNTER CASKET CO., BOSTON. ‘ Yearly No. R THE FUNERAL “2 Total to date Yearly No. R THE “a OF Total to date ; 2, | rh SIA MORK euih FT: bans (C0 -Sfreihn | ao ht. Resid em Residence : ; esidence _ . 4 Ay , yp Thileles Place of Death Laleauchle r e a 7 o aa - 3 un~ W He Os Widow of (Mae AA VAR UAL SMH (hls CKgierw - . t + ¥ ‘ ‘ Date of Birth I [ J Years os Cplor ae (Maenth (Der Years Sex /V a i | Color or Race (Ye (Day) | e ay | . F + ik 3 2, Date of Death 19 MR OL- i a Ages Months 4 Single — ie oe a tw dges Months 4 Single —. (Yer) J ss (Moot day) | 5 Lb Maiden Name , “ L Days _ Married \ </ ear | Maiden Name a. | E. Days Married t; QU we \ A Birth-pl <A AO overpssion POL AME A— od 55 — = Birth-place U ULWG) MA \ cs Occupation sirth-place , = fO * - eo > . Se — Ly \ Nan iat Mathes u- YO His Birth-place Chih Ke - Ne « Name of Father Sau acre UA His Birth-place MM ‘ amc 0 ith Y/ / (- la hy i * " ® } : : : Maiden Name of Mower PRG Ve Ply Her Birth-place AR, — {rade Maiden Name of Mothé nM | Qu. ’ SM AA Her Birth-place / Wu ALL f oh Cause of Death — Primary Secondary Cause of Death Prima fa} j i} Secondary - | { fying Physician Kee, Ce rtifying Physician ~ WUA Residence A> hk oe ‘ pac a | P f Burial TAI cee Meroth . f Place of Burial Cemetery . j eee j j ; ¢ } : CALM . Pe a lee ; luneral Service at [ot No. | Put in the Digan one mark like this Funeral Service at C Lot Ne; Put eD ne mark lik | . i ‘ Mi. / ; | for every Grdve in it. And mark this ae. ees \ ij * ‘ SS / | for every Gr And mark lime of Service Grave No. ‘ Burial with double dagger thus: 1 Time of Service e CALA Grd J Z B pee . rh i Sass | ate O arme { f") $ectio Date of Interment WY a 444 Section [ Tiesignate site of woonbinent Hits: Cc Dat f Interment Akg =f yy Pe tion [ Destin } | ] j i | | | | * mabseras omen = es at T 23 | niin eo es or ah ee 2 = Se es es a - f) | . . . } r Coflin No. ¥F a. e : lo v VO Candles Casket or Coffin No. Candles Made by Gloves | Size Made by Gloves Me | v Set Ne | Bearers or Porters | Lining and Pillow Set No. Bearers or Porter is | a > g Hearse to | a Ho C Handles Hearse t@ F { Removal ees — Plate hemoval | Z } 2 ' or Automobiles ; > X< | i Outside Box or Vault Automobiles j j } | } ? Buria! Suit t i } Z / \ Newspaper Notices Slippers Vewspape : ' a | | | . ; ~e |OOO | | embalming ‘ | Em balming y Fy | | | y Ak | Washing and Dressing Q j j | * ~ seine \ / } « a | Shaving f j Y i } | Ser es | | ; : ' Transportation Charges | Use of Chairs Transportation Charges } . Officiating Clergyman | Church Charges Officiating Clergyman ™ “ ; ( tery ¢ Amount of Bill ar, d Sg 2 ‘ Cemetery Charges Amount of Bill - 4 pty z ; Musi | Goods Ordered by e Mas nr. | | ata, Goods Ordered by : | ers | Bill Charged to } Flowers Bill ¢ barged to 2 wt Yh. Sa oe ee DR CR. DR CR | . s/a | oe ed ee 4 | oie pao oe ae JV F.00 ; LG {Uy ( ~4 —_ - lS Qo : | ae nea i : ag | -| | : i || - ¥) a | i Ky F J : a | | f 3 a a f 4 \~ : F | | , | | | I : j a * | A ' 4 | | —| fo i | | | | | i / ; | } YW i i} ' Jf ) | a 1) f } ! / i eee ( | i ' “4 om - | | iciiiihiihatiea hid {| | | | ety 'SSUED BY CORNTEE CASKET CO.. BOSTON, MASS., 1016 — 1918 i i : { I - ae Yearly No. ’ “y fla a. [h4raeree Residence Place of Death Date of Birth | (Year (Mouth) Date of Death 19 (Year) (Month) Maiden Name Birth plac e FOR THE FUNERAL OF “OLet Wife or Widow of Days Occupation - / J 7 / tL — Years | Sex Months 4 Single q Married RECORD AND BILL OF ITEMS Tota/ to date Color or Race oe AND BILL OF ITEMS Yearly No. Residence Ate > 32 FL —_ paxre- ih ~£ 1S - (Year) ey Place of Death /® | ho (Moath (Day aft a3 «Day jp Mlnenth Malin ee Date of Birth Date of Death Maiden Name Birth-place alo UNERAL pers LR. Aone cn ty t Wife or Widow of D¢ Years [a 7 | Age 4 . Months - Days Quill Co 7 7 § Single < L Married £ Oc ‘upation His Birth-place Total to date Color or Race wl Name of Father His Birth-place j Name of Father Maiden Name of Mother Her Birth-place Maiden Name of Mother fanny Zeer ve ceg He: Birth-plac i Cause of Death — Primary Secondary Cause of Death— Primary Se Aer | Certifying Physician Residence Certifying Physician oe pean Residence : : Cemetery ? Place of Burial ania Place of Burial : Lot No. luneral Service at | i Lot No Putin the Diagram one mark tik Grave No J c Sa ; ith i ibk . hayes ese Fa salbyisill Put in the Diagram one mark like th Funeral Service at . . for every Grave in it. And mark si - -¢ . Grave No. ! Aes Time of Service | Time of Service ¢ Burial with double dagger thus : 1 or L sctio Date of Interment Section Designate site of monument thus: C] ; Date of Interment 1/ anh r| — | oe cr Des CI } 4c 09 €@0°> Candles | Casket or Coffin No. Jif a. ass ail i L al Candles ' | | , Mad . Gloves | Size “4/3 Made by > J® GO Gloves : I : ra r . Piftow § , Bearers or Porters | Lining and Pillow Set No. Bearers or Porters rod Hearse to ..4 re aatero 7S |? © Handles Hearse § ae i a R H ; | Removal | Plat meres Ne i : a 4s . cs Automobiles Outside Box or Vault pom fe Z LO Antomobiles i \ 4 ei +$ | Buria! Suit | Newspaper Notices | Shir TEMepayer a Pcs | § iGed i 45 (0 o | | Embalming - eared i | . | I Washing and Dressing | 1 i eo. Shaving | i 4 pork + Thicke ) 0 } || Riis | ae aie , : } \ Transportation Charges Use of Chairs sransportation Charges Officiating ( lergyman ‘ t Church Charges Officiating Clergyman | & We & tery Charg 4 i\ O |} Amount of Bill . os ‘i > A } Cemetery Charges Amount of Bill } | or ’ , ; ' Miusin } Goods Ordered by | Musi: Goods Ordered by i ' Flowers “Oye SO b Leo« y 4 1S O} Bill Charged to i Flowe: Bill Charged to seme srtersenetanstnmnmcenstannnnnelinetneeieenenteattfiammmartanmnaseanseeumnmmstsunacntinies aestntt a penennsacanee Sh ade i Sai siniiinenatinnicitasietin ; va i CR val CR. DR RCN OE ee ke , | | f/G pg I CS ae $26 si ie Y/ay/r7 Ay: Barc ‘6 LO } \ | i | woe pm ) Soa So _ il ee yrs 2 i é, | | amet 228 = | | —— | | a of | | : a. | | 1} e | | : | cael / i | i i | | “i ‘ | . t | | 1 : + a, — ‘ J = | } } ' | pe : | j | i} } | i | | | } | | I } i Ls ] ; | j | | | | : a i | | i] 1 | | iy | | | [oe oe h | 7 : = ‘| | | - | a 1 | | | j . wit |_| Ld | | | = | | ‘ 198UEO BY DORNTEE CASKET CO., ROBTON, MAGS.. 1016 5 lasUEO BY CORNTER CASKET CO., BOSTON. mace. 1018 Yearly No. am«—, Si) Residence Place of Death Z RECORD AND BILL. OF ITEMS FOR THE FUNERAL OF Total to date. telenr Umer wb ae Wife or Widow of Date of Birth l # Years Sex f Color or Race (Year) (Mouth) (Day) Date of Death 19% : 27 Age Months 4 Single (Yea (Month) (Day) Maiden Name Days Married Birth-place hu, Occupation Name of Father. _ Pov lepase His Birth-place QD Maiden Name of Mothenaezad Ea “/ Her Birth-place ae © Cause of Death Primary TU ce Ue i asctilal ey reriga Ce ee Certifying Physician Residence y 4 . Place of Burial ens oti Cemetery i ) { uneral Service at No. \ ‘ luneral Service a Lot No Put in the Diagram one mark like thi: lime of Service Grave No. | YY | for every Grave in it. And mark si 4 Burial with double dagger thus : 3 ] Date of Intes.aent Section { [ Designate site of monument thus: j 0. Candles | \lade by Gloves i| | det | Bearers or Porters Hearse to Removal L Alara ase. ZA. Automobiles ae ; Newspaper Notices | a | | | | | | | | | { iH Transportation Charges Be ( Officiating Clergyman | ery ( es | Amount of Bill Music... Goods Ordered by | f Flowers Bill Charged to . . penclesiiitan ual a aes so DR. | : ee CR Li | a20e4 _ ok ie ’ i i} - |\Oo ; ip | AAS 1 | | | | | | | | | | | ; | e | | i| pis | 4 | i| | || | P | | | oa re | | | = — | : | | ca as | i " i |—— je | | | | tf i || } e | \ | ; } | | | il | : | | 1] | F } \| {| i | | | | | | | | | | | i — - | j || : | Fr - ! | | ce je ; i] Fi | | ee oe E l| or aap eats — | | saint co | 'S8UEO BY DORNTRE CAsKEY co., BOSTON, MASS... 1918 RECORD AND BILL OF ITEMS : FOR THE FUNERAL OF UT tx Lhlbar (—teiv Aaa No. Yearly Total to date 4 KA k [fy If dh / 6 ‘ LB / e é Ln 5 Q wl Od 3x c 4k Wit or Widow of Bag Ae Lhe ater Mlerieee 4 ep ttl- 1g $7 an J i Sex Jaa x J or Race Residence Place of Death Date of Birth (Year) (Day Color Date of Death oF wb; dQ ioe, lous. | ; ote Maiden Name ¥ Days Married (f/4AP Birth-piace Ae Behe Ze h 4 £ ft ( © Occupation A 2 Zz 4 “ Hrte P SS Name of Father é “i altar. < f . eee MC LG Birt Letece ltr (Ce : Maiden Name of Mother COLLLG FTME Her Birth-pla ta, LHe atilhle Lr 2 Cause of Death— Primary 5 anaatdiny Certifying Physician (5 > iB ag kk A +8 £4 ay, —— Place of Burial & MW He ; 40 AO J Funeral Service at td rad T ey tai N ieee tae ameiiilnt Time of Service ee 2 ( 4 § for every Grave init. And mark th , é Burial with double dagger thus 7 3 Date of interment AL ; { i ee gO +7 Casket or Coffin No Size Made by Y F Lining and Pillow Set No. Porters Handles ays Plate yee | i Outside Box or Vault Ay T f ? i 25 OF biles Burial Suit Slippe: Embaiming PC Washing and Dressing Shay Servi i Re a GREER ee er ss, a de epee eet ere o| 1 ee ah Oar een Church Charges Clergymar eee eed Cemetery Charges Bi al et e. ; eZ Musi 0 Flowers harged to DR. CR. wv. | “| ene ; : tf Lea < = {2 PD { \| ° | | | | | ISSUED BY DORNTEE CASKET CO BOSTON. MAGS., 1816 i | | i RECORD AND BILL OF ITEMS FOR THE FUNERAL OF ea CY. Mee Ag Plann 2x, .- 77 _E Place of Death (t4#0<<€2+—€ - Wife gr Widow of j- Date of Birth 1 ae e O Years [ Sex f Date of Death 192 j Size ~" 3/ Age aa Months oe Maiden Name ci ae ae ‘ao? Days ae Birth place 7 Name of Father Vf. Aaa fpae’ Maiden Name of Mother Yearly No. Total to date Residence Color or Race Occupation . Ais Birth-place AC & . er Birth-place 4A. C AK seq wt, hocks Cause of Death. Primary ° ° i ‘ yj p V ‘a ifving Physician. (AYA te AOE LA 2, Residence Place of Burial AVEC LY fr2 Ltt Cemetery ‘ f : l‘uneral Service at sf e Lot No. aa ; . Put in the Diagram one mark like th; ra ae 4 3 A af } ss? J (ieee Ma. | { for every Grave in it. And mark ¢/ a Burial with double dagger thus : Date of Interment Section f Designate site of monument thus: | 4S SSSA SS ls SESS om n No “4 Jb & L Candles | J JZ < ) 7 € f>, Made | } Gloves | Bearers or Porters } | Hearse to £7 Removal | at Automobiles | | | Newspaper Notices | | I} | } | i} } ; I |] | | f Chair } | l'ransportation Charges | harges \| | Officiating Clergyman ( ru | i , ery Charge | (mount of Bill | SU i t || | ene ge tee |} | |! Goods Ordered by | } : hiowers } Bill ¢ sharged to sesmiieennientnisnintin inclieiianils ssineinel cities il seecenmtnincenes hone DR. — ane NNN SORE eee = smesceeeivere ec SE Sore ¥. CA. Fe oy fy) 7 C) ty ry ty 7 a4 v « Ota sa NN 1-9 ¢ : 2 tase | | | i| { | i] ait vont | | at | |-—] | } } | | | | | | =~ we ammo | 'S8UEO BY DOANTEE CasKET co BOSTON, MAS®S., 1916 << rte RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Dy JSprmes sFAL A Yearly No. y Total to date Residence Place of Death As omntoad: 1. rs Wife or Widow of C4 yy CPi ro / f Date of Birth £49 ; 7 PD \ 7. (Mout = ears s ct | olor or ae (Year) te of Death 19% f ; | | ome 7 A J Mouth) é Months Singl J pie / Maiden Name y; ; Birth place a Name of Father Maiden Name of Mother Cause of Death— Primary y / \ ms = 6 4 Certifying Physician ©. > Monte AX ie } Le oe — 7 re. C5 Place of Burial PPC nr Comet 47 f Funeral Service at ; S Time of Service tf 77 ° e he " aa oie se i th : i Date of Interment (i _ ars 7 Mar prune Tl hPa Plas y cot thus: [I] Casket or Coffin No nile " Size Made by €é fio Lining and Pillow Set No Hand § Ser eet { oe Plate Out Box or Vault ; Burial Suit Jato a oe Sent Slip; Embalming Washing and Dressing Shavi on Use of Chairs Church Charges Cemetery Charges howesobien Musi Flows emer — DR. ; maerny 1s8UEO BY DORNTEE CASKET CO., BOSTON. MASE tee _—, : Yearly No. sf 7 fi 4 hd J Residence _ RECORD AND BILL OF ITEMS ¢ 4 s Place of Death ' f Caf Date of Birth 1Q2'f (Yeon) Date of Death 199 44 Maiden Name. / Birth-place Name of Father / Maiden Name of Mother... 4/ “4 if | Cause of Death Prima i ¥ f Ps} Certifving Physician j Plac e of Burial luneral Service at lime of Service Date of Interment (Whar) Ita if U4 (Y I 4 Mi rs ea seer aeeesnonameensnes DR. neers | | } Tota/ to date fe 4h h — ag Win 0 er. - a e Nad Sex mi ae con Ar. a4 GY Months 4 Single (Day) a [ lc Days Married fet. Cp Air Race UL Years —— Occ upation “9 hry 4 { His Birth-place jeg de i“ Ly } fi > Ail ; fer Giis Her Birth-place a dl / se Secondary a. ff Ae my ¢ - . 7 c . re WE Aayel PEP Aerrde fH Residence fat f / Cemetery Lot No. Put in the Diagram one mark like t] b | for every Grave in it. And mark sh; Burial with double dagger thus : } "1 | Designate site of monument thus: Cc] Grave No a Section Candles Gloves | {| Bearers or Porters | Hearse to | i‘, | Removal | Automobiles y Newspaper Notices | | 7 ransportation Charges i e | Officiating Clergyman 6} | Amount of Bill | Goods Ordered by f r LH (fecklsy Bill ¢ hese sd to “ey” z 7 “a | | i| i] 1] i] | 7 | } * , | —_ J . | 7 & | 1] c i ee . 7 | i es a | | if od | c , é | i j ig 1] | i i e | {| | I ee | f | | / } ; 4 | | / | if | : ~ > | i '88UGO BY DOANTES CASKET Co... BOSTON, MAGE... 1018 RECORD AND BILL OF ITEMS Yearly No. Residence Place of Death Date of Birth Date of Death Maiden Name Birth-place Name of Father amin A Maiden Name of Mother... Cause of Death—P rimgry eas Mt »* Certifying Physici ian“ . ie iO. Vee. _/4 Date of Interment bY vs Place of Burial! Funeral Service at Time of Service — Casket or Coffin No. He Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault ” Burial Suit Slippe Embalining Washing and Dressing Shavir Serv Use of Chairs Church: ( harges cee ) Cemetery Charges Mus ic Flow: SEES DR. | | WS Sal ghecs FOR JHE FUNERAL OF fy i \sis ‘ Wife or Widow of Dey Years f Sex “ ) | (Day) Age Months § Single Days Married O at His Birth-place > 1 R irth-p t N { il € 4 | s j ered by lto W/l Ao Cay f + 7 Tota/ to date ~ we eid fiss £27062 hemp Color or Race } ee - | vn hoe Put in the Diagram one mark like this [ for eve Grave in it And mark this Bur dagger ) nt I hus { ] sor rn ae sara aa ; Bee ee j | i u ‘ phigh stitial : } enentenmentlieneyes | Semeematgest, CR. 3 Ld = ~ eects acme uneceaeneme “¢ x g o-< ~ | — | } | | | | " | | | | | | | | | | / ; j | f ome | | | ’ sea AE | ’ ; 1@OUED BY DORNTER CASKET CO., BOSTON Mase. 1818 ! it ; Se pinsmemanene pecans AO S ’ ag RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF irfacnd am 4 V2 Yi7taa hate, D. awk Residence L Place of Death Ae sero coret Wife or Widow of. Date of Birth 1972 7 Freres Zz i f Years Sex I a (Year) te onth) (Day) 7 Date of Death 19 af ZS Age Months 4 Single 7 (Moath) (Day) ' Maiden a Z--... Days Married Birth-place Occupation Name of Father LA tipple bes,)) \ Jat His Birth- place Tale. .. -— <—: Maiden Name of Mother a her L La bf Okey Her Birth-place Y Primary Secondary A427tt, // / ‘ is VA ees Cause of Death Certifying Physician Residence Place of Burial Cemetery ; l'uneral Service at Jee > Lot No. | Fe i ; ; / I for every Grave in it. lime of Service “77 x A v, oe bbq Grave No. Y Date of Interment a Section | veers} Candles we Viade by fz iS oO Set ! || Bearers or Porters 1 Ctr ¥ Sa i > Removal Gloves Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Tota/ to date f [a GPG prussh,) Color or Race CA Put in the Diagram one mark like this And mark ¢h/s Burial with double dagger thus : j Designate site of monument thus: CI] o-~x) ery Charge Amount of Bill | if Mf | Goods Ordered by J - e d | Bill Charged to a sie | |__|". 9097 | Ze covey 20 | | sae | 7 — : | / Oo Q | | |__| | | | I | | } fee | | i I | | | I i | a | | : es ae | } | i | | i | + | | | | | ~ i 1 | | || | | —_ - — | a Ea | | | Sr eae ed 4 | od | } ertipieininneall iacaikialkc be Le 'S6UED @Y DORNTEE CasKErT co. BOSTON, wase., 1918 1s aed ameotiateoane xis Yearly No. Residence Place of Death: Date of Birth Date of Death Maiden Name Birth-place Sutil a Pst 7 2, Name of Father JLa Fee | err Maiden Name of ate Pde Orde Primary Cause of Death Certifying Physician Place of Burial O SES. De Ce = Funeral! Service at a. Se rs. . Wrar oh 23 Time of Service Date of Interment 1$6 0 / 19 2. 5 ’ ¥ (f ( Age § RECORD AND BILL OF ITEMS FOR THE FUNERAL OF ( forrs P22 aw ¢ 2 Ladera Wife or Widow of v4 Years Months C7 (Year) (Moath) (Day Kat) (Mo ne Single tem 5 } | Days Married His Birthplace M-.©@ > Her Birth-place YM i © Secondary 3 Occupation Residence : cemetery Casket or Coffin No Size OL Lining andl Pillow Se Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers DR. aa ts No. 7/4 Se ,* Fe cies ta a I for every Grave in it J $ ee Burial with double u ut] Sxeitan Ca | | G- TS os oe Zao Oo Candles Made by io Gloves No. | Bearers or Porters Hearse @ D-®&> 49 —~—<-<> Removal Automobiles Zid. OD \| Transportation Charges Officiating Clergyman & Vo Amount of Bill Goods Ordered by a Bill Charged to 1 " ISBUED BY DORNTEE CAGKET CO... BOSTON. MAGS... 18916 Tota/ to date lor or Rac ° Put in the Diagram one mark like this And mark this dagger thus ent thus { ] f > ne CR de ane Yearly No. QAQLM«, Keakteuwe < Residence ty pee y VV Place of Death j . : ; f Date of Birth ie #7 7 7 ear (Month (Day) Date of Death 7a * ‘ OS (Year) (Month) (Day) Maiden Name Birth-place Name of Father . Arte A Magee : v4 (44 f/f Maiden Name bf Mother fe Primary 7 Jat A -O-Ck , Cause of Death Certifying Physician Place of Burial. CL il Service at , ~ervice liowers AANA A SEEN ES aT Se DR. re eS ee mers mn et . Wife or Widow of [ Years Sex Age Months 4 Single | Days Married Occupation . 3 ‘ 27 i) His Birth-place oe eg Her Birth-place Secondary Residence Cemetery ‘Lot No. Grave No. sinisciatl een aie Section Candles Gloves LY Bearers or Porters Removal Automobiles Newspaper Notices Transportation ( harge s Officiating Clergyman Amount of Bill Goods Ordered by Bill ( tharged to | I I | Hearse a 2 I RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Total to date Color or Race Put in the Diagram one mark like this And mark ¢hi Burial with double dagger thus : 1 Designate site of monument thus: Cc] | for every Grave in it. CR. 'S8UEO BY DORNTER CASKET co... BOSTON, MAGS.. 1818 Yearly No. i} / /y Sang deat a) WEN Residence ~ Othe Ee A i Place of Death d. Mie Lae ‘ Date of Birth l Spl ‘/ £4 (Year) imei Date of Death 19 8 —— (Month) i Maiden Name Q) Qos Birth-place TYCALL x Name of Father a Tt oe Maiden Name of Mother < << R : Cause of Death— Prim, y A Pie Certifying Physician se me Place of Burial Jabs Nae Funeral Service at Time of Service Date of ‘gery = Li Y WMGer } Casket or Coffin No Size é&. Made b Lining add Pillow Set No Hand! Plate Outside Box or Vault a ? Buria Slippe: Embal: Washing and Dressing Shaviny Servic: Use of Chairs Church Charges Cemetery Charges er Music ; Flowers DR. 1S8UEO BY CORNTEE CASKET CO., BO 3-4, 49 fy aatt 4 7. 55 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Tota/ to date A ‘ e or Widow of Years Sex Color or Race Months Single ad \ TCO Days Married “4g Cin whe ee r a a . py U ll Put the Dia 1 one mark like thi ! ri vy Grave t And mark this I l lagger t} ht z | * La tices on Charges Clergyman sili | tical ents ry > ~ 7 {, 2 iedeced by fn Aivag, = 7 { edt an “ ae 2 wexssomnerrs STON MAGE.. 1818 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE ns wed Do i faue Afz FOR THE FUNERAL OF Total to dat he. / 7 Aplin PBAAc/ 2 : Residence : k 4 ae 2 Ord A ¢/ : OK 7 Mey ba: a a: “srg Residence. 2 aay le A . e. se SG tn / A f L “ é : Place of Death OAL DLL 4 Cs ¥-) LALMN Ah me ‘idow of... Proves Place of Death Posie a e i : A IG Sy Wife or Widow o} ; s Years Se E<ce dl, Fg Color or Race ; Date of Birth 1 ¢ Bic . 2G { i Date of Birth votes £ ‘ a é 'S (Yees (i @nth) y (Day) ‘ . (Year) (Mouth) (Day Ve Years Sex oo Color or Race Date of Death 1942-4 | eee Bile i Months < Single Date of Death 19 - —_ Y a ae Be es AZ ad B tf ° (Year) ion - As Age 4 Months ¢ Single a 4 i Qt ... Days 44 LL oe Maiden Name : Tota/ to date... : Yearly No. Maiden Name : a Days | Married t/ { Birth-place Ve he A ‘= 2. Occupation .. Renee ede Birth-place 7C- & Occapation i} Nina at Mabhine Pracek L - if His Birth-place B , 22. Name of Father fad Lene 2°88 of ee ties His Birthplace “7. (4 H | li C Off wv cht — Her Birth-place Bite A e_ Maiden Name of Mother Pe LALLE Wa. LRALD Her Birth-place as ° Cause of Vie Pamary Secondary : (aS eases : Cause of Death Primaty Sacteiiiiies Certifying Physician hecinalin Residence es a ae Lr sie Certifying Physician Residence : A ; | i eer ee A o Ly oh Cemetery /\ LOY Cecucl, ne Place of Burial Garrat « Aurch, Cemetery luneral Service at LS hhh Lot No. : Put in the Diagram one mark like thi Funeral Service at Lot No. 5 H < eee ‘es /) 2 MW/ ies oe oe 1 for every Grave in it. And ore thi Te of Ratvice Crave No ‘ ! viegiaohas eo ee Burial with double dagger thus R Fateh dacis Surial with double dagger thi Ao / “K. secti ai] Disia of Tokeement Lit ly of a Section ; Date of Interment Section i / a 8 Designate site of monument thus [ ] / | Designate site of monument thus: Cc] os | ; / 43 a : = apt farsa = aS a oor SSE i siete siete eae auf 4 firL al tr ¢ Cantina : . uae Q, te ci aaron KC re eR BI ) iin INo / ' / ra . -andies oy te Casket or Coffin No “a , 7: LC 6 FO Candles ti ; i / Lf : , | aa P H a | Med bs | FIOA | Gloves apy a O#EO Aelliors TASTE, Sie # Made by Gloves ‘ || / »P « ' CLs ue . loves | ii | Pillow Set No.. | Bearers or Porters f ‘ daeoack Lining and Pijlow Set Ne Bearers or Porte : ) i we. | ‘ fe . 4 | bearers o1 orters a i ii || Hearse la € Bex a, | Jef GO Handles Hearse to Ts - > : “ } . a 4 lLAn-w < j gw | - | t Automobiles 7 H Outside Box or Vault L Automobiles i Burial Suit Dstt “ : SO 1/6 ‘ i| ‘s i oo see a Stippers ~€-t1-4A 47 <1 te oe J é oO Newspaper Notices 1 c i} A} 4 | 4 £ | ea ; : i Fe I? it ¢ a 7 WO Embalming pen SA ID | | | | ; } | | : |! Washing and Dressing ; | ; I | i ' Shaving a Services i wa | Transportation Charges Use of Chairs Transportation Charges \ h Cha , } | Officiating Clergyman siciiisiadtalicii Church Charges Officiating Clergyman bis aos eaaped ¢ i a . Cemetery Charge K¥8e ag f VAC — v pe oi \mount of Bill alain —— sities emetery Charges Amount of Bill LEG gq | , Mi ! Goods Ordered by | Music Goods Ordered by in | te We | oe Bill Charged to Flowers Bill Charged to : ; DR DR. CR as eth Pena eer renee rere Te ae sep aii : : x 2 . HI A it | as al | | | | | | | ood 4 | | a } | oe | i cd | a ce ce | i ae | | | i BS | i | Pee -| \| 1 si J i} | | | / i | | ~ | li | | | i. to. | | pare poe j . ae V } | oe ee | | | =e am | 4 | I } | | | | | . i cm | : i a —-| | Le | | ~ J — | j (S8UED BY DORNTER Casket CO., BOBTON, MASE., 1018 ISSUED BY DORNTEE CASKET CO., BOSTON. MASS, 1018 9 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Total to date. Residence” 7 Place of Death Birth place Name ol Pathe: Maiden Name of Mother Funeral Service at bow 2- V7.€: l d Wife or Widow of Occupation His Birth-place Her Birth-place Place of Death Birth-place Name of Father _ Maiden Name of Mother _ Nn © Occupation of é ©—/f- 2 -—<wveges, His Bigth-place =. Inte | a 2 Yearly No. FOR = OF Yearly No. FOR THE FUNERAL OF Total to date y / ~ a ti YOd24p tt PD SEP Rect ert Soret trfa--T darn leben ue as p2eco . Residence J Le 3 Wife eR of Date of Birth [ Years Sex Color or Race Date of Birth 14 On 2 62 FIN : : (Year) (Month) (Day) f (Year) (Monn) | (Day od AN Years Sex | Color or Race Date of Deatl 94-4 paty a M Age Months 4 Single Date of Deat! 94 “ coh i | pei tases 1947 fawn 7 af S wise 6 cst sa (Month) x Age ) Months 9 Single ) p : » . | Maiden Name Days | Married . Maiden Name Days | Married 4.e- ms . rth-place ii Cause of Death—Prioary Secondary Cause of Death— Primary Secondary t Certifying Physician Residence Certifying Physician Dei. Phe Residence ' Place of Burial aenieny ; Place of Burial “A 7 oe Cemetery Lot No. Put in the Diagram one mark like th Funeral Service at ; Lot No. | isla the Daseiitictateabaie lime of Service " | for every Grave in it. And mark ¢/ Grave No. : ; Burial with double dagger thus Time of Service F2fr+>?- 1 GM. And mark this Buria! with double dagger thus Grave No. L | for every Grave in it | : bowen Secti y SP a " ° . . Date of Interment eoten Designate site of monument thus: | Date of Interment ° Section ] [ | f Designate site of monument thus eo + | - A EN nT D Enea ee ’ 7 oars = sme oe =o Tre sony cass serperie eae x a sonecatatN ; ; ( les | , ; : Ei ( N Candle | | Casket or Coflin No /O . C2 Candles | + | i ; as } } Af Aw fix oves & | 7 . si Made b Glove Size Made by Gloves | i - | | | 5 tf , i | i eiaiaiehaia aus Ri ai aces ae : : | ' nd | Set No Bearers or Porte ahd | Lining and Pillow Set No Bearers or Porters Bt | > fy . | 5 | arse Hh” VEYA Ze | f Hearse +6 LEAK A | | | Handles Hearse to 4 ' acid A ee Removal {4a dA A | | Plate Removal { a r | | i is f Automobiles | Outside Box or Vault Automobiles 4 | a ; | | ; Eee 4 b | ij | Burial Suit ( | pers Newspaper Notices Slippers | mitt - | | Embalming i } | | ; ; i I | ‘ashi »ssiny i | | Washing and Dressing if | } Shaving EI i i oe iy : a a ; | Services Wark yp A ley : ak 1 | a . ¥ | Transportation Charges | Use of Chairs Transportation Charges $ | : h ¢ ves Officiating Clergyman Church Charges Officiating Clergyman Oo (oXS, : . ; 1 i ; ea | ; Cr ery Charge Amount of Bill fs 7 Of Cemetery Charges Amount of Bill ae imei i Music | Goods Ordered by Music Goods Ordered by ; i | . | 1 : I oo ee cca ss ss i Bill Charged to Flowers Bill Charged to i = eee aE ni eanabaaie stasis aensneemneesentene i R. CR. DR. CR. ue. ecco eens aeemenes - - cervaern: “zones sassenneiiaiaeeeiiinatlidaamimeditinemerie danas at ne ear i | 1 | | | - | | | : | | ae j | | | : | | | i| } | } | I | i A; \ rH : {| | i i q isd } bi i si | "| i | | "i ; pee ] | a \| | tsi { ' | | bc | | | ; ' | | poe al 4 a | Par i] t i | | D7 | | | ey y e~ t oe | i} | a | q ’ | re a 1 | ry fe i y | | we | | _ | ! sia | | = | | apes yg, } } | ‘ and 1 | | | aw | | | | | | i Mi i ul | | | | : | eee - ce £% ee ee mre vOr, GARG, 100 1SBUZO BY CORNTER CASKET CO.. BOSTON. MAGS... 1816 61 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date... . Yearly No. ai 4c cna ides dies Jtus. Choa Pda Webfer | : jo Jel Residence wie apelin. HW... ©. : ee f) MhenTB yz} ee - 4S, : Residence , WY cad Ht ) vk, oe. Sn Place of Death ~ LL Place of Death Wife or Widow of é 5 som A pee a a 1859 Neh ; S g f 7? Years [Se fat,’ i ele nn Mana Date « 3 Jleot= ate of Birth ] a a wa. cide’ inte | ex Color or t Date of Death 192-9 Ctx // Age a Months 4 Single : Date of Death 19 ate HL n J of M Sinel j ae ene (Yea (Month) (Dey) : (Yea (Month) (Day) oe | Months 9 Single ) aiden Name L JZ Days Married . 4 q Maiden Name Days Married ad : pea coment fs Pm ass/ — Jot Prank Pahars rth-place 4) Lhe Go Occupation Birth-place R,. (go 3, Birth- -place Name of Father Deavi WV 7, His Birth-place A: &, ie Name of Father P ad . of ll Maiden Name of Mother Per rorelen Veh, Her Birth-place 71 - &. on Maliien Name of Mather a Birth-place betta bot enrgh~ A @U I Cause of Death — Primary Secondary vee | Cause of Death—P ay Secondary Residence Certifying Physician * . 23 > ved i rf 0 | ‘ ing Physiciz : . Residence Place of Burial Cemetery piaoranee : Place of Burial eee femetery | Certifying Physician : | 4 i ecfock pe Funeral Service at Lot No. Put in the Diagram one mark like thi Funeral Service at = OQ “as No. iss is thai Diesen cee eek a ol | | | for every Grave in it. And mark this { t | k th . . * Time of Service hf. No | ji for every Grave in it And mark this 7h J | Grave No. a omena te £ Burial with double dagger thus: : * 1) Burial with double dagger thu | Designate site of monument thus: CI) . Date of Interment Section | Designate site of monument thus i. taf P ~ oO i fime of Service Date of Interment Section ; Casket or Coffin No. [X : “a SO PD) Candles | . Casket or Coffin No thal } tLe O OQ 0. Candles q - “J Made hy SF L Gloves Hi Size Mad eb y Gloves a face 4 -N —a i. A OQ oa - ' ) || | : : it vm er Bearers or Porters i Lining and Pillow Set No. Searers or/Porters & s | i . , {| an S » " 4 i{ Hearse to WLP. ‘_ I Q2 eo Honties Hearse to eect pho Vea, J&\lo2d i ' | | H j Removal | Pl ‘ Re al | | riate Loi Re/ remova ; Box or Vault Automobiles : 7 YW; aA LL € 1S O 00 ! oe 5 sf eae - Outside Box or Vault Automobiles | | | . C. | : i | i > . r Burial Suit i | E i 4 as | Newspaper Notices Slippers 1 Newspaper Notices d - ’ Hy t om 1 I Embalming 4 00 if ‘ {| o i \ : | 1 ; Washing and Dressing Fs | i | Shaving /) nA” Vee A oo | ' = i KA hf V heyy. Jia i {| | i Services KT | i| f Chair ue ransportation Charges Use of Chairs Transportation Charges 1 / i | , . ; 7 irch Charges Officiating Clergyman | Church Chs g a L etl 50 Officiating Clergyman idee ‘ A f “- ' Cemetery Charges | Amount of Bill _f02/|eo Cemetery 4, Leet if Amount of Bill Nj CGA SO | ; } 7 ] Music | Goods Ordered by fe afi v€.l LU al Yeu Miisic ee Mh {i | eae ? te ' Seen) Beare een I “ a odo / Via htice } A. Ne. Flowers Bill Charge . $e : _ : sues ss <= * Se aed a DR CR. DR. CR. i 3 RS , i ‘ ee seistiiicaieaddeaiaticeaianaieia coal : / 1G ' : H* t fF » J f ‘ t | , Pd Fheaa_& | a ‘ i, fu { 4 | ——_;—_F__ = 7 A a | “ a ae | ~ J S allt ¢ . |] 1 ~ | | | ] t . ‘ges i al | 1 4 | nth i } Hy “| ti j | | / ‘ | —| Hy i | / : i 3 a | HI ag” Pre aa 1 | | if | : yf | a 'D 7 1] { ee i re - | ' I t j aa | } i £ | Bd | i , J | A : | —— he ~ . Po ae ae ‘si ‘a Mea: + * i 1 i ae | / - | _ _ | he aie a . # # i] | } f | | | :e = \ ‘ | li ; | f | i] | Fi ' ! i own #4 (SUED BY DORNTEE CASKET CO.. BOSTON, wass., 1018 tapUEe OY CORNTEE CASKET CO.. BOSTON. MASS., 1918 4 oe ae RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEM Yearly No. FOR THE FUNERAL OF Total to date.... _ = Yearly No. FOR THE FUNERA a ' Total to date Residence a Residence Place of Death Wife or Widow os. Place of Death .. Wifg or Widow of Date of Birth Years Sex Color or Race ee “ Kirth l a ae re f Ye on ie Culee itis Date of Death Age Months 4 Single adapta Date of me 19 244 AALS af hes / Months 4 Single Y fjoketr~ | Maiden Name Days Married ac ses lassscstesseh aie cog Maidin Name (} se ne ae 1 Birth-place NI REION inser acca see aso ncagaiganeee st Birth-place K Eh }o 4B 7 ¢ ts oo : as : a . Name of Father Yo is Birth-place Cor. cotet. SC - . . Name of oc 5: ¥ Birth-place phar. Cé SY, A Cc | af Maiden Name of Moth Her Birth-place van Pre Tsenne Maiden Name of Mother r Birth-place A of i Cause of Death—Primary Secondary ah ll cs tno osnihb Cause of Death—Primar Secondary Certifying Physician RMON a ascents iol etcee sence pry sisenes Certifying Physiciz an Kee Residence Ope ten tee, EEE | Place of Burial Cemetery cseeseeenneneesenessssssninnnsnan Place of Burial Fede NALA Oph. metgr Huuke, , mR Lot No. I'uneral Service at Put in the Diagram one mark like this Funeral Service at... tq Lot No. Put in the Diagram one mark like th LL I for every Grave in it. And mark this Burial with double dagger thus : 1 7 Designate site of monument thus [ ] Time of Service Grave No. Date of Interment Section ee ; | for every Grave in it. And mark (hi = sb : / i ; Y Burial with double dagger thus : { Time of Service \ Cia ? a Grave Wo. Designate site of monument thus: CJ Date of Interment Se ke i ee ion fin No | 25 Oz. Candles Casket or Coffin No i I/~: HOY Candles Size Made by 4Gloves ff @ poomeniiniamtical denice A ln OT ay i Made by Gloves >A rere - Pp > gig ‘ . ? Bearers or Porters Lining and Pillow Set No. Bearers or Porters y 4 ‘ U i } / |. || Hearse to Handles Hearse to. lUdAdtey Ake 5, a ' | . | PBT Removal Plate Removal ~1 ¢ ta Rte. i : iH Automobiles yore Outside Box or Vault Automobiles HOX OF \ ! } SORES ees hekedek aabdant f 7 A : i : araeave . . r Burial Suit VYC-Uf » cee. + gj | ; : i | | Newspaper Notices | -STippexs_ iad. “ ae Newspaper Notices | Embalming FT) 00 f | | ; Washing and Dressing : | | . , Services 4 | Fenmapertation Charges | Use of Chairs Transportation Charges i ~~ } Charges | | Officiating Clergyman ie, Seen Chasah Charges | Officiating Clergyman ef metery Charges | Amount of Bill | a Cemetery Charges Amount of Bill if f ’ nae U2SO ! : on a | r | ee my , | . Music Goods Ordered b¥ re PAA AA, dd, ne -_ yf ce ete | a Fi Pee os 3 DR. CR. DR. CR. i ieee eee aia ieceasoaheiibdaaideiilideaniiaiae dace a ssobiciaaiail : . es - pcan - | iy © 2-127) aL ty th fy | 247 o> | ence I. a4 UA o oun. £225 © H | | | | | | | | ; | | a | | | | Me i ' ‘ } | : | 1 a | | ne ( | Th =| -_ | L | | a | | | Ns | | | | | | —_ nt se iiishaaieee aa a — | | | } | | Per og - agi i“ , i ~ cuneate <atememstenenneeasesenenst el y iin ; 1 | - —4 | | j if | | = a | | | ad | canoe Bei 1S8UEO BY DORNTER CASKET CO., BOSTON, MASS, 1018 ISSUED BY DORMTEE CASKET GCO., BOSTON. MASS.. 1816 ere ante RI hn ci tei ATE OS: Yearly No. Residenc e Place of Death Date of Birth Wirbh-- RECORD AND BILL OF ITEMS FOR THE FUNERAL OF ( Y LoOre 4 ee : Se ade. Wife or Widow of f Years Sex (Year) (Month (lay) | Total to date... Color or Race ‘ t ae iain Date of Death 19.7" bt A | @ Age Months 4 Single (Year) (hoapo) (Day) ‘J Maiden Name : Days Married Birth-place Occupation . Naine of Father His Birth-place Maiden Name of Mother Her Birth-place ise of Death Primary Secondary ‘slat Certifying Physician Residence Place of Burial Cemetery Funeral Service at Lot No. Put in the Diagram one mark like this a ke Cosco Noa. | 1 for every Grave init. And mark ¢/ Burial with double dagger thus : + Date of Interment Section | | 1 [ Designate site of monument thus: | ( bor tol \ Candles t oe | Si Made |) | Gloves | Pi k( Oo | | Linirs i s Bearers or Porters | | -~ -“ | — Han Hearse Qe 4-22 | #84 lee | | P Removal : Box « [Toa L902 | Automobiles Newspaper Notices a f ; f, / J | f \f A | | sone f \ i | f ce | f v f 1 mw : me f 2 go Transportation Chargeg f rye | Officiating Clergymar CL a t rz 71+ Cemetery Charge 6 Led | Amount of Bill boa "y a \ | ! —, Musi | Goods Urdered by Ban aie ee DR. oer Sa Sener: Flowers eval | — | au (oe _-S~+2A4 Bin Charged to oe a CR. | 7 | | | | | | | | - ad | | | | | = | | | |——| | | = F panes | I | | oe | | i i I | '@8UED BY DORNTEE CASKET CO., BOSTON, Mase., 1918 ieee a i “ RECORD Yearly No. Fir Mu Residence Place of Death Fititiintlbnciia ioe Date of Birth l % Y 3 (Year) Date of Death 19 eI Maiden Name Birth-place Name of Father Ohiloa—ol. Lacle Maiden Name of Metter ial. / : Cause of Death— Primary Certifying Physician At: —, IrN“-C2 Place of Burial FOR THE FUNERAL OF oe a > ae +9 Age ! ¥ Car2hn—a_ AND BILL OF ITEMS Tota/ to date Wife or Widow of %E Years Sex 16 Months 4 Single 4 = Days \ Married Upandaut Occupation His Birth-place Re bLithe~_E s A - o.. Her Birth-place Eaves. S$ o eS. Secondary Color or Race so Residence Cemetery Funeral Service at . a . J Lot No. Put in the Diagram one mark like this Time of Service Grave No. | i | for every Grave in it. And mark this 4 Burial with double dagger thus : 1 Date of Interment Section | Designate site f monument thus: [ } Co. 4 Casket or Coffin No. O.© '!orR.) Candles Size Made by Gloves lining and Pillow Set No. Bearers or Porters Handles Hearse th Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers J Newspaper Notices Kmbalming y Y Washing and Dressing Shaving Services Use of Chairs Tratisportation Charges Church Charges Officiating Clergyman Se Cemetery Charges Amount of Bill btclesimamiinataiia Music Goods Ordered by | t Flowers Bill Charged to | a oon oop “Ln NERO mae eieenieaetiaaiaes a DR. CR. eo = os a = nceeeneegenemetipenfioaee AEE (SESE ARS COR EE aR DUS Had of > fe ata ance aeenene a eel ee 1s8UED BY OORNTEE CASKET CO... GOBTON. MASE. 1618 65 a ce Cel RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS : Yearly No. FOR THE FUNERAL OF Total to date. a Yearly No. f FQR THE FUNERAL OF Total to date j i . ee ' arck- | ae ~ barks Ubhxaules 2a) a 6 3 7 MZ en Residence 4 - { | KA ow 2? < I | mapa een: i D “f . (\ » / . f (Fann a Wife or “ idow of / Aace of Deatt ; at f A, ff ‘ ene ek . . 4 = t : : : i : f 67 Y Voors as x g XK nits. Date of Birth 1~IO ad — = q aon Sex THU Cutie wii ate of Birth J =) oush) (Pay) } : ath , an Moth) (Day) “s \y Yate of Death 19 ge ¢ J soma thu Date of Death 19 ; a4 L Age Months 9 Single , a, Date of Dea 4 ] f Age 4 8 Months + Saji ; bye . " (Vey) | | tinned / / i I Place of Death XT dL (LEA Wife or iden of a (Year (Menth) / : Month 4 r ‘ | t Che —— wre rt .. Days Married Ue 7 Bosses. sees Maiden Name . yy. , if : u 19 Days Married ' : \ Maiden Name . \ & / Mill 4 j ee ; i Rirth-pl Occupation. . Birth-place ee a? tH we 4, Occupation . irt place f i ¥ Baei A E ; S “se wa | N f Fat! His Birth-place ' Name of Father £4 af VY AY | QO , His Birth-place A CLA KL CA... ar ; —— a o , ' i - 4f? J ‘i ee Her Birth-place d Maiden Name of Mother a/ Z VG FL ‘IE ¢ Her Birth-place EE / ee ' Maiden Name of Mother P C j | Sec vs ‘ause of Death— Prima >A f Secondary i Cause of Death— Primary Secondary... seven : | Cause 0 f) <n it epee i . / ; wal id Wark. DP : c Certifying Physician NY Ss PULA FSO \ Residence lithe I ¥ = ‘ — _— 22 Pe, Cen é . +. Jer 1 y a . Kel { Certifying Physician lnm ty Kesidence 7 g ) i} PI £ Burial it : or Cemetery A Place of Burial LA fi Mk f Prisca Cemetery i lace O uria - ¢ . I; ! > if Pur } Service at Lot No. | Put in the Diagram one mark like thi Funeral Service at Neds Ai AA Reece Lot No Put in the Diagram one - like this i error ; 7 in j for every Grave init. And mark i/fus d . a : : | for every Grave in it. And mark th: es eae wry Cee Me : Vi } lime of Service Gf nee 7 ee 4 = P.M Grave No. 4 V Burial with double dagger thus: ¢ Time of Service - ty! e. 7 mare oe é L Burial with double dagger thus : J ‘ ‘ af . ~ ° . ie ae » > { ee #] Section = & ] } Date of Interment ies sf Section Designate site of monument thus: | Date ol Inte rment ate C4 f A ” ” ] r Designate site of monument thus i ee Seip Meee 8 Sc EE i semi ISS re en scans mame Tae ae x i‘ i i Ri Candles bcd A Me fe os Casket or Coffin No £2 ©.€264 Candles . Fi j { et or Coffin No j q i } f.. oh Le a Pe PP a Le é i | Made hy Gloves i p o hyh ra qf hs vw size Made by Gloves é \ i : ee eg i : | ee 4 , 1 | S \ | || Bearers or Ponte rs ( | st j ining and Pillow Set No Rearers or/Porters iL | Linin und Vill N« | | - | | : 1 Hearse to he 7 vhun OA A | cr at Handles Hi Hearse to. kA | la | | L temoval : | Removal{ |....W Ae Plate Removal p OA; ta ft LU- / eT, ; . me ; | Rox or % | Automobe) NE. SL WW iw CL wind | e Outside Box or Vault 4 &S Automobiles | Burial Suit ' lati : aH Newspaper No es ‘ rs \ | Newspaper Notices “). & : | Slippers | ewspal tic i} | I KA Aare « MAA : : ; i i so LP sane TE RPEN. “| | Embalming . | 4 | i} ne o y "aa | ; cae i " i § i | i] Washing and Dressing ; a ‘ | iI ene | . f { F | | Shaving J H | | i | Services / E i MOC es Chifves j / is } om . , | rr nS CD, - ansportation & 2 Y f id | { | Transportation Charges : Lise of Chairs : Tra isportahio a j 7 t - ver . | ' , Miciating Clergyman f sesiichsamsah saesliiail ih ® Officiating Clergyman aa Bee ok Church Charges Fag Officiatin; exe = Ae ryves ° J oe a 8 / 1 { y Z ¢ ' : | 7 fj i ) : cs ‘, ‘ ‘ Bill i At AP a i? retery Charge - | | Amount of Bill — Sa Cemetery Charges | f ’ }| Amount oy’: J 5 vy C u | Goods Ordered by ae M é Goods Ordered by Music oot rderec | We Bill Charged to : Flowers | Bill Charged to Flowers Soa jill Ae, REE Reese 5 Tenet i Se RR oa eee ee SE: Lo RE as = om it DR & t DR. eee at Sa a a . = - 7 aces Ht | 10/3/33) (24. Ce. -—'d|_ BO ee | \| : ij ee oe Sa ee receeraiienetaeet ‘ ; | } } \} | | i ' i i i| pose - te } | i : i i | } \\ > i | | or LY } | ivsigplleels on | ; } | \\ 4 ¥ H | | i| : a ' | a i snocemneenmnnanaiiygetllinan * eh j ie | | | | . | | | | } ; | Stall | ; i . ' Hi i| j i i =| ij | | | a | | i ae | | ) 4 | i | f | | t wal { | _ - mi tH } Beg —| - | | | it | | me TON. MAGS. 1816 188UEO BY DORNTERE CASKET CO.. BOSTON, wASS., 1918 (esUED BY DORNTER CASKET CO., BOP ve Residence Yearly No. Place of Death, 4g (1/10 = RECORD AND BILL OF ITEMS FOR THE FUNERAL OF / fleece peu Beh a J/ pGaiden Wife or W ar of F // $f q ¢ “Wt Ages ...-$. : Yo Py yell; — alley Total to date... } Date of Birth 1O Years Date of Death y, 19}. lb, C o Months - pm Oe ‘4 y, Maiden Name / ip ; CU sf Je vO “)? Days bees { Birth-place ) ‘¢ ul E( 2 \ ANE Occupation. o f ; f f ; ole " ke (é : Name of Father 1¢ ‘ é ILL fe ce v: His Birth-place & ££ GAL & m3 - | ‘ ' } ¢ 2 fn o 4 7 4 Maiden Name of Mother /) ¢ bn £ aie Her Birth- place ne C. KL. LA er Fh oe Cause of Death — Primary i Secondary Certifying Physician Residence if Place of Burial Cemetery i 4 Funeral Service at Lot No. | Put in the Diagram one mark like thi i ; es Cian 3 | for every Grave in it. And mark th: i Time of Service rave No. , Lr Burial with double dagger thus : 7 ea eT t S 2€ ; ; i Date of Interment ecton r Designate site of monument thus: "| i wena . Tae ; oe | - i ( n é . f Candles i) 4 sft : ; | i ; | er iP we j We - {7 e i MI Clowes (of v4 ANNES fite) 4} i si ; | S Bearers or Porters , / > f 5 A i Hearse to ii “yd tz, [we BtrAv4 N Le \ a \ Fi = Zi u Refepvs alf \_£ OL plat Bek ; _ } 4, . ” u/ WW] 6 i. as ae 7 \\ ; o Automobiles | } | ' | ‘ I | Newspaper Notices 5 ; 4 i} ff I| j o..1 6 | : | i ; | | i 1 | | | é Jd ae if | | t \ f / | lo ll LY, ‘ ~* | Transportation Charges i iy ’ panic, Officiating Clergyman, ~~ : LY j 1, - j/ sf / | Aur) i} ry Chargé € Amount of Bill ji A \/ / e | me Se ; | Music Goods Ordered By ZX f | | i 7 } Flowers | Bill Charged to | = - sae SN DR CR vases si c fl i " } \ | | | . | | | i A ; | | | } lj j - tt : | ] ae | | | | | | | | | t ‘ } \ | | I F | \| | || | | } \ | I| { 4 | | | | | } t | = | | i : . | hie , al uscd ciinclnitl | its | | } ea Nie <a eee " 7 | se i| | i 198UED BY DORNTER CABKET CO. BOBTON, MASS. 1018 Yearly No. Residence Place of Death Date of Birth \e4¢9 (Year) l9a¢g (Yea Date of Death > "OR THE FUNERAL OF Tota/ to date La La - aa on sakeiiee iia Doe i ee ee ] Wife or Widow of a . 18 Years [ Sex | Col 4-O Age 4 Months ¢ Single Maiden Name Birth-place Name of Father ae Maiden Name of Mother Cause of Death— Primary Certifying Physician Place of Burial Funeral Service at Time of Service Date of Interment ee isket or Coffin No Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault Kurial Suit Slippers 'mbalming Washing and Dressing Shaving Services Use of Chairs Church Charges Farews eas Her Birth-place nn el RECORD AND BILL OF ITEMS (Day) Days . Married Zu eee @. Wf. 2. Occupation His Birth-place Secondary Residence Cemetery Lot No. Put ery Grave 117 Grave No } L a“ < lurial h doubl Section Candles Gloves Bearers or Porters Hearse to Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to | ee 7 | Cemetery Charges: Music... Flowers DR. | ! — j | i j 1 | | ead | wy ~~? | | P ® \ } } | + ¥ | | A ‘ | wri NU er at A “ta > | | | “i | i| “7 { ieSULO GY DORNTER CASKET CO, BOSTON, MASE. 1018 n the Diagram ee 69 or or Race one mark like this a at And mark this vwer thus ent thu CJ CR. — i | ee eS i enon 70 ai ce = Salm ES Te. RECORD AND BILL OF ITEMS Yearly No. UL Le Be +n tL fFyoz = hitideuce’ 1h b0 - (Year) (Month Date of Death Map 7O (Yes) Maiden Name " (Month) Birth place ¢ Residence Place of Death Date of Birth (hy 4 hie JO (Day) ae Cc 4 L wl CD War aa le eas, OE ptee Ais Birth-place Z < Name of Father Maiden Name of Mother Get Her Birth-place Wife ¢ o7 , Ly ERPAL OF Widow of Total to date... Sex pial.’ Years Color or Race Months 4 Single BEL, ve Days a a Married ian, —— Tie ee , (Fs I ee ee Uta uss vess Snasteeenn aE Ce { use 4 a 4 . ‘ause of Death — Primary GL (4, xe wh y Certifying Physician : () fi y £ aie : Residence rejo0 I) “Leest fle. * Place of Burial ( Z fii he o ? Cemetery ( ‘4 7 2 42 2 Me / T funeral Service at é at € 4 iv Lot No. | Put in the Diagram one mark like thi 4 7) YALL”; . 1 | for every Grave in it. And mark ¢/: | : sna A ie ie yrave ‘ . ‘ i Time of Service ¥ re = Grave No 4 V Burial with double dagger thus : { es > ie ae | : Date of Interment YC / 7 section | | =6Designate site of monument thus: ey or \ ee _~ — = # . = é FP} | Casket or ¢ n Ne i Fe C Candles \ | os I eg BNC Peo ro S l"Tfearers or Porters ‘ j j , | ~ my ' 4r,shats \ | | Hearse% DEAL MAC aS “Te Tey IVa. | | “ f Ar \ Removal ' 4 } j Outside Box « Automobiles i | Newspaper Notices | | - Wy | ; |_- | | | | pn || ; } Transportation Charges harges 4 i| sd Officiating Clergyman | le te ? Re ELIKS Cemetery Charges” \ 1 Amount of Bill id : Music ; I | Goods Ordered by / | } ] lowers | | Bill Charged to | | DR. CR. " oa ORT ES TTS OTN OE TREES Ts ratte mm SVE SE SS wa | if} % act Ly (den | | | tA - | | 4 : U | | | | 1} ] \ \ | oe pc ss } | a | | i} I | j | | | | 4 | } }} || | \ | | | i ———w ! i al _ | } - { { ul \ ul 19SUED BY DORNTER CASKET CO., BOSTON, MASS., 1016 Yearly No. 3 \ i Residence [: ) LA: Place of Death aoe 77. a hy M/AMA\ 4 RECORD AND BILL OF ITEMS FOR THE FUNERAL or ) ; j om jp hy Tota/ to date Neen een OI LALA Wite or Widow of CLA i Laps, Date of Birth 1d afé 5 ee (Year (Month) (Deb i/... Years Sex { Color or Rac Date of Death Ud Oo ka eS (Year) onth) Dey} \ge Months § Single é — Maiden Name “V . Days | Married iA { CsA coe py ae Birth-place AV MAL wo, Occupation } a ‘ a I , Name of Father ; ee. ae ee ft Mis Birth-place ’ uu ts uy Jd Maiden Name of Mother-W rey As &, id Laer BIM-place Cause of Death—- Primary Sensidery , he ‘ ; a Certifying Physician /~ we ue Residence : . A a ’ Place of Burial Cf ye hd ‘4 Cemetery i tes tel Funeral Service at 4 Lot No , sa ta aca edit ty aoe, Time of Service ry Grave No i I Ans k th i ' lager tl Date of Interment e : Section : : : eo ae aes omens eee DS ee fia Casket or Coffin No CK POAY H Candles Size Made by Gloves | Lining and Pillow Set No Bearers or Porters Handles Hearse to 7 4 P Remoyél Outside Box or Vault Antomobiles Burial Suit Slippers yh Newspaper Notice : Embalming fw / } Washing and Dressing Sbaving Services Use of Chairs Transportation Charges a Church Charges Officiating Clergyman Pa arene, a Cemetery Charges Amount of Bill ha Music Goods Ordered by Flowers ’ éL. & 7 f LM bn Bill Charged to : — = dgcvme geri —— ~ ~ — : ~ : DR. CR. Bal _— dip -ayonrnenqageguemeernases it | } ff f ~ i i : + s - i ’ i ‘ i ' ; | ; H ta | a ia | a | | f ; Po ; ia | Y . f jt i i : (he beh ? ; a it | | i } | i | il i 1e8UFD BY DORNTEE CASKET CO., BOSTON, MASS. 1418 anil ¥ ssh =o aul Eh Ae: AIO a nena iste ati as tie lain. <2 RECORD AND BILL OF ITEMS Yearly No. ears LparlotHe . Residence Place of Death Date of Birth ] (Year) (Month) Date of Death 19 (Year) (Month) Maiden Name Birth-place Name of Father Maiden Name of Mother Cause of Death— Primary Certifying Physician Place of Burial! l'uneral Service at Time of Service hha fe BG Date of Interment FOR THE FUNERAL OF Wife or Widow of...... Years Sex (Day) Age Months (Dey) Days Occupation ... His Birth-place , Her Birth-place Secondary Reside -e Cemetery Tota/ to date... Color or Race Single Married Lot No. | Grave No. Section Put in the Diagram one mark like thi I for every Grave in it. And mark ¢/), Burial with double dagger thus : # Designate site of monument thus: eo Casket or Coffin No. Candles tt Size Made by Gloves Lining and Pillow Set No | | Bearers or Porters | : ae ‘ | iA# @) Handles | Grane to”. ALL - pile Rese tre | | late | Removal | Jutside Box or Automobiles ull i] | Newspaper Notices | oF mm | i | va | | I | er es | | | Chair i Transportation Charges | hurch Charges | f a Officiating Clergyman | eva | Tele Cemetery Charges | * te’ &"'| Amount of Bill | t l| Musi I Goods Ordered by Flowers } ] Bill Charged to DR. | | a [af hes — “I 2 ha -| fer) i | aq a eo | | - if | ; : 2 eb “ | | 7 aa | | 1| | | y | | | a me | | | | Pe “| Y" | | i | i sal aad < } ] 4) j } | | | = i fig Gas | oe a | {| i] ap j a | | | 4 f | sae | . | | — i | me | | — } ae a oe | A en om - _- 4 —|——— | — sccchaieiillcala Mm | cee } i —_-- ee a i ee =n - . | —— Po [—.--——————_—__} | i | (S8UEO BY CORNTEE CA tT CO., BOSTON, maAss., 1916 Nees —— RECORD AND BiLL OF ITEMS Yearly No. Wn Conma. Mhewrtt/ FUY Lye Ado NOd, Residence... / Place of Death Date of Birth 1 9b4 é (Year) (¥ eas J (Day) Date of Death 19 ccf J y : Maiden Name Birth-place Kavid Name of Father Maiden Name of Mother\. a, Gv lweca Sebvaci 7) Ltd LU f Cle tod Cause of Death—-Primary Certifying Physician ; Place of Burial Uy (LU Od Funeral Service at Time of Service Date of Interment Casket or Coffin No. ie Size Made by Lining and Pillow Set No. Handles Plate Burial Suit “7 Slippers Embalming Washing Shaving and Dre. sing Services Use of Chairs Church Charges Cemetery Charges .. 2. Music Flowers DR. (Month) os “Le FOR THE FUNERAL OF Mz, LO-F- | LL, fegd eee ke act 3 Wife ox W i a A ‘ “KH? aX Years Sexc eee cale Calon up tleie _ Ages a Months 4 Singl thee, ff KUL / ee ieee . Occupation iff His Birth-place /L€ Her Birth-place re Secondary Ka phr \% ls 7 y Residence (“Cetcele f / Cemetery jf Lot No. Grave No Section Candles Gloves Bearers or Porters Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill ¢ tharged to = Ee IS6UED BY DORNTEE CASKET CO., BOBTON. MASS... 10°8 en Sse Total to date ge a 01th ig DAP—# ‘ oy FULL I Diagram one mark | t (srave in it And ] e dagger tl { nur +} ke this aeons RT 74 RECORD AND BILL OF ITEMS Yearly No. J FOR THE FUNERAL OF _ Total to date.. X€ pa AIer stl ft. 4 Residence. Place of Death Wife or Widow of. Date of Birth... 1 Years Sex Color or Race (Year) (Month) (Day) Date of Death 19 Age Months 4§ Single (Year) (Month) (Day) Maiden Name Days Married Birth-place Occupation : Name of Father His Birth-place Maiden Name of Mother Her Birth-place Cause of Death—Primary RN sh iiinccaceses citi mame et ea Certifying Physician NI ei cs Ue may nt tee meaaey Place of Burial Cemetery Funeral Service at Lot No. | Put in the Diagram one mark like thi Time of Service Grave No. I for every Grave in it. And mark j Burial with double dagger thus : Date of Interment Section | 1 Designate site of monument thus C1 ssi | Casket or Cofhin No | Candles 4 i} | | Made by Gloves | | Set No | Bearers or Porters : } i Lf E A 7) | i Hearse to ~?. 18-441 § a AO) | / (AMhe ' Removal ‘: Vf Lf 4... Automobiles L22 a A on ) } I eae Newspaper Notices i] | | ay a | i | | | | | | i | i | ] [ool | i} | Transportation Charges I | harges | Officiating Clergym: | | iciating Clergyman = Cemetery Charges I Amount of Bill é / + ; || _— Music i| | Goods Ordered by : | a‘ Flowers | | Bill Charged to | DR. '98UEO BY DORNTER CAsKat CO., BOBTON, masa., 19 Wife? J + Reaecnatane 2. segment Mone emenen A asmtiemaccametn RECORD AND BILL OF ITEMS FOR THE FUNERAL OF j = Yearly No. Tota/ to date ge nonmenaoeyi k, ; < AA 7 ’ ‘ - \ o / ‘ Residence.. fir — GS-4 f Deatl f { oa . 24 Cis @ ; : Place of Death 454 “if Pia Wife or Widow of Date of Birth 167) fice ee f wee ; itis ad Heat) (Day) | “Years Sex | Color or Bese Date of Deat ‘SEL. af 4 2 (Teg) (Moni), i Age 4 Months 9 Single J « y ' ; ‘ | } Maiden Name Ky ; : Eitt it oe | Married : v? é x ot ( : , Birth-place J SP se ee Occupation Name of Father tc $ > His Birth-place . 1 Ra Maiden Name of Mother/\/ Her Birth-place Cause of Death—Primary Secondary Certifying Physician io Residence ‘ Pe CE. : Place of Burial tf. f Wok Cemetery é f Funeral Service at “4 d b hbed bat No. : e it in the Diagram one mark like this es is { s a Time of Service wohl Ciuace Ma. I for every Grave in it. And mark this B louble dagger Date of Interment VN Section : - D f monument thr e { ] == SS a a ee Wee ses es 2 RE om a lg ee * se rg cans BS Casket or Coffin No. Candles Size Made by_*~# ey Amt Gloves Lining and Pillow Set No. Bearers or Porters Handles Hearse to Plate si Removal heen Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Notices Embalming | sale 5 ae ! Washing and Dressing ee) | — r Shaving ri Services Use of Chairs Transportation Charges Church Charges lie Officiating Clergymat ae oe -p:] f ” Cemetery Charges). Lat Amount of Bill nicnusicagtemilo Music “) VY (OS Goods Ordered by Flowers iY Ls, yt 4 ABU] Capped 4d, bb cae oe > ’ Petr & erie VS anne eee ianaaatel indiana ae aeons io a Se Sart ~~... DR. F CR. | | | | | 1S6UED BY CORNTEE CASKET CO., BOBTON. MASE RECORD AND BILL OF ITEMS Total to date... Yearly No. f FOR THR FUNERAL OF ,— \ “Lh Pe ff Zo 7 (7 live ferrell SB nn ii Residence i Place of Death Wife or Widow of. i Date of Birth 1 Years Sex Color or Race f (Year) (Mooth) (Day) Date of Death 19 Age Months 4 Single (Year) (Month) (Day) | } Maiden Name Days Married L ¥ ii Birth-place Occupation fe i Name of Father His Birth-place 1 Maiden Name of Mother Her Birth-place ' Cause of Death— Primary Secondary j Certifying Physician Residence ' Place of Burial Cemetery | al minha « : : 4 luneral Service at Lot No. Put in the Diagram one mark like | : lime of Service Grave No. I for every Grave in it. And mark ti { Burial with double dagger thus : Date of Interment .. Section [ Designate site of monument thus r ] . & j eninianeniian = a ; p : 4 (la tor ( Candles i ia ; Made by Gloves 4 | : S | Bearers or Porters lp bs oe | | Hearse to fA: -& a i 4 | | Removal ene i | Automobiles | : : > | Newspaper Notices . m j | ; Washing and Vressing “a ‘ i i : ii | : having | | ' i] | j services i | i ; se of Chairs I lransportation Charges | church Charges | Officiating Clergyman Cemetery Charge \mount of Bill é | j Af nat Gcceresl cericcrenes 1 Music | Goods Ordered by { ; ) i oe esr ell Bill Charged to - ale a sianibahctniiaetaiaaniai a DR. : ‘icing CR. '98U8O BY DORNTaAE CASKET cx SL te ernie AR at RECORD AND BILL OF ITEMS Yearly No. Residence sy Place of Death ys Le ‘ Date of Hirth 1dAD (Year) Date of Death 19 (let) Maiden Name hr Birth-place v7 gous, / Name of Father © ey Maiden Name of Mother Cause of Death—-Primary Certifying Physician Place of Burial Funeral Service at .* Time of Service a Date of Interment Casket or Coffin No. Siz Made by Lining and Pillow Set No Han Plate Outside Box or Vault Burial Suit Slippers Embalming Wasting and Dressing Shaving Services Use of Chairs 40 Church Charges watt Ay! Cemetery Changes 4. ' EEE Seonth 47-4. (Month) ae Flowers ree fi. Gio Ah be 5as ‘ oy, FOR THE FUNERAL OF seinen tien aoe ~ Wife or Widow of Years Sex | Age Months < Single < Days Married Occupation His Birth-place Her Birth-place Secondary Residence Cemetery Lot No. | Put Grave No J Section 7 ee pie — Candles Gloves Bearers or Porters Hearse to Removal Antomobiles Newspay] Notice Transportation Charges Officiating Cle rgyman Amount of Bill Goods Ordered by ol Bil Charged 44, BM BLL eS uimmnmmbemenal Tota/ to date SERN TT @5 r or Race e mark like tha permerng CORD AND BILL OF ITE ECORD AND BILL OF ITEMS early No. Total to date. | Yearly No. Yearly FOR THE FUNERAL OF y FOR THE FUNERAL OF Tota/ to date <— SF 1 7 : Are A GAarcte C- AV ACE beretmcmicntereninteiinakcetistconsin = =| ne fil WA Td OAL O {. u EY aes J fe r 4 . E Residence...../.../ d r LA tO41.4 ; Ce tas D cs Residence Ene f r 6+... F i 4 ey Place of Death 4 Wife or Widow of Place of Death Wife or Widow of Date of Birth ] Zz 2 Years Sex Color or Race Date of Birth ! 5s = é- Vo ; Pe (Year) (Month) mr ‘Db bh ae (Month) (Day) uf | / Years Sex { Color or Race Date of Death 194.” + de Months ¢ Single Date of Deat 94--\. Prose (Dey) Age AP 5 (Year) (Month) (Day) Age (oO Months 4 Single < ' aiden Name / i iden Name j ' Maiden Name Days Married Maiden ‘Name Days | Married |) 4,k¢ ; Birth-place Occupation . Birth-place Occupation it i Nema of Pathe His Birth-place 4 Name of Father kK - Bs His Birth-place € j Maiden Name of Mother Her Birth-place i Maiden Name of Mother ABROK Ww Cnt - Her Birth-place f : : : . . i Cause of Death Primary Secondary uo Cause of Death— Primary Cana duen Certifying Physician Residence Certifying Physician Residence i Place of Burial Cemetery Place of Burial . ocr <A Cemetery ‘ T . . i ge oe 1 | ] luneral Service at Lot No. | Put in the Diagram one mark like thi Funeral Service at ‘ TZ" Of , Er + Lot No. | P ? . . . ‘ i ne mark kK { : “ae a pat ee | for every Grave in it. And mark (/, l ae \ \ ‘ = ne ; j lime of Service Grave No. Burial with double dagger thus : 3 wmme of Hervice Sond aaa” - ana Grave No . : oy Date of Interment Section | ot » : i a on } Designate site of monument thus: Dat« Interment . section Dien ' f nt ' 2 ) me — | Owes tpt ge- IT | ai iat <= : ae soeenemeee SSS Se = SERRE Sa 2 ee eee = 7 = mone =e . ; asket or ( 1 4NO | Candles Casket or Coffin No Candles ; ; | / i Made by i Gloves ; Size Made by Clives 5 i | Be: Pre | we and Pillow Set No | i Bearers or Porters 4 ; | a Linine and Pillow Set No Rcavare Gr Paris A] Wl / 6 dé tt4 oer Af Sol J Bt H || Hearse to 4g ej Yi (At A6 £66 (18 Handles Hearse to h2e-past-t ><> Removal et : Plate Bical Ae pe — PO Tr ese os z i | | | f i = ; Automobiles Pes y y ' "s Outside Box or Vault OL Automobiles . . | Af LX Y hice“, : | | 3 | | Newspaper Notices | ? ay Slippers Newanaer Natives ' 4 | i] ‘ . ; r / ; Embaliming } : ; | j ly 2 Washing and Dressing bi | ! i . | Jove Shavit | | | | i 3 | i Services | lrarfsportation Charges \ Seles see Use of Chairs Transportation Charges y | : iarges | Officiating Clergyman | Church Charges Officiating Clergyman Piicrk te hf metery Charges ¢ , ; 7 , } ' e He Amount of Bill Cemetery Charges &<<«~ ~ Amount of Bill . nti i ; lusix . 3 sie ; | 1 i i Goods Ordered by Music Goods Ordered | ) lowers | : RA Chases Wn : a Sous | Bill Charged to Flowers Bill Charged to : DR. vane oe . : i a CR. DR. CR. ee : “ye ovealiliel ite i senna a 12415 199 Il b adcof | le l , 4 t / _ | | + + + & 4 | A Aimee ccc a a C. a | | ms Ww « y i | iI Mc = ~| —_— | , 3 i i ; | A} Bae be | 1 | i} | creation —_ | | Seid | | | os | Pediat a | j | i Fl | aap : | | | | | ba | | - iH i anion | j P | | 1} i ound t | : I—| E | | | | = | cS mo e a | | — yi | } || — re I! j 4 i H : | | i “tl is “I 1} j l | ; | | ee. | | * | { i i } - i i | je — | ae 1 | i | | | a“ i ; i , A | 1] I i 3 * ; ‘ : mi | i] | ; | i | i| | | a / By | ] | | | Pal : | oe | | | | = a ———-—— coe } “7 | n't } | } || | | | =a P a i 1] u i oF i rn ' 1 gilt if . - a i | ij | | F A i ti i i ——| ——|| —_____ 2 pa 3 mee snl el si ia bao oe | : rae ie = ' — - —_ —_— — os mein | } | | : | | | en So ; ' | cd | | ‘a | acs | ot | i j | i} i i zg 1S8UEO BY DORNTER CASKET CO., BOSTON, MASS., 1916 — ‘ Si * x ISSUED BY CORNTER CASKET CO., BOSTON, MASS. 1918 | ab id easel icine earn Aes Dial NET Sister = aiemmeontenaaeees er 78 RECORD AND BILL OF ITEMS Yearly No. a. THE FUNERAL OF mow “Y etecseg Tota/ to date at Fe Residence wilt ; ; oe Place of Death A herg) (jhe ah ——— y sp 70 mae Widow of / Date of Birth l f Z Years Sex Color or Rave (Year) (Month) (Day) Date of Death 19 Age Months 4 Single (Year) (Month) (Dey) Maiden Name i Days — |, Married Ulaii Ga se Name of Father hare) 7 Maiden Name of Mother C Oro Birth-place , Occupation Oy a 7e— is Birth-place AC. Juih, _ Sathu. Go re a ler Birth-place Cause of Death Primary Secondary Certifying Physician ‘ Residence Place of Burial 4 6 JM f Cemetery jai 7 44 f val Se ; tf thy N : luneral Service at : Lot No. Putin the Diagram one murk like th ai ij a (4A Guia en J a | for every Grave in it. And mark ¢/ Burial with double dagger thus ; 4 Date of Interment Lis 4% Section 7 ] | Designate site of monument thus: ae iageenebiniaiiin “ 7 men e * | ee 4 t or Coflin No... 4 44 | Z E.9.| Candles | | | |} | . j 1] Made i | Gloves A) | Ee | i f nd Pil Set N i] {| Bearers or Popters . J yy hut hk) j 1 5 V4 || /j nee ee Pid i } | | Hearse VW av Ck a. Ow ne z of ud || Removal {| } | | Automobiles | | ers ok , | Newspaper Notices 27d | ming | Ze | i | | | a | i i j | } j i | | | | ‘Transportation Charges ue | | Ofliciating Clergyman eerie amon metery Charge Amount of Bill : 7 / O i sie Pg . ey j Goods Ordered by” /) J 9 | | ¢ ‘4 - i } Flowers | ie J06 Foch/auhode i | } Bill ¢ hargyd to l Z ula | : $i es F Le Dore. Ty - oo = ee ee ee - rf ; CR. 1 |__| | \ tech By dy, Mc =~ | | ! 3 '98UEO BY DOANTEE CASKET co BOSTON, waee., 1010 Yearly No. Residence Place of Death Date of Birth Kael ai Date of Death 1990 Maiden Name Birth-place Ness of Father... I¥¥ Maiden Name of Mother Cause of Death— Primary ; mp Certifying Physician Place of Burial ‘ Funeral Service at Time of Service Date of Interment Casket or Coffin No, Size Made hy Lining and Pillow Set No Hand! Plat« Outside Box or Vault Burial Suit Slipp: Embalining Washing and Dressing Shaving Service Use of Chairs Church ¢ s-harges Cemetery Charges Music Flowers DR. RECORD AND BILL OF ITEMS FORTHE FUNERAL OF j Dy Nf LA a J Tota/ to date - «2 ’ - £ ' Wile or Widow of x Years Sex { ror Race ; ij | (Month) fey \ Months < Single Days Married Ocer i Birth place A ¢ ’ iS . , P \ Her Birth-place f ee ndary Fi : ' “ Cemeter i Diagram one mark like this ( Ny i Grave io it And mark thas th double dagger thu il “a ei ‘ eof monument thus [ ] emcneanceanage seem f4 j y ! Pall Chharg CR. ~~ + naam 08 asorveneqnmenenyepnens _ on J / # at ie a - | 1S6UED BY CORNTES CASKET CO, BOSTON MASE 79 ARE ewer ee ee ee %. 2 LODE BC TREE HT arr oe ell toes Yearly No. Residence Place of Death e Date of Birth LoO./S4 (Yeads Date of Death 19 a (Year) Maiden Name ¢ RECORD AND BILL OF ITEMS WE FUNERAL OF » YA Altle ns Lt S/- be or Widow of ¢ ZFOR Cpl Kh. 7 C ” gf La C <> Years Sex Mh —~_ i po” Otten 1 ted / ; Age ce onths 4 Single chow bey) 6 ? ~Days Merzied, f Tota/ to date Color or Race LPL . Takers P : oe {fe Birth-place sf Occupation\/ 4 4 é . Pre f ‘ (4 . ° A é A, vn z Name of Father, i: : ie i His Birth-place A : ; : ; / J} | 4 F —— fi z “if Maiden Name of Mother C ( Her Birth-place 7 Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial Cemetery J luneral Service at Lot No. Put in the Diagram one mark like thi: ; oe 4.f fk - | for every Grave in it. And mark th: rime of Service >rave No. ail Burial with double dagger thus : { sities . : Secti 3 Date of Interment ae ] f Designate site of monument thus: L_! iwideleas sil aicteactiiatie Siiisiniiias ‘ |e oa y me CIT GTI et or Coffin No i w kas Candles eo ts @ oA} Made by | Gloves | A | | ~ | } nd Pillow Set No | Bearers or Porters | ; | i a wes re | c | Hearse to ~J KAAS. -o4 | 13 | | Removal I¢ Automobiles | Newspaper Notices | i } a | “ } ide | | 1] os oe. | Transportation Charges | ges ; l (/|& Officiating Clergyman | } . Lea uetery Charges si Amount of Bill a VEE, i Goods Ordered by | vers | Bill Charged to | DR. | ATG | | + nl } Wt RY N | | + Mo i | | | | | | b - | | i oe | } i} 1} 1} | i] | || — ij | | | a - | | | | a a j | | | I — . 5 ae . | i} | | | eee — | = adhe ie on fC , | | g ee sei il — | 'S8VEO BY DORNTEE CasKET co., BOBTON, MASS., 19016 RECORD AND BILL OF ITEMS Yearly No. y FOR THE FUNERAL OF Tota/ to date 7 2 » Residence ae ZL FLA re dha Ck atten CA Lh é ace of Death see 5 wy toe Wife or Widow of - Date of Birth I {ne lf if f typ cy Aacuny “ ( f * Years [ Sex il <4 Con Color o Date of Death 193f cana ; f A n) 7 (Day) x \ge 9 : Months 5 Single oY id .. Oa / oe a Ke 4 t a | = Nam 74 / Ws. /4 l 4) Days Married Birth-place 4 KLE A< meee é Occupation . ; a L ' s m rs 7 i. Name of Father bx A mer df bon 7 His Birth-place <4 pe the é oa Maiden Name of Mother A224 A df yy YU CLL Her Birth-place . J ff Cause of Death—-Primary Secondary f Certifying Physician et dence Place of Burial Ax tt C ‘ Cemetery Funeral Service at N Lot No. Put in the Diagram one mark like this Time of Service / / Grave No | wa 1 for every Grave in it. Aad mark this hes ; a < a Burial with double dagger thus: ¢ Date of Interment PL Iivive Section said / j ~ f Designate site of monument thus: ae Casket or Coffin No. Candles Size Ld. deisel Made by ‘ Gloves i gi Lining and Pillow Set No Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Notices Embalming Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman poops thr iain Cemetery Charges Amount of Bill aw hadee g e Music Goods Ordered by Flowers Bill Charged to DR. CR | | 2 a’ . sid i i . | | a " ee | i / ‘ “| | | } A | | | 4 | | wf | | | | v | | | # | es | | | | = } ee || oe 1 bi Gi i ecane | | | I 1SBUED BY DORNTEE CASKET CO.. BOSTON. MASH, 18018 81 a itt ss ON tin Metin ices ie ci ee i] 82 Yearly No. Residence Place of Deathé 4 Date of Birth Date of Death Maiden Name ... y Birth place | ‘4 ‘ ; f i Maiden Name of Mother/ ( ause of Death i q 0 19.4 / Name of Father Lf j Primary RECORD AND BILL OF ITEMS Afi ba fi & ea h pu 7 ¥ (LAA Baggs se (Mon — < th) iis pee {Deay) FOR THE FU AL. OF é | / ae f Wife or Widow of. ‘he, Years Days Single Marrie« Mabe. ‘olor or Rac e OF LE Tota/ to date ee ing Physician ‘Residence & f Buria Cemetery ner ervice at : Lot No. Put in the Diagram one mark like tii i ¢ Cada By | for every Grave in it. And mark ¢/ Burial with double dagger thus ) ont A Section ] f Designate site of monument thus: ce é c ” 4 a “) | pe O66 Candles tS Gloves ! . | Bearers or Porters | RZ a if Hearse to f wd ; at } Removal Automobiles al rs | | Newspaper Notices tn a | {} | | | | | i Transportation Charges a if - Officiating Clergyman if ¥ at aes |? te hag Amount of Bill 3 | \| ' iH Goods Ordered | I 2 glee | i Yr ng lowers | et Bill Charged to eh 46 . 2. (Cebix be og VY CR. ' TAle | f ye 7 i [ 'S8UEO BY DORNTEE CASKET Cco., BOSTON, MASS., 1016 Yearly No. Residence Place of Death Date of Birth Date of Death Maiden Nam« Birth-place Name of Father hia. 83 RECORD AND BiLL OF ITEMS Tota/ to date FoR’ THE — Chu l ie despa fe of Widow of \ j oD Years se Tt / Yiked ae (Alor o Ra. & Age ff Months ¢ Single pfs Days “ y oa ¥ : A Occupation ‘ "gee va 3 4 His Birth-place ‘Ag Oph te / a — Heco KH Married to]. SS Maiden Name of ] SAA ? “ha Her Birth-plac eo! = Nee Cause of Deatht- Pkimary ica j Conaa;ry a j ° Certifying Physician } ’ me Kesidence Place of Burial = iL Lal ws ie pao temeters Funeral Service at See is Putin the Diagram one mark like thi Time of Service a Creda Ne L [ for every Grave in it, And mark thes * 40 ¢ I il th double dagger thu Date of Interment ie | a ee Designate site of monument thus ss poe a wnicnbahasidenaninte SRR RERONUTEEREneRED Casket or Coffin ere \ BA SS Candle al - Siz Made by Glove Lining and Pillow Set No [he or Votters . PY 4 fy - \ ae Ha ' fearse t ne “_ : mn A, j \ -_ o > > » - Pla 1 A fi% } ; [ j wi Outside Box or Vault \ tomobiles Neen f Bur Suit nr } Slipper aAper Notices embalming \ ng and Dressing Shaving oe ryices Use of Chairs Pransportation Charges Church Charges Ofheiat Clergyman nt 2 —_ Cemetery Charges Amount of Bill anti CY Music Goods Ordered by Flowers Bi il] ( harg rt dt 0 ar yee i sciteteitaaiitatassiamaassmmamesamssciess easntanaisnnsitaicianiniiaiaamiinitl comm ecmornaameoworayhencne prema pean DR. / /¢, ye CR, ja 4 sia pe ate ghee - hnnenslle a earn pane r - iC if ; os "4 “ |} “yy + ed /@ - / / 2 | | | | os ’ , ft t a | ™ ae | | | / j | ~ oll a ip me | | | | | H | | i MA | | 1 i i ; | | | ‘ere 198UEO BY DORNTEE CAsKET CO., eO8TON Mase Total to date. Yearly No. FOR THE FUNERAL OF ; Yearly No. 4} ) Fon THE FUNERSL OF Tota/ to date . r . (+/t fh ie Vf (fe | Krrutsthe Chitd iy 9 | - t o> Residence Le b Jd Residence KAN Flin ue S - i : -- 4 Place of Deathé £ “ / Wife or Widow of . A Ve om atl Place of Death v A o tA. Wife ife of Widow of " a i a ’ M LE ‘s : ’ Birth ; Tk A Date of Birth 1G 6 a wv i A Years Sex | Color or Rac« Date of | p Wiaie [Ses / Ltd Cher offies o ‘ ) A Ft - date of Death W ‘a [ j Date of Death 19.9 f it Cy \lqnut! Single Ys ad CORT. Date of Dea e Age ea Months 4 me $ r 4 (Year) i . ae : y Ke { i y-) | / 2 } | Maiden Name Li ’ t . Deys Married Maiden Name a“) ~ " fF Days Married © é& a et | | ¢ | j Wf lace Wi Ad ‘ . Ogeupation _ Birth-place a Occupation £ c. on go ‘ Birth-place ‘ fi et . AN j A i } Name of Father. <704 kt (it LUA AE am His Birtlyplace Name of Father His Birth-place Aplin AC Cw i i ame Oo ather fede. 4 Z ¥ : A 7] ip : _ “Uf : me a Maiden Name of spl iC { (fi 444 / LAY Le Her Birth- plac e Maiden Name of figther T Vines Her Birth-place* J* eee \ L ill g I j Cause of Death — Primary econdary Cause of Death+ Primary acidic : j ; _ seifving Physi + r pa a Certifying Physician | Residence Certifying Physician | } nt. 9 vesidence Disss of Burial... £44 Cemetery Place of Burial OV Um pe Cemetery f Funeral Service at Lot No. Put in the Diagram one mark lik. Funeral Service at ot No. Put in the Diagram one mark like this i t : ' | for every Grave in it. And mar ; | " ] for every Grave in it. And mark this i { Time of Service f Grave No. 4 Burial with double dagger thus Time of Service Ta A Grave No ; t Burial with double dagger thus: ] ‘ as ww < whic : 3 i Date of Interment j section — S Designate site of monument thu f } Date of Interment meena { = Designate site of monument thus C] : ' . s aoa naa tc SEITE aaa = wane = a ccna we caer a sos pssonaemi eR NT en 8 0 AC REE | — nh : = capapaey : Fz i ; isket or ( oftin No. . f ; — . | ; Casket or coffin No (Yh cs A Candles . —_ ip A i ' Size \ Gloves | Siz Made by Gloves : : 1 \ m } } Lining and Pillow Set Ne Bearers or Porters Lining and Pillow Set No Bearers or V¢ i < : Handles Hearse to | ts ding iFicavan ti = Gg) t ate Removal Plate : Removal { 2 yutside } i ' Automobiles | Outside Box or Vault Re _ Automobiles ev | | is 4 e Bu Suit A i er { Newspaper Notices Slippers Ne wspaper Notices ; | | if | Embalming : fp | ' | \ ashing and Dressing ie i i | i i { Shaving mo : ; | | Services \ { , | Transportation Charges Use of Chairs lransportation Charges t t . ; ) ‘ sal < fa. Officiating Clergyman ae Church Charges Officiating Clergyman a oa Z Oo i metery Charge Noe |} Amount of Bill a eel Cemetery Charges Amount of Bill Jaassifairithast Meenatons ; ; Music | Goods Ordered by bh hale ; ; | Music Goods Ordered by ae | 9 A|CF || ; 17 / ti i blowers 4 | | Bill ¢ charged to\ efh 4.( * tks ibe 00 / Flowers Bill Chi irg zed to ay | Sack ne | | = a ST Ee / CR, i DR CR. DR. [lA fs, i ' sommes — 7 : . - rh: F : oo f é | fa , ae ‘ f on ~ oe : f “ff , oe “fe - es o - + ¥-+ ee Ast S ‘ ff y — ; j ’ T\ c Sf 3 } J fiZ fg Oo : j j | f “LS “ - } / 2 | f ' | |-—_t-= | | T | ~s e | j i} ean } : Le (a Pr > | if | | Ce eo ” oo | EF | f | _At it | - | | i | - wa j | “ | | [a i j | | 4 H Ks } | | . i ’ 1 } } ui | , 1 Ma EY ”" i a | | ; eo | i | i E, tsi ! 4 \ | | | | | y Kk an sad | 2 Y j | | : | | | “ | Bee ed | \ | il | li t ee i Fj 'S8UEO BY DORNTER CASKET CO., BOSTON, MASS., 1018 1eeUED BY DORNTEE CaSnkT CO.. BOSTON, MASE we . Aare ADE Re aie on al ae em ney OR pienmrmneneanete , ydhalt OF Woh | {7 “i ; a i" | | | | | | | | | |__| | | Cs | | (4 | | —___,< | e | | 7 | | | wi | | 2 “| j | / | r - [ee 2 | oe | i | Oe 84 RECORD AND BILL OF ITEMS Total to date... Yearly No. FOR THE FUN Residence { . Ms hawt S : Sf Lo Se @ Ac Wife or Widow of Place of Death Date of Birth Sex Icale Single Color or Race Sa die Age q Months JD pe Married Yad As Occupation . Bre His Birth- "two CALLE Her Birth-place fc ene. (ig baa een A Cemetery . Sees, as 4 . Haig Birthplace Name of Father Maiden Name of Mother: Cause of Death— Primary Certifying Piveisien A if : Att>/ Crane Oakwook - ee fi Place of Burial l‘uneral Service at yy 30 Lot No. Put in the Diagram one mark like thi s . / ieee | for every Grave in it. And mark (/: lime of Service ps /; / Grave No. ae Burial with double dagger thus : { be lef Ip Secti Date of Interment "Vn section | 7 [ Designate site of monument thus: [ } oves PS nn Bat te ee = = it rs and Pi Set No | Bearers i Porters G l/ / y ra iming | ’ | {| i || i i oe : ; ha f | Transportation Charges Officiating Clergyman re Amount of Bill Nv 0 | Goods Ordered by gt —. Bill Charged to 'SSUEO BY DORNTEE CASKET co... BOSTON, MASS... 1018 , Candles Le GFR oo tala J OOO cl} sv Pee. (ema Cb F150 a 4 ss Yearly No. Residence Place of Death Date of Birth 3 a) l Date of Death 19 (Year) Maiden Nam« Birth-place Name of Father Maiden Name of Mother.. Cause of Death—Primary Certifying Physician Place of Burial Funeral Service at . Time of Service Date of Interment 85 ne Tota/ to date ‘ife or Widow of pa i _ Mhik, Color or Rage Months 7 Single — 4 7 a \ Married oie o His Birth-plac mp CtEIE A " Her Birth-plac Years Secondary Residence Cemetery Lot No. Put in the Diagram one mark like this And mark this ith Jouble dagger thus : } | for every Grave in it. l Burial w i ] Designate site of monument thus CF 4 Grave No Section iilene stad . ‘ ‘s Casket or Coffin No. tls rS 4 L Gq Candles AZ co < Size Made by Gloves lining and Pillow Set No. \| Bearers or Porters — 4 Handles Hearse tov. alle’ ¥ ‘C7 Wwe Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Notices Embalming Washing and Dressing | Shaving | Services | Use of Chairs Transportation Charges Church Charges f wt So 3 Officiating Clergyman Cemetery Charges £ NALA VY MM a }O Amount of Bill Music Goods Ordered by Flowers | Bill Charged to DR. CR. = /- saabaitinnapiacingti Ba, Soh b4:0le Ech | { | | } | | i | | | | | | | | | ) | | | | bad | | | | : | | a ne | bee 1SBUEO BY CORNTER CAGKE! GCO.. BOSTON Mee tole - > RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS ~~ Yearly No. FOR THE FUNERAL OF Total to date. ' '" Yearly Ni - Total 16 dat y early No. ; FOR THE FUNERAL OF ota/ to date f Mbit fe a: CO LS Lh / phe tht lhe é 4 LL birt Ct Residenc > . Residence Lf ; ( He é e A , : j a a a , 4 Fhe or A Cte i Place of Death hoe Wife or Widow oi : Place of Death ely ee PA Ax “ttn AL W? fT. Tf ife or W id gy of Date of Birth gs Years Sex ; Color or Race Date of Birth loa ~ none , val oo 3 ta Pe ee \ £14.80 Coles be Wien Date of Death 19s anes “a Age Months 4 Single Date of Death - 3G Z l ‘ ae 4 we Age 5 x iia Single Cents. Maiden Name Days Married Maiden Name /UZdL Ln ALMA { Days | Married¥ ( Ad: i Birth-place Occupation ..... ’ Birth-place ‘a 4 \é CA_(Pe A ay “Occupation Name of Father Vr. Zz. His Birth-place Cutacdo. HEC 5 Names of Rather Oh aser Us, Fé} is g Lb Mh man. -place | Maiden Name of Mother Her Birth-place i o.. Maiden Name of Mother CPO / (4 Pe Gg “ A Her BiIrtBlac e . Cause of Death Primary / nie Secondary... pevneaavedasseaiiettaned vernal Cause of Death— Prir.ary Secondary Certifying Physician y p Residence sesnenecs Certifying Physician ; Residence Place of Buri sabe = Coleaofa Cemetery bs j Place of Burial. CXR £000 Aor 4. Cemetery neral Service a Lot No. Put in the Diagram oné mark like {/!; Funeral Service at 44. d ¢ U . ele “tot No7 Pat in Cie Disarm one mark ike ths cof Servi . Grave No, | of | eee Time of Servic tp PWD” Si]3Ocrane ni | ye nen And a tte of Interment ¥ —¢/ g-3 Section | 1 Designate site of monument thus: 7 Date of Interment » oo Section | Designate site oftrronument thus: 2 Caddie eo : oo er td og ‘ j C. or SO 2B.) Candles Casket or Coffin No. <* . x Ad 4. Set te QOi10.0 Candles | ) r i” ' Made | Gloves iH Size Made by Gloves/£L4 met ar ? ‘ i | Bearers or Porters Lining and Pillow Set No. i Bearers or Porters | | Hearse to Handles Hearse to [0 Removal Plate " | wt cae Removal Automobiles | Outside Box or Vault a / TO } Automobiles j , | | ; Burial Suit | Newspaper Notices , Slippers Newspaper Notices : : | | | Embalming | a | | | Washing and Dressing i | | j Shaving Ba Ej | Services i : | Transportation Charges Use of Chairs Ye rica Wt Transportation Charges MEY - Officiating Clergyman Se Church Charges Officiating Clergyman : *9a>T | Char; | Amount of Bill F Mh i Cemetery Changed! o y x | )|, Amount of Bill pee a : | A Goods Ordered by Music r oe aaa | pe Goods Ordered by ae } | Bill Charged to Flowers 7, Ba) fi adrs tt a” Bill Charged to | Gecriasiiiaca ae coe ates I REE E 2 overs OP fi rtp + BE | Bil Coe aise cee ian i j DR. CR. DR. Cr. 4 ee seniniepiinsitiiinaiiasiiinins wi ay igen | | I YM fad Chale £0.02 | (/ L~ > >= | | | J } | i] | } | | | | | } j j | H] nneenne a — a - | } t | I 1 is sh aa — } | a I ace Jains | j i" - i | | | | | | ae are i | ~ | \| | | | i i I | | | Bd mn is tenes vas GASKET CO. COBTON, Hass. 1010 ISSUED BY DORNTEE CASKET CO, BOSTON Maus Lote SIO oe BO ee ae PT SOE CTE Ttna SFE ca ai hi MCR se rE erent ee arena eatin seins cnestameierne A Casket or Coflin No. [ies RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Nitra cael Ve PS eg or ie Wife or Widow of. Hace ta hang 4A by Years . Kale Color gg Race (01 th 19.2 7 4? Age ff Months Single (Year) (Month) (Day) ai Days ea Ya2 elles Occupation ........ Name of Father pa -place Maiden Name of Mother. “Ge ager ant, Birth- Pep tele a, Cause of Death— Primary MA eine ieee i Residence Certifying Physician ws nde . ; — | Put in the Diagram one mark like th ~ NI for every Grave in it. And mark ¢/; G ave N . I y i ees ee i Burial with double dagger thus : + Yearly No. Tota/ to date... Residence Place of Death Date of Birth Date of Death Maiden Name Birth-place Place of Burial Funeral Service a face fe lime of Service Date of Interment Section Designate site of monument thus: ? is L>~ '| Bearers or Porters | Wir tara rlle Z= | Seles Removal A, E lt | | “ pwtomobing ee ee — 2° . a 1S\20 | L4y¢ tcc ha, ete/ ices fla Te | | (7S Ce Candles Az/ ~ Gloves Madé by and Pillow Set No... | Hearse to ~ Newspaper | i | se . we , | \| ; Lvl hort We to i Cha i | Transportation Charges Charges if Officiating Clergyman ee tery Charge: i| | Amount of Bill esi | | | Goods Ordered , Chl. | 146 — =— = | Bill Charged t bey » of/¢ DR / CR. pe aa ea iol LL Ola Co UCIT | I —| i C2 Aig Neh, SS ha 2KG KS | j 7] | a a i Gas ae | Sell cee med a | | | . 4 ie EP re eae : | | | ; | | L | | 7 ee | - - | F i — | ~~ | | . |Z Pippi | | Co es | | | Pel er uy pee s8 mie: ia | —— _ -—_——|| — | il eipcltibess ised Ae Rs Cae i tot a neki: = | | Ld | | 'SSUEO BY DORNTEE CASKET co., BOSTON, MABS., 1910 ial eeeeeel RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date 2 Die ti caiils. Maistaile rales — Residence 7 bO/ Iauclbe At 4 4 y Place of Death ee gaa Wife or Widow of ‘3 LK tile pene, ‘ f Fe ke oo g _ o T?...Years Sex 7 Leal 4i— Color or Race Date of Death y £O Age § Months § Single La ye (Month) Maiden Name “OD tie Lity, Korithiedk— l 7 Jays | Margied Birth-place i LG. Occupation Cia finn seus ‘a Name of Father Te et His Birth-place Cac Glare, lef Her Birth-place 4 . Maiden Name of Mother‘ 7 " ie tek £ Cause of Death—Primary Secondary Certifying Physician Residence Place of Burial Cemetery Funeral Service at Put in the Diagram one mark like this And mark this Burial with double dagger thus: } Designate site of monument thus 7 Time of Service | for every Grave in it Lot No Grave No. | f— FH) ge Section — ee Casket or Coffin No. Beek PJ OPO. Size Made by Date of Interment Candles Gloves Lining and Pillow Set No. i} Bearers or Porters Hearse hes “ia ke To Kh / Td “7 Handles S& OW Plate ; ! G Removal Outside Box or Vault hiffpe-y sae /O oO c Automobiles {| Burial Suit .. Slippers Newspaper Notices Embalming z i? c sae ah aloe = Washing and Dressing thy = y ; “. A wee Shaving / nue: pry Z ke Services . F Transportation Charges Use of Chairs Church Charges Officiating Clergyman Cemetery Charges Amount of Bill 7 — Music. Goods Ordered by BEB: af” Zz } ff | Bill Charged to Flowers DR. CR. — yb Oy ZA T3777 ve j 7 we 4 2 ad Z Aw et | ? | . —_ ——— 4 . | = | ela iil ISBUED BY DORNTEE CASKET CO, BOSTON MASE 89 " a —_ ~ a ns Nena e a nes tenon an 91 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date.... Yearly No. , rn Fetal te date Dike ee Jr-t Jno CG entrale A, Affe eo Outen Yu Mmoce. Residence a vod Residence ALi: Uklauf, LF Place of Death Wife or Widow of. Place of Death ec Cee ak A Wife or Widow of Date of Birth 2-9 Years Sex Color or Race Date of Birth 86 a a. i ee oa | Cntae oe le Date of Death aa os Age Months 4 Single Date of Death oe o zou Age Months } Single é Maiden Name Days Married Maiden Name L Days | Married Birth-place ae ae Occupation .... Birth-place ese. : Occupation Name of Father His Birth-place Name of Father His Birth-place j Maiden Name of Mother... Her Birth-place Maiden Name of Mother .. Her Birth-place Cause of Death— Primary Secondary... Cause of Death—Prim:z 1 . Secondary Certifying Physician o71¢ CLerce— Residence si Hidiyc canta cc aceon es ' Certifying eae 8 8 aT: Poke — Residence } Place of Burial Cemetery . Place of Burial - Lg ete kn Ce segnotery ; l'uneral Service at Lot No. | Put in the Diagram one mark like ti: Funeral Service at os Coe No. Pat in the Pines one wk ike thin P| Timo Servi Grave No Yee Time of Servi oo Saar JL yer cA Date of Interment Section Designate site of monument thus: [7~} Date of Interment b/s [30 Section | Designate site of monument thus: [J | - [ee L * | ciel : bee ae ie | 3° Casket or Coffin No | as GO || Cand'es 5 , Casket or Coffin No SM 09 Candles . ra | Made by | | Cloves | Size Made by iia bave lhe 0, tis | } ing and Pillow Set No.. i | Bearers or Porters , Lining and Pillow Set No. Bearers or Porters <a a : | | ae | Handles Hearse to K Ale vcte, iV i ere / || Removal Plate Removal | 1 | | Automobiles m 42.8 ete. | MN | e< Outside Box or Vault Meet LR Re Automobiles | t | | na Burial Suit . | | Newspaper Notices Slippers cr Newspaper Notices I i i a Embalming = a it | | I. Washing and Dressing t | Shaving | ie | Sexviens | ro4e \ } 1a } | Transportation Charges Use of Chairs Transportation Charges j I i larges } ‘ | Officiating Clergyman Church Charges tr Officiating Clergyman Se a ‘| i ietery Charges | S E ao | Amount of Bill oe ae Cemetery Charged we eee er A pe sag | | Goods Ordered by Music / ipoees Semana 29 f r rs | Bill Charged to — Pin, i Jo | Bill Charged to =a iy DR. Cr. DR. alles le : | oe ue Yaofs> Dec! t ¥é eh | 3572 ee | A | pone eae | | ae ee om Hi} aac Po re art : H ae | | HT) i ae oe ae | ie | Hii) | a | : | i \ i | a 1 | | re | ) | a A ae | a8 | | . " i. Hh Eo ee We ee ———i— | | J ~ ~~ |- comedll I Paes He hi ume = Bees co as | | | a. [209 8 Raia es coe Es | l Be era pec eaten et aan meena is | cd al | : 4 | }@8UED BY DORNTEE CASKET CO., BOSTON, MASS., 1910 ISSUED BY DORNTER CASKET CO.. BOSTON. MASS 1016 PTOI ala aR ame oA SST ane: aio ee ee 92 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Yearly No. 4 dak AC. Au Mleviin, AE LZ. kava Residence Place of Death Date of Birth Date of Death i? fous st Maiden Name wre i wo Pri?) b.rth-place Name of Father Maiden Name of Mother : Her Primg Cause of Death Secondary... Wife or Widow of ae Years Sex Months Days Occupation .. His Birth-place Tota/ to date... Color or Race Single Married Certifying Physician Residence Place of Burial Cemetery luneral Service at Lot No. | lime of Servic e Grave Date of Interment sre oe ee " soa ee . i ket or Coffin No. Made by Lining and Pillow Set No.. | DR, | Section No. Put in the Diagram one mark lik I for every Grave in it. And ma: 5 Burial with double dagger thus Candles Gloves Bearers or Porters Hearse to Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to Si p20 [4y Such | Designate site of monument thus CJ ee enrieseeienesseesniestae '98UEO BY DORNTER CASKET co. , BOBTON, MASS... 1018 Time of Service 93 RECORD AND BILL OF ITEMS Yearly No. . . FOR THE FUNERAL OF Total to date Fite Te Sut tate a JA Spb Residence Pr C34 E1 of —— 3 4 ; Place of Death Zz Wife or Widow of ate of Birth... 1 Fd | pices ae a Sis Tile ie se la le as Date of Death 193 O Y * (2 Age}. G4 Months 4 Single 1 J Maiden Name whe Jhon Ata Core, | / ¥ Days \ Married as | Birth-place Print. KM. e. Occupation Ake Lge fa AN ee 2 a / Name of Father POG! { - / Fax His Birth-place tt CT t Maiden Name of Mother Re © Di PCan~eM Her Birth-place rel Je Cause of Death—Priméty Secondary Certifying Physician be t- AS Gtunmec Residence Place of Burial LY: ee ae 2 / ee ‘ Funeral Service at B ‘ “ hn. t CH fa KK 41 S070 - o/{=f3 Cemetery Lot No. im one mark like this And mark thas Putin the Diagr 1 for every Grave init N/ Burial with doul \ * Grave No le dagger thus ain > eas Date of Interment 4 Section r a cet Cc ‘ " a ona alana eel SSS SSS SSS Casket or Coffin No. j tof eh & a @)'\<¢ Candles Size Made by Gloves ning and Pillow Set No. Bearers or Porter ape NS Handles Hearse to VA Wilke | Uy 4~. See é liad Piate Removal bho Ch Abbi kA C Cutside Box or Vault Automobiles Oak Colla, th Purial Suit rhe ee ars Ss. / Ca ; 4 . a | : lippers rem Aisa Ved Oru = Newspape r Notices | a . ; Fold mbalming / Vashing and Dressing shaving rvices e of Chairs Transportation Charges turch Charges Officiating Clergyman iil iach ainsi metery Charges Amount of Bill L anissiesttensaanitt satiation Isic Goods Ordered by ine aaa ; ale Flowers Armee ver eee “| Bill Charged to DR CR. ie caiiieaiiaeiaiietdasianiaseinn a ms om a . eet —— Goeur (Gin Key @ A < Ce J cA Dv iM T | | ps : | | a 1 | if | | fi | a | é wf | | i | | ] | | 1 1 | | 18BUEO BY OCORNIER CASKET CO... BOSTON Maes e'e a OTT 9 as Pi RG RS PARTE ars ae 94 RECORD AND BILL — ITEMS Yearly No. Residence iY Place of Death J Lid Date of Birth hy ( re Date of Death 19. 92 (Year) Yel, a —. fl 1‘ he fy, ves Ak , Maiden Name Birth-place Name of Father Met {A Maiden Name of Mother Lt CI Cause of Death —Primary, = / ertifying Physician Place of Burial Lf KC “uc¢ luneral Service at Time of Service Date of Interment bua, hac “Gra Lig Lthéi CS ALh ib ii: 7 =.) 1G ) FOR THE FUNERAL L PORE’ af QDays Married : Occu ation. gp ple oF Wile os. W idow of II . Years Age Months 4 Single bier Le Hh G hi irth-place A ba # ' Secondary... Salis hk, tao Residei.ce Cer pttery .. tie ttl ’ Lot No. en Grave No. = Section +e Total to date... n Vnri$ae™ ne ee {Fler Birth-place |...) x<€ Cc @ Race Put in the Diagram one mark like I for every Grave in it. Burial with double dagger thus : ; And inark Designate site of monument thus: Cy we 7h | f a ‘ o a | eo I 9 | Lr c a , Ga pe ‘a a ae “ Made by | G loves (4 t Cat ot f be Tot bus @ iad. | é le 7 ind Pillow Set No.. i || Bearers or Porters I. j | | ee ae - i || Hearse 187 Lk Kb Eh dl / “ Removal................./7 fpf | ‘ wll Al wll ~~ a, i < | di Automobiles SIO hs q Q \. , | Ce S Bho Aetan” Sy | SS News Notch t£ € 2 oo. | ia paper Noticés ; i | ia hee ki _ SO | | iti i | ~~ a | | | rl | . I | | | ha i | Tranefortation Charges 1] | 165 | a . Officiating Clergyman | 4 A || 4 y Charges ~ “| Amount of Bill CG: | ERE A Pp i ay { ‘ HWS SS | Goods Ordered by St... At / / eer mares ai. airsas | Bill Charged to c ooo DR. i : Y ‘ CR. | j | of A 1 , | oo Cha || «a \/ 3s | z me | _ fig. ise PA. i onal he é 4 { ~~ } iss | | | ae | | | cm = SS] —_ on ‘ } a | pte | il | ties : " ‘ | | an ee | | 7 . | | er ee | a ~ er ill I cninnitana ~ ee | ot t mi | | | | | | ie ee eet eee : : | So oe Cpe ames ee | _— _ onan — en - lead 7 | mabe sodas P | '88UED BY DORNTEE Casket CO.. BOSTON, MABS., 1018 RECORD AND BILL OF ITEMS 95 Yearly No. FOR THE FUNERAL OF Tota/ to date Key lea (Ahis Je en Cin / Residence.. Adee — i... Place of Death W 2 or Widow of X60 te of Birth ¢ f °..f Date o (Year) O€ rie &f Years [Sex PA aAle Citi Date of Death 19390 AA ae | . (Year) onth) (Day) Months Single } Maiden Name Sic iene ved Birth-place ie Occupation : oe ¢ His Birth-place Prefer & AC, bL4 x Lk... Birth-place i i (i Seconda ary ad Ege Af Cemete ry / : Prw,. ree ave No. i a fauts Casket or C —_ Ne of LLSO. OO Candles 2 fr Siz ey oy Gloves he fare - AOVte Name of Father Maiden Name of Mothee<e Cause of Death—Primary Certifying Physician Place of Burial Funeral Service at Time of Service Section Date of Interment Py Bearers or Porters Lining and Pillow Set No. Handles Hearse to Goase Lacy yr Kklory< Cé2 Plate Removal Outside Box or Vault Automobiles Burial! Suit Slippers Newspaper Notices 2500 Embalming Washing and Dressing Shay ing Services Transportation Charges Use of Chairs Officiating Cler . 5 CO Amount of Bill gyman Church Charges in ky fy — Cemetery omni pre ae Goods Ordered by peer eaten sem | Put in the Diagram one mark like this | en } for every Grave in it vl mark thas < Burial wit! il lagger thus | os Designate site of monume } —=— o sens ame > ne mark / oo} SDiOc eer ae —— ass Ui C Musi : 3 Flowers ye om * fa g / pC wo Of Bill Charged to FU os. DR. cm | | a y YY’ ca | } i - | | . ! | | | | | | 3 es I 4 a ae |__| od en | cal | | ee | I i 188UED BY DORNTEE CASKET CO,, BOSTON. MASS ere — a en a Se ee as Yearly No. Residence. Place of Death x a Date of Birth £59 1990 (Year) Date of Death Birth-place Name of Father an file Maiden Name of Mother Prim by GI ~ Woo Cause of Death Certifying Physician Place of Burial l'uneral Service at Time of Service Date of Interment wy MM borg ~te* coh AC onth) oe ar jonth (Day) Maiden Name a - Locle- ” a FOR THE FUNERAL OF CQife or Widow of. ‘ Years Sex (kA Lhe 1 Age Months 4 Single Days Married & Le Occupation ..... His Birth-place Her Birth-place @ t Secondary............. — Residence eve betes <n Lot No. f Grave No. d | | - 2? Section RECORD AND BILL OF ITEMS Tota/ to date... Color or Race Put in the Diagram one mark like jhis I for every Grave in it. And mari. shis Burial with double dagger thus Designate site of monument thus f ] Casket or Coffin no Foc Regul Size Made by Laning and Pillow Set No.... Handles Plate Outside Box or Vault Burial Suit Slippers Renae” Sane si ee IF) 20 Candles Gloves Bearers or Porters Hearse to ¢— Aenwwe 223 I i || i} i | | | | {| Removal Automobiles | "1 Sed | | | | | ipy | Newspaper Notices inbalming dV A r | va hing and Dr SSinyg | | | i | | | | : | vices i | } { ‘hair | 7 i | airs i | Transportation Charges Charges ; se uu Q Officiating Clergyman............ f larg pert 0 Amount of Bill i 1 Goods Ordered bhai were ... ... | Bill Charged 0 fads OR : 1 ae s | ieee ae | | a | | tie al cad | aa e | | ie | J I | RR ais ! RR et npc | oad ; ds ak | ; 'S8UEO BY DORNTEE CASKET CO., BOSTON, MASS... 1018 | | | ; | ——SSSSaNaNsS=aSaESEESEaSaeSSouaua=_q==={Ex&x{&{x]:*{["x"=" RECORD AND BILL OF ITEMS Yearly No. Residence../, Place of Death Date of Birth. l (Year) (Month) Date of Death 19 (Year) (Month) Maiden Name Birth-place Name of Father Maiden Name of Mother... Cause of Death—Primary Certifying Physician Place of Burial Funeral Service at Time of Service Date of Interment Casket or Coffin No. Size Made by Lining and Pillow Set No. Handies Plate Outsid Buriai Suit Slippers Box or Vault Embaliming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges OR JHE FUNERAL OF Tota/ to date fi ‘Mato . Wife or Widow of fs Years [ See f Color or Race on Age ; Monihs ¢ Single 5 Days Married Occupation His Birth-place Her Birth-place Secondary Residence Cemetery Lot No. Put in the Diagram one mark like this Grave No sv ee oe Eisai we she Section Sa ae Cc fs iti iin oat careers oe taiwan Candles 24.22. Gloves / S® Bearers or Porters e es He arse & &2+4~<_ A is oo Remove from Wg tne } WW loo Automobiles Newspaper Notices 3B \e0 Transportation Charges Officiating Clergyman (icicle! Sabine 6 iw oO Amount of Bill si accessed Silents Music ~ bi Goods Ordered by Cr Flowers Bill Charged to Mf /: Ce. | situa whem aes any peinmmmnenian aneeioue CR. DR. 4 oe een aee iiidilai ce en RE SS rare ene ram as Race SSC ee hee | | — ” | it = | | . i r 1 ( } | ae } Sas — | | i | | | | i | ss |] $+ - 1) ~ - | | | | } ere ISSUED BY DORNTECE CASKET CO., BOBTON. MAES. ea IT a Fc tt age see 98 RECORD AND BILL OF ITEMS FOR THE et Coe) Total to date... Z Ey all Laltr my Residence a ro, i , 7, ; Place of Death Ca eZ be Vnrikle Ritter Vidow BP. KF en Lh eklon Date of Birth 1S t 6 @, Years Sex r Month Yearly No. Color or Race gar ! Date of Death Tat '/ sf / Age Months Single } 19. r) (Mofth) ny) : Maiden Name Days Married ‘ a . / . j Birth place Ca? <7! fa tH“ da di La LDcc pation Name of Father G2 cid &F a (A His Birth-place Maiden Name of Mother... 4 Her Birth-place (Cause of Death—Primary Secondary Certifying Physician Residence ‘ ’ ae © rv SEE wa Place of Burial. Z Cemetery SJ 6 Mp wh an é f eral Service at 7 Lot No. Put in the Diagram one mark lik» this i | : a a Bs r) if Ries Nos i L~ | for every Grave init. And ma BSG OF SEEN / ps A ‘ eae 4 Burial with double dagger thu . | Date of Interment Section } peti 1 r Designate site of monument thus i ] isket or Coffin No : Candles a Made } n Glove | | wand Pil Set No. | Bearers or Porters } Handle Hearse — Plat Removal Box or Vau Automobiles ; |. Newspaper Notices ; | | | | | | 1 1 j : Cl | | Transportation Charges Officiating Clergyman } | | « | | Amount of Bill | Msi ‘ i} } } | | | Goods Ordered by ./ Trott ‘Ttin uy | | | Bill Charged to . 1 | P DR { ; } { i ; | } = sili _ i | 1SBUEO BY DORNTEE CASKET CO., BOSTON, MAGS,, 1918 99 _.RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date , Cy Mt UL. Ly j W. he M t sition ° Lice { f ~~ s Residence Yi ceyf / ow \ io Place of Death * Wife or Widow of > j : es = os 7 5 f Years Sex Ak ere a ve { r or Race ff } : Date of Death 4 Bu une sf Months 2 Single #“<As<ée0 een (Ve 7 ’ 4 an | ‘ Maiden Name mm £ad Davs Married & ( ¥ , s “ - om Birth-place / wt Occupation ... /“-“ ve & ft so ef © Name of Father 7 His Birth-place MEtae aiden Name of Mother /. Cth << é~\_ Her Birth-place ¢ Mai 2 } . 3 ‘ Dry ; ‘ Se. ar . Cause of Death I On By, i Gd *J wry se Der ondary i ~~ tp / } be e Fy Ee . = Certifying Physician 4 4 j f se 1s sath Yea Met itig eee Np Sick | CREM CA a Place of Burial r Yom PEt UM entfetery Funeral Service at Ws gheermmmanens cena Lot No } 4 ha Cee sl : 4 for every ¢ e init 4 I k this Time f Service / / Qh fs Grave No gee cla a f “a 2 : Date of Interment 7 4 ™ Section ee wer es Casket or Coffin No. Candles Size Made ' WAL AAVA i¢ OiGis Gloves E a Lininy and Pillow Set No. Bearers or Port Handle Hearse to Plate Removal Outside Box or Vault ae Automobiles Burial Suit ¥ A Slippers a aye Newspaper Notice I Embalining Washing and Dressing Shavin Services Use of Chairs Transportation harges Church Charges Officiating Clergyman os ate : Rill Z en . a | Se Cemetery Charges Amount of Bill a ae ! Musik Goods Orde red by om” + ” c ( rd to ii Flowers el ea ae is cettinns wii oe | DR. at ‘imap ie al one i sani ee - a = + os E ee J + ¢ 4 i 3 : 4 oe } . | | on | } a ' \ | et | } ; | } } | | : j } ’ ’ ’ } ' } } | | | { ed is i | } i — jj i} ae ~ MASS tere teeuto BY OORNTEE cagKet co BosTo ae eee ee subi 5 yma, 100 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Studien. Ce ei Boe. Place of Death aT Ae ' a Date of Birth ] Leeg f eee aan ee 1930 eS 32¢ iis (Year) ‘onth) (Day) Maiden Name t it ne Oe fperrecle LE Name of Father Lechy ow - _ Maiden Name of re ise of Death Primary Yearly No. Total to date... Residence Wife or Widow of Years Sex Irate’ : Color or Race Months Days Married fed Date of Death Single Occupation . His Birth-place Her Birth-place A ee Keriary Moresa oka Ye, Residence Man { I ician a p of Burial (LEEL O a A. ee Cemetery Service at Lot No. | Put in the Diagram one mark like this f Servic /. Grave No. iV oe yon ep arog ) { Interment ee, AA, 3 ? Section 7 Designate site of monument thu: rj r No Candles ; Made by Gloves j 1 Set N J| Bearers or Porters I. | Hearse to Removal Q) le B : Automobiles 006; | rial St J $\CO oe a: ‘H.-Y | - VV ry pers Ce ; Newspaper Notices | una aS | O I | . | | i in : Me La 4 | 7 Al j I Pg | j i YE Vo } [/ | l\ | | | | oe | i} ~~ Ch | A Transportation Charges i O Officiating Clergyman iene ( ( | 2d. Z 27\7tO harge 2 | Amount of Bill eee ; || | | { Goods Ordered by | Bill Charged to | DR | | | | ae 4 | : | | 7 3 oa be 4 a ae 'SSUEO BY DORNTEE CASKET co., BOSTON, MASS., 1918 101 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF ye ee ao 4 i ae <a. “Loe Wife or Widow of es alprdin BeaZ~ Ae icine Tota/ to date Residence. Place of Death a a icin 4g whi A =s/ Years f Sex (Year) » (f 19 are 13 2 (Month * ) Age } Months ) Single 4 Birth- place Occupation HS Date of Hirth r or Race Date of Death Name of ie Rance His Birth-place a Maiden Name of Moiteecher Vere Lob f ben Her ogc ' Cause of Death— Primary ie Bieta Certifying Physician . ie Residence Place of Burial ran Cemetery fle-. ree dk ¥ Funeral Service at ot vais a Lot No. a - Put in the 1 mark Jik Time of Service ae FLV f Z Sr 4 / “2 2 Grave No. v ; ” hp : Date of Interment Section saa © o Casket or Coffin No. Candies Size Lp Made by Ok» if Gloves ‘¢ pe —_ Lininy and Pillow Set No. Bearers or Porte: Handles Hearse to # SUS 6~ Plate Removal Outsid: Bx or Vault Automobiles Burial Suit ¥ Lmdruwwrar 2 Maa. Slippe Ne wspapel Not Embalining Yv Washing and Dressing ¥ Shavins Services f Use of Chairs Transportation ( harge s Church Charges Officiating Clergyman bos - . o“ Cemetery Charges Amount of Bill Fife reo © 2 Music Goods Ordered by Flowers sill Ch irged to D CR - 2 MIO e ee ee ee a pore E ; 7 : ; [ih 4 - - wa } ae iia | al — 4 a —m oe } oe — inicio | } ei Pe | ied 4 i r | } OSTON, MAGS 1018 1e8UEO BY OORNTEE CaeKer co,. & peers ALE Soto a ta Re Cd eT iin ements 102 RECORD AND io OF ITEMS. or “ Total to daje, Ins £4. FOR aint FUNERA Arg JM, bah “phi dha. Mle Residence CL he Ca J Ky Yearly No. Place of Death Na é ime . Wits or Widow of. Fe 4 a ¢ Date of Birth 15d ‘ne 10 ‘ta Years teeble—— Color or Race Ospr) (Day) 3 in Date of Death 19.7€ F4 ~~, Months 4 Single , iia Wak & Days Married ad Z Z , 7 Ite (fy \laiden Name Messe ki CLEEY Birth-place YW, ft Name of Father /\ EAC F et nw OL CG Mephee Occupation Age é A jg m / tn un ¢ a ge tA Y? OLE His Birth-place # / C A. litth, altfccer] Birth-pl “ Maiden Name of Mother, A“ &—"* ¢ fix ' ar ¢ Her Birth-place Cause of Death Primary a a 4 Secondary Sha nn. Pp +7 C y Certifying Physician fs J C , Residence bl bau the— yt : Ad f f ' Place of Burial AN LA fl J 4 Cemetery v4 : luneral Service at 4 Cw Lot No. Put in the Diagram one mark |ik« i , 7 7 wae | for every Grave init. And mark Vime of Service ee P Grave No. La Burial with double dagger thus Date of Interment CL.EE 7 Section - =©Designate site of monument thus i] Casket or Coffin No Candles | Cia : Made b Gloves Lining and Pillow Set N Bearers or Porters | Hand} Hearse tA Plate Removal | 0 Box or Van Automobiles | u uit | | ee | | ippers Newspaper Notices | mi i | -4 n Poe ung | | | | ] ] pr Aaeges Oe | 1 ie ais oe ao '| ‘Transportation Charges l Officiating Clergyman ss | : i we fm ’) | Ag " i} | Amount of Bill hema x) jk a /@ A AC Fd j aieal {| = l Lo all l Goods Ordered by . “= ¢ 2 hha wh } } F | Bill Charged to ce c PY | ees EEE ! Z. = : ee Er : i DR. CR. | 4 i tj | |. <j Crane O Eevdneenaahals z 7 -~ ps | 2p | ' j a ——™ ote! | | | foo z | - | | 7 | i] ts ~ j | i oso oe | te Lf ! ag | 1| ws } j | \ i} | 1 | | | = | i) | I | {| | i| I tl | | { | {| | || = | | | || | i} | — | | | | | | | | | | iI j | ~ ~ ‘ wien | | _ } 1@8UEO BY DORNTEE CASKET CO., BOSTON, MAGS., 1016 103 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF (am @ By Artaat baught 1 /}ts 7 Lye Tota/ to date ~~ < fy (ice Residence Place of Death \\ or Widow of tir < as Date of Birth BO ¢ a / sf \ | Sex ——* { Calan on ace Date of Death OP } iglesia ss. hos iciiten 3 Maile J Married . ts he : i i é s 5 e. Name ot Father Kitt ( \ i Birth-place bk he ong fF . —C, Pe wkd j | vets i > Maiden Name of f. ee —* | sirth-pla te Cause of Death—Primary ‘ — + Certifying Physician 7 : : : : a i A ee Place of Burial — . Maiden Name Birth-place Funeral Service at | the D Lone mark like this | for ( And mark ¢h Time of Service . : B sas Date o! ecm Lae ie nisise she cme r Coffin No. tor Ce | Size tL Made by - | Lining and Pillow Set No. Hand! : Plate | Qutsid: Box orgie A : Burial) | Slipp« Embali:iing Washing Shavin; and Dressing —. hairs Servic Use of | Church Charges Cemetery Charges Music J , : ZL Flower - DR. . ime — Oras PR EOI \ “ es ep PAE S ase jesUEO BY DORATEE CASKET CO, BOSTON. cl 104 105 RECORD AND BILL OF ITEMS RECORD AND BILL. OF ITEMS : Total to date HE FUNERAL OF — early No. Yearly No. = ¥ Yearly No FOR THE FUNERAL OF Tota/ to date ie : bit Rie coeds ELE. 0r. N@ A fa WN +’ “ Ly >. fGastcas so Residence : . oF y ; Residence xe a. on << fy zr v r x 4 e FKhla Lite { er dé ? A * s) . ‘ oi ee on Laer Newhanadhnes Tad 4 Place of Death Yt 4" ta She Js AA pf Wife or Widow of... 6¢ ¥ . 4 onthe Behan Place of Death 4 ta teat Atanaetic? Wife or Widow of » HHtallag &- oe ee. ee phar i Date of Birth l 7 aa ra f %.... Years Sex Color or Race Date of Birth LS site -_ * ayrt (Month (Day) “ : (Year) Month) J {phy is Years Sex Color or Race Date o X ! Age Months § Single Date of Death l } ss , e of Death g 8 < (Tea) (Month) (Dey) (Year) (Monthy Day) Age ] Months Single } oe \laiden Name Days Married Maiden Name | £o) Days | Married <— | Ww) sirth-place Lé¢4 Ll t r Occupation ; Birth-place (Corre eg Mn or & Occupation | be ’ [ -. Ri ana: Das eee, > a a i a Aa Sear f 4+ Ais Birth-place 43.4624 €4K....0-6), Name of Father ag gig S yaa ed His Birthplace Cts co. | : | - ; an “t Ct 5s ; ry Maiden Name of Mother Ka a ZL hoe - — nynstincgeamns ws Lee Her Birthplace <2«cwZ€’ Co- Y&.€., | § ' i Cause of Death —Primary 4 Secondary Cause of Death— Primary Senneideary 3 Certifying Physician Residence Certifying Physician a. eu a ood ee Rasidenee f U i Place of Burial Cemetery Place of Burial (Qe Rix oOcl_— Cemetery YG l'uneral Service at _ | | Lot No. | i Put in the Diagram one mark |i; Funeral Service at A)..7- A. Reekor Ce Lot No. eae asks { =) . . amish u n « yy 4gram one mar ike this iat J A Geave Bo. Y oe every Grave init. And one i eee. 3 ie o YC .N Pe | for every Grave in it. And mark this ‘ lime o ‘ ( urial with double dagger thus : dau ~~ ME rave No. EE oe Tie et th é 4 5 “ dura: With double d ager ius Date of Interment Jf ~ J Section “al Designate site of monument thus r 4 Date of Interment >... Be7. ee Section . te | | | rd . 1 | esignate site of monumen t thus: C] : Paciotne Cotin Wi Candles | Casket or Coffin No. ~~ Candles | ‘ er. Made i Gloves Size afb Made by ~ “ a { Gloves *~ : @ | { . I ad Pi Set N | Bearers or Porters Lining and Pillow Set No Bearers or Porters i 7 Hearse to Handles Hearse to? i » i e Removal | Plate Ch Removal 5 ’ k Ow : < } f “ ‘ i x Outside Box or Automobiles —QuisideBeror Vault /77 3° > ER / /& © ° Automobiles H : i ‘g ; a j ; {| o ul Burial Suit i . t Newspaper Notices Slippers Newspaper Notices he | , - i Ea | pF -4| Embalming 4 | / ' ; | : | ' ae : " | | Washing and Dressing ! ' { t | Shaving i | | | Team | | | we } i ; | rvices 4 ’ Transportation Charges | se of Chairs “~~ Transportation Charges we | | 4 bf | Officiating Clergyman sete | Church Charges Officiating Clergyman Bs ie i] i Cha | Amount of Bill Ec a emetery Charges 4 \mount of Bill —— —. mat | 4 F M | Goods Ordered by ilusic Goods Ordered by F | Bill Charged to iP: f g stad lowers Bill Charged to : } | eeenninbinsae meuneaibiiedieie nike ™ = iii eit So aoe eerie serene eS NE NRE eR a Hie OR. CR. DR. CR. Hie ae is = sisiaiaicaamia secninieetiemanaaaaion i} | : ba.| 13-7 Caek_ | a _ | | | bed C}) i | a | | | A H | |——| : I sil | I | i | 4 | | | 4 | | } | : 1 | : | | | | | es — t ! \ ed \ ae 4 | | | A cd ee ee : | | “| - ' . one ee ae nae een - +] | ee | | | ‘Gnemees | | | — eee i : 'SCUEO BY DORNTEE CASKET CO.. BOSTON, MASS., 1018 1SBUED BY DORNTEE-CASKET CO... BOSTON. MASS. 1016 Poe nana RECORD AND BILL OF ITEMS FOR ” PUNERAL OF RECORD AND BILL OF ITEMS Total to date... Yearh N. 7 =. FOR THE FUNERAL OF Tota/ to date Yearly No. 4), “y / ) ts btod ht ~ oes j ‘ , . ° - j Weg 4 / 1 fZ ‘ — : WE cA 4 ~ A A t/ ? MEAL tA. Ce id ah WAAL ' , ae 4 i Residence A ; — r Residence ft Gls C + .—_— oe i / ; Wifear Widow of an = Place of Death ¢ 6 / oe . Place of De ath Z. > Wife or Widow of Date of Birth ivéd f Years Sex Color or Race Date of Birth r \ ee : ‘ . é (Year) (Month) (Day) 7 Years Sex i Color or Race Date of Death 1946 Age Months 4 Single LJ he. 2 Date of Death 19 30 fc }.2 Sn " (Year) 7 g F (Year) (Menth) (Day) é xe Months 7 Single ) Maiden Name Days Married .; oe Maiden Name Days Married SZ at Occupation : : a : a : Birth-place Me ccup y Birth-place on e ’ Occupation i A#, (Mund p; a “ - cae A Name of Father : “HHS Birth-place Ake “is Name of Father His Birth-place ii & Bi ‘ ; : . | Maiden Name of Mother Her Birth-place ee. Maiden Name of Mother ... Her Birth-place ae } ace i i Cause of Death Primary Secondary “ Cause of Death Primary ‘ Secondary fi ‘ : | Certifying Physician L Residence Certifying Physician > Residence k Bicnn af Rusal } Lf ft A : / Cemetery . Place of Burial Cemetery b § luneral Service at Lot No. | Put in the Diagram one mark like {!)\s Funeral Service at Lot No | : | for every Grave in it. And mark Put in the Diagram one mark like this A lime Of Service vere sf Burial with double dagger thus Time of Service Grave No I for every Grave in it. And mark this i . ; S Burial with double dagger thus: f i 4 so 20 | oon . z ‘ % Date of Interment ' <rOEOT | > Designate site of monument thus f : Date of Interment Section 4 | oe’ = wt | 1 Designate site of monument thus co 4 “ ia — —_ t a Be - Se a 7 ee oe = Seto emetceneneete ee, sree ee eee erro -eeenreeeeereeteneen: a . aan a i : Casket or Collin No Candles Casket or Coflin No Candles : é bet ; | Size Made by Gloves {> Size Made by Gloves i b o a ee iat pon ‘ 4 | / { ; a Lining and Pillow Set No Béarers or | :y | Lining and Pillow Set No | Bearers or Porters ' k Hand! 1" Hearse to fable” | Handles Hearse to... A-enpie f K Px e - H/ : | . i. a ‘ Removal 4 t | Plate Rasiaunl ig ¥ = ( H i Outside Box or Vault Automobiles Outside Box or Vault Automobiles | i . Reeds Hh) burial i | Burial Sert —_—- iti A i e Pe News Notic | ies Ht | & lipper Newspaper Notices | Slippers Newspaper Notices | tf | i ‘ mbalm Embalming ar. | j ' I ! i 6} j | Washing and Dressing si) i . ub LF 4 a2 i. 3 “havin i 7? yw : ee Shaving ig ' I vv i | ° | a : | } | Services ‘ | , . ‘ . - 1 ~ t i ( | | Transportation Chargeg Use of Chairs Transportation Charges ah i pees ; | ‘ pF | Officiating Clergyman lesipaisia Church Charges Officiating Clergyman palace Ei. ¢ ’ 1 yr , Hl it tery Char | | } Amount of Bill Se Cemetery Charges Amount of Bill toca eat Ce ; | | | 5 : a © ; : ag } | | ij \ i Music Goods Ordered 7 Music Goods Ordered by : i ; fin Hl i i er | Bill C —— to whit, evu/ | Flowers Bill Charged to “7* ‘ ~- - “/ + eo i] : z grea wom air red So Se coe <= L a aera eee tener SS TS RRS SRR SAAT TRCN reearnecteeeion: — g . H a ae be | DR DR. CR. i ; icine b sieelshieamicsibiainingeiaiteseliimniaiieanapiiimiaiiiiieliia aha cai chil BR | | | 4 > foiaA f 4 of SG mate hed! Ht St web ¥ G6)<”x | | A$, , } | | | : | + i | 4 i i Be? 7 BES ait ‘cael fT P IER j | : i | - H | ' er } | A hat bs Pa = - 4 - | of A x r o f ' | r | an “ | i Vay - qq ’ | | ; | a ie | aa | i | 7 a i} 7 ' | * } | | i wie | | | j — _— nS a : i ISSUED BY DORNTEE CASKET CO., BOSTON, MARS.. 1918 198UED BY CORNTER CASKET CO. BOBTON MASS. 1918 108 109 RECORD AND BILL O a RECORD AND BILL OF ITEMS * 0 ate... Yearly No. FOR THE FUNERAL © Yearly No. - FOR THE FUNERAL oF Total to date Mage ‘ casein Ps & fly a D a e/ : r apace ee passa & ALA Le © YLCA i ca Jap [-. ah Sa Pheler Es co 7 ee Residence = : esidence Y fi Pfy oF. j fee ee : Place of Death hodedivee Wifgpr Widébw of. ae Place of Death Kk LAK L444 G ls Wife or Widéw of - Date of Birth Spy — vo : 6 Years Sex fale’ Color or Race Date of Birth l {vb deh H— // ps Setide 4 R (Yder (Me (Day Year (Month) (Day ears SEX | jor or Rage ; | Date of Death 1990 {0 Le Age — Months 4 Single rae ee Date of Death 19 40 OE he co “ he Ye a a ara 4 i i (Year) (Month) (Dey) Ga (Year) (Month) (Dey) ge 5 nen onths < § ingle ys $ : es r. $: JO r ‘ JX Days Marrie Sette Nems \ ae Py Maiden Name a . hs 7 Rare WTOTES «aol Days | Married an fl ; (te Lt th, , . a Birth-place bsbherr2- Occupation . Birth-place eH ALES Oe . a C Occupation i i Wana of Pathe: eae is ee a His Birth-place . Name of Father C, : / i. CLL His Birth-place GAAS Letice<- A ‘ oe 4 : . . by : a , . i 1 — ¢, , +e f i a Maiden Name of Mother pe feous Her Birth-place - Maiden Name of Mother. (/LA“G ihe Xt Ut Her Birth-place Mold heey iba Cause of Death -Primar Wtlvee” Secondary nee Cause of Death— Primary a ’ eee Secondary | if , Vth. tie. 2 ef i Certifying Physician dy 7 Residence Certifying Physician AN Ge ‘ re ‘Ch Lita 1” Residence CtL« : . Ala” Dicca of Rusial hake Cemetery . Place of Burial A_——~ Cemetery Funers) Garviae at Lot No. | Put in the Diagram one mark like t/1i« Funeral Service at JRE Ak ame PE Pir in the Piesniie Sue ease ere n ' | for every Grave in it. And mark ¢/ i , i fe 1 os sas ee : n os rt a ais eaears —" V Burial with double dagger thus : { Time of Service ae Grave No V B 3 a - i ins de a a surial with double dagger thu : Date of interment oO CF / Section | Designate site of monument thus: a Date of Interment | q...” Section De ne : thu Cl , J ate site of monun us i Ce 7 | 14 ; ‘ a ——— - Ce - : eee pre seeateiiiemeai seems i Casket or Coffin No \ bef o 22. Candles |: Casket or Coffin No.c¥"/ Zo Ze re > Candles f Size Made by | Gloves | | Size = s Made by 4 Us. Gloves be r. : b ‘ | | i Lining and Pillow Set No. l| || Bearers or Porters f . lop I. na Lining and Pillow Set No Bearers or Porters i] | } hy// sf cH >|| en © rer Jo | Se / f | meg Handles Hearse @ m | + | '| Removal | | Plate Removal 3 I! Automobiles Outside Box or Vault Automobiles H me | \| IC eo | : } | | a | Burial Suit | [ | j lta | | = ! ao | Newspaper Notices Slippers Newspaper Notice | b Fe OQ} | Embalming anh... 1? i | ; i |} . Washing and Dressing | sl | | “i: | Shaving t ; | Services | ce | | 4 Ch | | Transportation Charges | Use of Chairs Transportation Charges if i ( Officiating Clergyman | , Church Charges Officiating Clergyman te y i | | hit | fee Se , 6 $0 ies tery Char | Amount of Bill / ’ Cemetery Charges ~~ Amount of Bill a The eH | Goods Ordered by | Music Goods Ordered by i | Ae h ; sill Charged to | Flowers Bill Charged to ai t ee: a — sonore loans - Heb i ' DR CR DR. CR E . ae oa es a = as es ns es ae - j / if} i| Par sae ail ly >) , | |_lJ2 -23 <8 eee Je | o/ / 3 I | S f (2 . JA SO LF2. | | r ° t/ % | all | | | | SARL, | | | } | ; | ‘a | | cao j —~T j } e | | i| | i] | | | | a : 4 Ee : 2 | “| | | | II : ra } | | — } | | ; | } " || | | | : | il | | | { 1] | ie | | i | | - i Paap J | | ahi i | } | | } | | | | mecca | : | | a, | | /—--| : 3 poke sir ‘is 2 | : wis \ | | i t (SSUED BY DORNTRE CASKET CO., BOSTON, MASS., 1010 ISSUED BY DORNTEE CASKET CO., BOSTON. MASS. 1810 110 Yearly No. Residence Place of Death ZL et A A FOR THE FUNERAL OF had bobbins ge Wife or Widow of Sex RECORD AND BILL OF ITEMS Married (Clos Px aot Single i Total to date... Color or Race ee -— —.- Put in the Diagram one mark like (| I for every Grave in it. And mark (/:/s Burial with double dagger thus : 7 Designate site of monument thus: f ] Goods Ordered by, Had lla WG Bf tens ie oo = — Date of Birth |. if ze fi” fe f Y Years : 7 Mooth - pS my) Date of Death 199 Cf é / Months Bt (Month) (Day # \laiden Name i. ie. Days i! 9 é i Birth-place v L407 Crees ha 4f Occupation . Name of Father Neh C4 (74 Me Cert C His Birth-place /4#-*-* 4] i i Maiden Name of Mother He C4 Z ¢ 4, Her Birth-place i if Cause of Death-- Primary Secondary td Certifying Physician Residence s 4 Place of Burial ___£! 7 Cemetery . i l'uneral Service at (f/f ee Lot No. | We lime of Service Grave No. ; D a f % - i ate of Interment ff Section | { | ! | errr -_— oe " ! Casket or Coffin No. i ‘€ ~ Candles i] | Size Made b | Gloves i Lining and Pillow Set No. | Bearers or Porters Ha Hearse to Piat Removal Out Box or Vau | Automobiles I ial Suit j ie ; ers | Newspaper Notices : | Ps 4 n I \| i i| | i || | | eS i i } oe } i | i] _ i ‘ Transportation Charges ( ge Officiating Clergyman a : U ery Charge | Amount of Bill fh Meats \ f BE | Flowers | Bill Charged to Aete 3 4 ite a 1 tl 3 iy F 4h ah | | | : } ag ioe | } | ! bd | i - 198UE0 BY DORNTEE Casket CO., @OBTON, mase., 1816 Yearly No. FOR THE FUNERAL OF 111 RECORD AND BILL OF ITEMS Tota/ to date <Z# of We thes an: mnt -- Residence > S { ike ee he? Place of Death /e« Wife or Widow of Date of Birth FeO age aia = i Sex Cie ihe Date of Death 3 aia ions ~ Months 9 Single Maiden Name L Days | Married Birth-place } hl hae Occupation oe Name of Father. ~~. His Birth-place Maiden Name of Mother AA GLtwee ** Her Birth-place Ora Cause of Death— Primary Secondary Certifying Physician Ap ' wi cle fe Residence Place of Burial. (2ee-At+~eend__. Cemetery P Funeral Service at i Lot No. Putin dhe Disecom Gan ak ikea Time of Service +f Eee Grave No ees re eee wis “hee eae fo Mel gk ; Section on engine steninneaaa ieiaiatiieab puerta Z ae =aneem ; a 7 : / Casket or Coffin No. »& I} A ¥} 450 Candles i Size : Made by Gloves Lining and Pillow Set No. ij Bearers or Porters Handles Hearse to Plate } Removal ' Outside Box or Vault Automobiles Burial Suit i Slippers Newspaper Notices Embalming i Washing and Dressing | | Shaving Services Use of Chairs Transportation Charges Ps Church Charges od Officiating Clergyman oe all on Cemetery Charges S oe” Amount of Bill we Music ‘Goods Ordered by Flowers Bill Charged to DR. CR. ‘ae / 7 “a [~ity -\P° 9 ol | | | | | | | | | ~ | —— | | | | onal | — -—__— - epee } i| | be 188UED BY ae CASKET CO... BOSTON. MASE. 18'6 112 113 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FCR THE FUNERAL OF Total to date... - Yearly No. FOR THE FUNERAL OF Tota/ to date . _—_—F — — ee , LZ, ‘ : ital, Z 7 ? nes a Ct ons ee eon A. Late Bact etd eet, hone et ipaseoocee. | Residence a Chae fn tet ¥ of in \ eo oo Wife or Widow of — « = a : : — Date of Birth acs 7 ( aa a F _.Years Sex fet— Colder Race 7 Date of Hirth lAbkb 7 CRAAA iM fet. Sex Color or Race onth) yo | J t er — VIA Residence , Wife or Widow ohare. rf Che Sf bert ¢ het Vinuls < Rett A FH ae (Year) (Day) — (Year) “[Manth) i (Day) Date of Death 19 34-) Z PS aa Age a Months 4 Single re Date of Death \g-3-<> Kee Lb A rene z Months ¢ Sinalé (Tees) Goan) (Dey) (Year) (Menth) (Day) we ] 2 : Maiden Name s = anasae oe a — 4 ae Maiden Name | + Days Married { Birth-place Ku Ae 2 watt Le ‘ A _* Occupation Aiece Ph Re occ . , nna Birth-place Ct ag Occupation ote: ial — Father aad “A oc . i, - - aes < . = a gl Name of Father . —_— ' LANMUAL itt Smee His Birth-place Puce — Maiden Name of Mother.7.4-¢¢ €*# C4+-0€ fee ~®¢ Fler Birth-place oe Goons Maiden Name of Mothé( Ln wrt ry €. fu C4 Lit fer Birth-place } ff ~ Cause of Death—- Primary " Secondary... Cause of Death— Primary Secondary ) ) Certifying Physician a Residence ; Certifying Physician }~1_- “yY Residence } Place of Burial Je (A fe (Ts Cemetery . esseee Place of Burial Le Ch EON geen Cemetery Ye ° hii / Funeral Service at os Lot No. | Put in the Diagram one mark like Funeral Service at ) “2 ee bers ee Lot No. ! Put in the Diagram one mark like this ; eat A ee, out - - bf, ‘A ; I for every Grave in it. And mark ¢// ss ais ic 4 . aT for every Grave in it. And mark this i lime of Service ae 7 AY / > 7 «Grave No. LY Burial with double dagger thus : } Time of Service - a a ~~~" Grave No sat Burial with double dagger thus : t | Se i Date of Interment Section ; : : Date of Interment Section | lai a ahi aa i : 1 Designate site of monument thus: 7 | Designate site of monument thus: 7 i L Brean seh a a ee Soetna se ee = a + = + = silat sicaliaiit . one <= amram zs T Casket or Coffin No | Candles us s Casket or Coffin No hoc : i oe “Ss Candles , size Made by Gloves Size Made by Gloves < ee a | | 5 p Lining and Pillow Set No. H Bearers or Porters Lining and Pillow Set No. Bearers or Porters i a | | ? ” ‘ { Handle | Hearse to Handine | Hearse sg i=. "4 , i Plate | Removal te Plate Removal i ry t Outside Box or Vauit Automobiles Outside Box or Vault ~A“e ——— Automobiles % ii a | | 4 Burial Suit {| r Burial Suit ! = : i i 1 wands Se ae | *}: } Newspaper Notices | ipypers {| he | Newspaper Notices | Slippers i pay i | eb || | ! i] o i j 7 : | "eh 4 nbalmin | hal | Embalming “ "| ing and Dy Washing and Dressing . f \| , H | | | Shaving f i| ~ . " i} Services g * ti 1 : : of Chairs | | Transportation Charges | Th ot Chsinn Transportation Charges ; h Charges Officiating Clergyman Cliurch Charges : Officiating Clergyman —_ f Cemetery Charges I Amount of Bill a Of Cemetery Charges “< / Amount of Bill a . | | M | Goods Ordered by | Music Goods Ordered by pee itl iis / i l lowers | Bill Charged to 3 : ; ‘ Se — Flowers conan = | SS cs renee enc eens = Pre | CR DR. CR. DR. SS A RN ST eee == see = - ee | ¢ - | | {| GH f { f aoe ff ae WA ~ ~ “p.. | | | I -\FO} #2 ‘ Ph © : - i > * _ } - ” en 7 ener = - , lf | sacentel_ nie a vee | / ; ; / } P ea at | “ne . ear | | : | . } F | | - ; ‘ae fF | R I | t Li } | by + i | | i i Vi / | . i | | “ 1 | | I i | ' | | i ; | | ; i | sa | | ; || } } | ea j | j | - _ — vin ’ i | | i | | — | | i} Sia sic ilies aii ce a4 a seid i : | i | sti ad isin : iz 3 Se | | |. | — | | | | | | | od J | . | | J | ‘i inal on oonnran CASKET CO., BOSTON, wase., 1018 1S8UEO BY CORNTER CASKET CO., BOSTON. MASS 114 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Total to date... Yearly No. aie FUNERAL OF soe Yearly No. " ’ , FOR THE FUNERAL OF e Tota/ to date 7 ; / f) Residence Zt, r “-— Cf — Residence... / ¢ K i { eh 2 i Place of Death LE we We Wile or Widow of Lilla. ate Arahen. Place of Death herd Aaa. ws Wife gr Widow of Date of Birth |. 1 6 ‘-. f ~ = Years Sex Color or Race Date of Birth iSSy Ky oO f R Years Sex Colo Rg LOS (Btbath) (Day) —_— ne (Mon Dey) | ears x oor or Nace J 7 / i Date of Death 19 30 La Lil Age af an Months ¢§ Single Date of Death 9d © Kee el wit f Months ¢ Singte Maiden Name : 2 ~. 6 Days Married sy ieee ; oe: Maiden Name _ f ; [ | Ui thkile A e = “oecupt Soler iddn nO ve Ling SAbeo' Birth-place # teal ee 7 C Occupation .... sees : estes icp i ekerancumenots Birth-place ¢ - o Occupation = daa ; 0 Name of Father aa Le sat (LA His Birth-place 4 & x Nisan at Father Ly A Kueh LAHis Birti- -place RE, Maiden Name of Mother © Ce a é oe.’ Ci - Her Birth-place nil dese : Maiden Name of Mother / Ovn/ Her Birth-place RG Cause of Death — Primary Secondary. seve serecacnenseasnaneenessase . Cause of Death— Primary Secondary Certifying Physician iL le OR ‘ OR Aaceeet ES ERLE ROPE RULES AN a SN een Meech Sty ee ie Certifying Physician = MAb ps2. tetien te Cate ch pd / Place of Burial fe et Cemetery . ; Recetas be Place of Burial Cemeterv é l'uneral Service at Lot No. | / Put in the Diagram one mark like this F uneral Service at i Rei, AAR Ch_— Lot No. | Put in the Diagram one mark like this ie a i ee | for every Grave in it. And mark (/:is ae : V/ zi } I for every Grave in it) And mark this lime of Servi Grave No. Y Burial with double dagger thus : / Time of Service / / art Are = 4/2 ? Grave No 2 Vv Burial with double dagger thus: f i Date of Interment Section i S| Designate site of monument thus: = Date of Interment Nee "-— 3 oO Section | Designate site of monument thus: C7 ; icine aie om a - a CS = Ltn tangh ~ r | / eo wie Casket or Coffin No f i { ~ heb Candles ate Casket or Coffin No. * # Lo g ing Candles f OaTa' i} ) : | “ 4 te fais = 4A i ‘ i i Size Made by I Gloves 5 Size Darkly [7 Q oO Gloves y ; Chu S (OAL MALY OS lye oe 4 Lining and Pillow Set No.. | Bearers or Porters ; Lining and Pillow Set No. Bearers or ~~ Ts ; eas oe Di a 4 Handles Hearse to cae Handles Hearse iT er VC ve 3 j ts G 4 ) > 4 : | " Plate Removal : a 2 Plate A Removal | | | | 14S oc | Outside Box or Vault Automobiles donald ee Outside Box or Vault Qh “Automobiles 1 i. a} Gast | . * | Burial Suit oe | b Burial Suit ar “ag ! Newspaper Notices Newspaper Notices Mippers 4 Slippers Lh by | mbalming | 1 Embalming i = 1} } MOTTA SHG t TORR | | Washing and Dressing / } I | | | | : Shaving : | Services ' Ghar | Transportation Charges Uni ut Chairs O60 Transportation Charges ( it ine | Officiating Clergymanh .... Bs 4 es Church Charges 4 L Officiating Clergyman ms :' ‘metery Charges 1 | Amount of Bill 3 Cemetery counts © Ku Lag +e < ~ Amount of Bill ele tee vo f ons IO ¢ . Hii M Goods Ordered by Music v OR Ltire mf — ? x OY Goods Ordered by R f s Ah hlowers | Bill Ch ! Pliswek gy, Bill Charged to | DR. DR CR. | | E | / og bass : -| | || A APP ects! aaNet Easiness Bp | i| | A ‘ ee ' “| 7 sil I i | Hh) + ;—-|-—— { nd aoe } | : I | | | |__| | H H ' | } _ ' | eR olla ah | E " e ; — | | wy | . Ani ae) Pat | | | 4 f Y | ra i. | | ae | a ) ee SS ae | | | ‘ t = | | | , si | | Pes | | ia uneeenaee Cee os wrested sen alsin | ! sicaue a ie ' sscicakabealiealeihibnce | a | fe pa ee Vigaue eon | | | F een nce inne ee ne | | | css sienna { | ; I ———_—__— ——_$$—$— re —_-—_——--— 1 | i! | i j oe | oo 4 | | ! t | — (S9UEO BY DORNTEE CASKET CO.. BOSTON, wAse., 1018 ISSUED BY CORNTEE CASKET CO. BOSTON. MAES. 1818 sh 116 RECORD AND BILL OF ITEMS | RECORD AND BILL OF ITEMS Yearly No. Ij FOR THE ee OF Total to date... E Yearly No. WF THE FUNERAL OF at tia dt i o / f— Vhd sa : — YBAtce-t— 7 er d Residence y iy 77 7 4 a pesos ities a Residence.......4 AZ ‘ iF ery Place of Death UA. . ‘ite or Widow of. : er eer es ps Place of Deat eo af i Wife or F 7 of é > ip ae ; 7, Date of Birth oo ok A. Date of Birth ey / bbe Vien (se al ia .. Years Sex : ; Color or Race sag (Month) 5) ’ : S { Death 7 Months 4 Single a OKLL 2: ms 98 Pe — Age 5 f Months } Single i (fe (Peath) Date of Death — Maiden Name ree Days Marriec Maiden Name , eS) - Cie Days \ Married Birth-place og er $eLZ Ez Birth-place . : Occupation Name of Father AAA 8 Birth-place “or Name of Fi ; c 2 pte. Birth. white Maiden Name of Mothe , Hei nee 7 Maiden Name Mother (fee wo AKAn+ fv wetter Birth-place W D2 j Primary 4 Secondary > i : Cause of Death Primagy ce oe Secondary a Cause of Death Certifying Physician : (ho . Ah ae or Residence : Certifying Physiciar : cee Slr Co ey $ Cemetery Place of Burial Le C L, et eg Cemetery * Lot No. Place of Burial l'uneral Service at : OS Nne Lot No. : ‘ , ao , ’ Put in the Diagram one mark like this Funeral Service at a ae | for every Grave in it. And mark this pe ahs Grave No. é Grave No Time of Service ei Burial with double dagger thus : } Time of Service Section Section , i Designate site of monument thus: 7) Date of Interment = he ] Sa Re ae siifrone A : = as Casket or Goffin N&Y I MEA: 7 : ] ICS O. oO Candles F +e 4d). , Z . Casket or Coffin No pe e. Pee Candles Date of Interment Size Ef2 Made by Nort Pa Gloves Made by : | | Gloves Lining and Pillow Set No i] Bearers or Porters Hearse to caies Removal Removal Plate Outside Box eadiaamabe ee Automobiles Burial Suit y lig Outside Box or Vault | 4 Automobiles Burial Suit Vippers | Newspaper Notices Slippers Newspaper Notices valming “ , Embalming Washing and Dressing ning and Pillow Set No.. i] 4] Bearers J : . | is . Gi Ha Hearse to /[ “* | | | | Shaving Services e of Chairs — : . ‘ = hair p Oo Transportation Charges } Use of Cline Transportation Charges Officiating Clergyman : j j / | bt ‘ ch Charges Bal / ‘Lads $0 Officiating Clergyman | Church Charges A} ae A sal " 7 j UTC * e Cemetery Charges |‘ pA AA AR / * C Bi gre 3 ; ; — Amount of Bill | Cemetery Charges Amount of Bill MD | Goods Ordered by “an Goods Ordered by Bill Charged to 4 wi viii Music Bill Charged to ; Fle wers Ki wer DR. ° DR. i | | } = | lj = 1@OUED BY DORNTEE CASKET CO., BOSTON. MASE. 1816 = 1S8UEO BY DORNTER CASKET CO., BOSTON, MASE... 1916 Sie REF EID 118 RECORD AND BILL OF ITEMS Gis ae Kc THE "ZA OF f a , ZF 7 a. Be | - "hd al a Rear mmon : or Widow of. y : Gell ce 1§ 4 me a heii Color or Bace | BS steel a im |i 199 WAG A, " LLE C hfe fiat Occupation , (Year Mbt hes lle ud Ons Birth-place Her Birth-place Yearly No. Total to date... Residence Place of Death Date of Birth ] Date of Death Maiden Name Birth-place Name of Father Maiden Name of MQjMer Cause of Death — Primar Secondary ‘Ui Certifying ae 2 : “. a Place of Burial A CL44 // GA l'uneral Service Pe A oe “7 /§ / 2] | imme of Service tf [eet 2 Residence ; teak fa, Sk spogmete tery . 6 Lot No. Grave No. Put in the Diagram one mark like tii; | for every Grave in it. And mark 1/; Burial with double dagger thus : } Section Date of Interment tee x $} Designate site of monument thus: 7 or Coffin No. Candles {LasKet Made by Gloves Lining and Villow Set No.. || Bearers o orBore rs s. Hand || Hearse eau. a - (Cn AO Ke Re walt / ! | ) le B \ be Auto iles 4 Te py Autonet, | S iH A ag 6 CL | ers i | Newspaper Notices - | pay s | ik ‘o) J 4| | a i i 4 at. be | Sle ng an i | eo w | ie | | I Ch | | Transportation Charges 1 Charges | Officiating Clergyman | i Cemetery Charges | | Amount of Bull og Musi i | Goods Ordered by in | llowers | | Bill Charged to d} CH & I AA AM AW DR. CR. | | { i | il '198UED BY DORNTEE CASKET Co., BOSTON, MASS., 1918 Gun ecu 119 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Gs ln OMe A Litt hone 7 Tota/ to date Residence. Place of Death Wife or Widow of ee ane, eee i, Na te ems 1853 ° f Date of Birth / VW ry seentes ‘ : D f Death 34 (Month) (Day) Dal Years © oe x en | Color or Race ate of Deat ” : J sa shew ‘ody Age | L Months Single ‘2. lame oF Maiden Nam« L j Vays L Married Birth-place MO hada. “0 : ae & Occupation Pe tilapia sed ‘ i he Name of Father eked Red “Barty His Birth-place Ka tetas PL Maiden Name of eae Ihake acd CL¢ a. Her Birth-place Cause of Death— Primary Secondary Certifying Physician Residence "a mt Tr. oe a f> Place of Burial} 0 QAUC1C Creed L. * ae Cemetery Funeral Service at : cas Lot No. | Put in the Diagram one mark like this . cx : aie ‘ | : : Time of Service J ef \- Ceive No | La { for every Grave in it. And mark this fe x oH s Burial with double lagger thus Date of Interment ol r4 f Section as a ( wi * | Designate site of monument thus i ] dles hd ” 9 ec an FY VAL ALE tes. | setae. fap = = ———SSS SS Ss Se Soe a cneieeiiaiae a Casket or Coffin No. ~ Candles . Size Made by J 2g? A C® Gloves Lining and Pillow Set No Bearers or Porters a Handles Hearse fo ALM conf i Plate Removal €€e*Ts+*€ i Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Notices \— Oo ao Embalming “a Washing and Dressing having services Use of Chairs Transportation Charges Church Charges Officiating Clergyman : Cemetery Charges Amount of Biil Music Goods Ordered by Flowers Bill Charged to DR. CR LAL bs || cy 7 v4 | a a —_— eee eo f] me: } a sl wen wot - | * } | | | | } } i | | | mes i| \ | ‘ine 7 j | | | | | | ae ! ISSUED BY CORNTEE CASKET CO. BOSTON. MABE 1018 pane TTS SE Te ATTN TENT eae = 3 on apo m SEE Sn Een an ene nnn eee eee ne — Se — — } Yearly No. ¢ FOR THE ERAL OF Total to date... Yearly No. FOR THE FUNERAL OF Total to date Lee) Aut | — PC Caro Urtyverctor, -¢ f ' a - fee Resed pisnskentnbncaineepsaces latinas caseusieneseammauanacabestaiauniie aati deseanacensanatiedaciensss > : > mal + c Residence oe | oe seactincemata ; 7) 7 ZF CPF2 “ee. Residence... | 1s te Yk 7 me “ y glee ¢ Wite or Witow of. GLA: ren Place of Death “YS... is “ Wife or Widow of 7 4044 /ttoati nn header rife, | Date of Birth SHY 2/ Years Sex Color or Race Date of Birth i as ae J ss f Years S Color or Rake (Yeor) {Moar (Day) ay) ? Fi ace Date of Death 192 i Age Months § Single Date of Death 195. wae 22 hind Wins 2 Silas (Yeaf) (Month) 6 (Day) Maiden Neme Pog dh "/ 7 J IEE Married f. Bei casiscedaiass Maiden Name . . L Days sha / 12 - ‘ L/ ‘ ! Birth-place Vipul 7 : Occupation Malu ee PNR a Picasasacceores cs Birth-place i gy Vlog f Occupation sh : oo »/ fgone ; Name of Father His Birth-place ; en i y Name of Fa er Lhe re... Et La pe fem» His Birth-place Gétet-e , Li 5 fe lS » » ere : - Maiden Name of Mother Her Birth-place Saas ite Maiden Name of Mother A[ 04 LE DO, 7° MeO Her Birth-place C-b4 a Cause of Death a z# J yt Ly oi a Secondary ae Ae staiisecscaaeeh eek Cause of = oe Secondary ; Certifying Physician Ps @ —— — Eee oe Certifying Physician \/.-Ss (\ Residence ; , ) + ie ba eonagiiaass 7 ls / 4 ‘ fe) 4 i; ff - . . or = é Place of Burial Ot J a cod te é i Cemetery . seeetneecenananens senses f Place of Burial 4 oF wed Cemetery 7s * whee F ad dhe te Whe he Ol bot e — l ies ney Lx i ae seta Sse tes or au _—— | ha usoleaw Put in the Diagram one mark like this 1 Funeral Service at oe *~ : Lot No. Put in the Diagram one mak like this i . 3 } } : co E | for every Grave in it. And mark this | oc ia Ad IT; ae { i ie | for every Grave in it. And mark this | lime of Service s in : PV or Greve No. 4 , Darlel wih doable Gimeie Wes: | Time of Service i Grave No. J Laers teres ee Date of Interment 7 Cc v q OL Section Shistassati shi labelled ny Date of Interment Samir eee cy | . } wnat e¢ monu t poo. j 4 —— oe eee cmeaiase: eh ae asa = cmmmmaeeeeeee see = ——— viceiaciietaniia | ket or Coftin No. \| 4s © é G — } Casket or Coffin No. _ | Candles i Made by | Gloves . AN. Size Made by zy Gloves | | Set No Bearers or Porters | | Lining and Pillow Set No I) Bearers or Porters i wn . i | Hearseto / 4 Handles Hearse to ¥ i | Removal i| Plate Removal Outside Box or Vault Automobiles | | pMitside Box or Vault Automobiles {| \ — | . Burial Suit i el | | Newspaper Notices Slippers Newspaper Notices | j j | | 4 Pa os o } | ne 02 | | Embalming 1—- at o men | | Washing and Dressing j ea |i \| | ' 5 | | } Shaving ! : i} i | | II Serv wes | | Ch | L¥ |@Q@'| Transportation Charges | an of Chaise 5 Transportation Charges irch Charge I Officiating Clergyman — Church Charges Officiating Clergyman ascii lainiisc ida | ‘ my || , | - ; , , Cemetery Charge | 3 1S QO) Amount of Bill ssciget Z i) f Y Cemetery Charges Amount of Bill pt by te | : Music | Goods Ordered by<4 oO tk re = ~ DB | Music y Goods Ordered by | | > || ! + | a ‘ ! Flower | J C O Bill Charged to | sS 1 Flowers bill Charged to : piers rs a = / | DR. CR. CR. | / ; SRE Eee ae eae ni “s aes Pp DR. . s a — i yt “9 / i f4,2\ A ez, 7 ‘ ‘, — ~< » | * | ; C4. ' i yy | | 2 fa he A ‘ fe a | a ar i é 7 | atl i, A 4 | | i f || i] f | ies | | : 8 | | | | ae | m4 | | 4 | | i || } I | ee ae Gee | | | a | a | | | ee | cd | | | _ | ot | | oa | | ay LL - } 7 } | | | | CH ] | } : y -“ | j | “ | ae i 3 a | 7. is 1 | Ba ela. I - | | } H . | | Set ee ee eet | sli scsi f | | or Ge ha ete — oe i rears ag a. i — { 7 | | | | j —_— - - 1] | } ae 1 \ | \| | | } | | | | e , (1S8UED BY DORNTEE CASKET CO., BOSTON, MAGG., 1910 eoen ae Tae CASKET CO. TOM. MAGe. 1018 1eeu oon gn et is or a a coy at Sa aN gallate Pc ee 122 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Yearly No. itn . en a ad. Residence i Place of Death ; oy 1f£ J E Date of Birth (Year) (eM Date of Death 193) 2 (Year) (Month) Maiden Name Birth-place LA Cefe Ate tm OL Eien 4aarrnd Ch) Mother A Lf: ¢ Primary Name of Father Maiden Name Cause of Death Certifying Physician. 4 Place of Burial... luneral Service at me fi Time of Service + # ty vw Date of Interment 2 ifm CA (Day) af (Dey) ef ace CMF UAA ANA Age Occupation .. Mh. Settee tec LEAS Ane Wife or Widow of Years Sex Months 4 Single Days Married fe His Birth-place Chk Ke MY... GP..2 Grave No. Section Total to date... Color or Race C 73 irth-place - she Secondary -Residence Cemetery Lot No. Put in the Diagram one mark like thi | for every Grave in it. And mark // Burial with double dagger thus : t Designate site of monument thus: [ } r encod neoremet Casket or Coffin No. | eich Cones 1 S Made by. i s $ , iC ° Gloves | 3 Lining and Pillow Set No.. } | Bearers or Porters : , r Handle I i Hearse@S, \ ; CAD 7 Rak ee Plate | Removal Outside Box or Vault | / | | Automobiles Burial Suit Slippers | Newspaper Notices IR INR ete php cdoyasi gues bn inne tecnisiapseeao ogi eer ED eae | Vashing and Dressing | Chairs om Transportation Charges hurch Charges | Officiating Clergyman ed. cs Cemetery Charge i Amount of Bill 7OO LY Music | Goods Ordered by l lowers | | Bill Charged to DR. CR. ‘ id wef Lean, lee | | | | | - - | | ; | | | | | | | | | a | | | e | | 7 | | I | | | | Ee cs | | | a | | | | | | | . | | ; + = obs pitti - wee —— | | | |] Gnvtiemennasicmnes omen | cementless | | | 1S8UED BY DORNTSE CaAsKET co., BOSTON, waASe., 1016 | j | | i —s Yearly No. Residence. Place of Death Date of Birth \¥S0 Date of Death 54 Maiden Name Birth-place Name of Father Maiden Name of Mother. Cause of Death— Primary Certifying Physician AY Place of Burial RECORD AND Bi Year Tica (Month) Gridece Ce 2e, OF ITEMS © a Years Fin 4 -. Days ol eo single Occupation His Birth-place Her Birth-place Secondary Residence Cemetery Ii Tota/ to date W ig se San l ae 7 Aare 123 Color or Race, | | 1SOUEO BY DORNTEE CASKET CO... BOSTON, MASE wre ere J f Funeral Service at ce bit / KO A, fi JEL 4 : Océ eae I’ ! mark liket Time of Service Jf C4. ‘ waka He, GF “Ctave No. o for Ar tk th Air ; “a 5 B | ' ‘ Date of Inter ment ar ed, v? ow f Section F si CJ pale 3 _ sath sane: SE RSs REL SeEEa se cee was Casket or Coffin No. Candles f q Size Made by OFF ee ae < Gloves Lining and Pillow Set No. Bearers or Porters Handles Hearse 16 Plate Removai Qutside Box or Vault Automobiles Burial Sui yy Slippers : Newspaper Notices . ¥ mbalming inn ial ‘ 9 Washing and Dressing r Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman es Cemetery Charges Amount of Bill ic mE Ne aah Music Goods Ordered by Flowers Bill Charged to ~~ DR. CR : j ij are aeER sy pe o + - ¢ , age (4 4 ho Cn fe 2. —— J s ~ - - td 7 ‘ | | log 4. iF / Lew. ae | sjeter | ey | ee a | — | | ttl. “” “ a ae | -” see | . # | — | “ Y - TSO i ee eee net ge et te 124 RECORD AND BILL OF ITEMS Yearly No. Ge CF FOR THE FUNERAL OF C Jie Le if Residence... ‘ew % im LOL, | Qfeey Ce A. G.... Place of Death Wife or, Widow of. uae OL 4 * Date of Birth 1062 + 4 Va Years y on ont , (Day) Date of Death 192 | Mer ety Age ~— oe (Month) ¢ ) Maiden Name ae Liu hig i Ce / LS, wee His Birth-place Birth-place Name of Father Maiden Name of Mother. . Her Birth-place Secondary. ..{.../ t f HA eg hd Mirjer 5 Cause of Death— Primary Hy Sex Hue -- - Single Mckhanzey "wy the —_— Total to date... a a Race Chat POs Repidence ee AO RO: Certifying Physician thacey Ve a Lhiky & Place of Burial LG Ch _Cemetery/ Pre a — f tees “hil No. Funeral Service at F 75 Lm = Z t & f A Time of Service Section Grave No. ly a Put in the Diagram one mark like th | for every Grave in it. And mark ¢/ Burial with double dagger thus : ¢ Date of Interment 483 y B/ ‘icelieaiaa 4 kL 4s _ or 77 . Casket or Coffin Noy Z cs. f hihi H i allt } Size Made by J I] Candles [ Designate site of monument thus: C] FD -. FO $F 7 | wo |. | wy piggies | 7120} cloves pre | ae Lining and Pillow Set No.. | || Bearers eo ters | iy ag A bs " | - Handles i | Hearse to we (Grr | ao e hate Removal : ul y sa f ~ & Outside Box or Vault 4G er Automobjles Sal. g, i ad | | rs I zd | Newspaper Notices ; in mm SPE! 29 lla | | fir he 4 F Jy Guckieassik Ssesaiine | | see f¢ bdo i“ i a a. | “ tr Lied p. ~ ky » ; €s | Ach: Rt. nt | Chair | Transportation Charges / | Charch Charges Officiating Clergyman Cemetery Charge e _—+ Amount of Bill Mus sa te ° i Goods Ordered by ps e ? ae ZA Lik PE = 5 Mowers ya ee : | Bill Charged to ....4#-7O™ ei = - bes TKG ate # —— / DR. oR | , z CR. | i 4 / f I ah 4 - iI j | | 49a [By hee 339 Vs } ee eee 1] | } | ' f i | || | | i i| j | | xs |__| Cty | } a a ‘ ap | has tae names | 4] | | i i | oe | —| | i oA | | a | } ee } | | | it | I } | | | 1} | =e oe | | . | | | : : | | | | z | | | | | } ] il - ee ee | cm Pd | Aa | SC ae ae 'S8UTO BY DORNTRE CASKET CO.. BOSTON, MASS... 1916 oe due 125 RECORD AND BILL OF ITEMS nil THE FUNERAL OF Residence... Place of Death Date of Birth iSTY (Y, pe Date of Death 19D] (Year) (Meath) redede a WE Maiden Name Birth-place Name of Father oT gogtnge eek /O (Day) (Day, 4 a Mer TY 4241s Birth-place Maiden Name ofMother et AA Uk | CHWS SOW Her Birth- -place oo Widow of S . Years Age F, Months Single / Days MALL Occupation Total to date hale { — rR é t FOL M Uf Cd oN A 7 Le I Li tketh du i ecake-. Mit ae , - 4 x) = BAL Lé we a Cause of Death—Primayy , Secunda cme : pa Mw. Uf / bid f ——* — Certifying Physician iy AL. es % Residence CA Place of Burial C4 tv 7 AMG fi ' Cemetery . : ie: z . ft $ fe f Funeral Service at aL ey (Uw A Lot No ‘dit ~ i a oo Pu the Dia n one mark like this Time of Service a. ees Grave No _ i very « it. And mark this | 4, /% } es soe thus | Date of Interment Abe YOGA 30 | Set Section eee eae a Sane | | Casket or Coffin No wv ore Candles ; i es Size Made by Gloves moe a Sess Lining and Pillow Set No Bearers or Porters . ary wea Handles Hearse to VES €e¢ —-™ - Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers | Newspaper Notices ' . ry eT e imbalming Fail? o \\ ashing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman pip DOT he a Cemetery Charges 77“ Amount of Bill nb ; Music / Goods Ordered by } / Flowers Bill Charged to DR. CR i eerie | Way VS Oh, A We | a | ; as a J ad 4 BK g * a } : | | | | | eo ISSUED BY DORNTER CASKET CO.. BOSTON MAES. 1016 eS eee 126 RECORD AND BILL OF ITEMS Tota/ to data Yearly No. FOR THE FUNERAL OF j . , P a 4 r ) _ tO AFCA A OA OLE he, LE <™ V0 LA Residence A “YL A oka ; ’ : Place of Death A AB ——~-* s ' Wife or Widow of Date of Birth 18D # UV [2 4. * Years Sex Color or Race (Year) Month) (Dey) Date of Death 193/ ARM a ‘ \ Single (Year) St on Age 7 oe panthe 5 Shag Maiden Name -)... Days | Married Birth-place AMM EAS, Occupation j i , ie \ : 5 “) anid Name of Father (f/i<-t4.©-0 . : a His Birth-place Ate OL EA f Maiden Name offMother i. fic? Her Birth-place Cause of Death — Primary Secondary Certifying Physician /{ J Residence Mlace of Burial Cemetery luneral Service at O.. fac ir he 7 4 @ s / Lot No. Put in the Diagram one mark like ()) : ; for every Grave in it. And mark lime of Service Grave a / I y Gra ni oe rave No. d Vv Burial with double dagger thu Date of Inte . ( Secti of Interment ee | Designate site of monument thus { ] eS a ee an te ae oe r (.asket or Cofhin No, ~ » Candles es > | (i, fh. < FA Cb 4 : / ne Made hy Gloves <4 f Of mee Alte {| , Lining and Pillow Set No. | Bearers or Porters Handles Hearse to | | Plate Removal | Outside Box or Vault : 2 | Automobiles | Hurial Suit ppers Newspaper Notices | } | salming i *r. |i ny and Dressing i | | | | i] | i . i | Daan { i| | Pransportation Charges | j | hares i} Officiating Clergyman | tery Char Hi Amount of Bill ‘ 6 Ee . M | | Goods Ordered by | ; I | | i} Bill Charged to | DR. CR ioe io ZL : | Wg Ett /©0| | i a) /¢ | j | a - | | | ey : | || | = alles | l} —_—" ' i | | | | | i} | i tt | i] on - | Se es | “i } {| | {| Pal | i i wv’ | | } i] | ti o | | | | | | | | | {| H I | 1] i] | | | i | | | | | | } | | | | | | I} ie | | . “ll | | | j j a | ed | | | 'S8UEO BY GORNTER CASKET CO... BOSTON, Maes... tere RECORD AND BILL OF ITEMS FOR THE FUNERAL OF J.xg Lay Yearly No. Tota/ to date 127 Residence Leotk eae eee } yo < Place of Death Wife or Wido Je Fixe Ie on Se ee Date of Birth I £6 oO Pr 7 70 \ (Sex a Date of Death 193 | Fe a aS ve / aoe Sinele Maiden Name /4 1) uf Birth-place SERA . OQveupation 7 yaw Name of Father ae ae Weert Y = 4 » His Birth-plas Vas \ ~ Maiden Name of Mother AHarn ‘ a 4 Otvre« Her Barth, ( Cause of Death Primary / Certifying Physician pe...“ |: / Place of Burial 2 Mk (fia { cceahauleecaienaniea , s f ne mark like this Time of Service 3 7 “~ i 7 f Cy \ | ‘ . this ‘ Date of Interment ‘ [ ) ae ry Casket or Coffin No a pu : Six 974 Made by “| 47 Lining“and Pillow Set No Har ’ Plats Outside Box or Vault Bur init Slip Embaiming Washing and Dressing Sha Service Use of Chairs Church Charges - Cemetery Charges Amount ee 5 Musi: Flow: DR. . neat ny Scene RY ante ps (meen | partie 4 /4h/3/ i dey aut & /%O 290 i | | | j | | | | ' eevee 6 OORNTEE Caseet CO. eostonw mace tee RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date... Yearly No. FOR THE FUNERAL OF Total to date lahEcces. hie TE ceria | od hawgh fan Y Pw, desiree z. Prwr-l«uyg PES G3 ; . ~~ % Residence ¢ tte Law : Residence. WANA_BLa :., ‘ Kn 4 z Place of Death Wife or Widow of j Place of Death Wife or Widow of Date of Birth 1g3/ Cprcf rd Years Sex Color or Race | Date of Birth l ; : a i D. 37 soca . i 7] (Men) (Dey) Y _ sex j Color or Ra e : ate of Death 193 a N s < Sinel Date of Deatt 193 3 | : 93f os £0 Age fonths 4 Single ate oO 2 — a. ab Age 4 Months ¢ Single ‘ | 7) Days _ Married i Maiden Name - a pat Maiden Name L Days | Married Birth-place . «424 aoe : : Occupation i Birth-place Occupation : Cc 4 — were . ; Name of Father floacor/f ‘ His Birth-place 4. C 7 Name of Father / : ¥ Qubterarwy His Birth-place aro Cian kK | ae Joa A- Vidal. | S.C | Po 6p Ra Maiden Name of Mother: “ Her Birth-place <>: : } Maiden Name of Mother vtlice a BR, than Toate: Birth-place / Mt. | | ; ; j : Cause of Death— Primary Secondary sinner Cause of Death— Primary Secondary | Certifying Physician sy Residence j Certifying Physician Residence | * Z : arce€ > . : * = : at - t al} f) e ss : YS) 7 oe Jace of Burial Be 7 << ~ Cemetery ; . Place of Burial Cinna Ch Wrntk Clear “akan “: CemetervPiau Ceinbe._d&_ — : | Funeral Service at JEL = - Lot No. Put in the Diagram one mark like this Funeral Service at } Lot No. : ; ; ‘ z 3 i. og iz i ee i Fa | for every Grave in it. And mark ¢/: : . air | ies alec: 1) lime of Service a Pg AA f- [Grave No. 1 r Burial with double dagger thus : j Time of Service Grave No. J : hy oo ee Ni} i uw aoe A a J ¢ . : ie ae i ; Date of Interment Section Designate site of monument thus: . | Date of Interment “/ “Af. / Section Fs ¥ tt Poa . o- / | CI t zi sean ae ae oo ee Sy na MORE Sr a i Casket or Coffin No. i Candles sone Casket or Coffin No Candles : : A], } oO eae) | i i Size } & Made by Sis 66 Gloves / | Size Made by Gloves i i a: >: : Pe eee | ! ; oe 4 { f i Lining and Pillow Set No.. Bearers or Porters : | i Lining and Pillow Set No eae, ee Hi bai Hearse1 jet e<0 a A | | ) Handles ‘| Te Gane . | as r Handles Hearse to iit | | and Wi an Plate } Removal Plate Removal j Ni Outside Box or Vault Automobiles Outside Box or Vault Automobiles H : ry ie he 4 Burial Suit 1 Burial Suit | i j | } | ETS | | Newspaper Notices i Slippers Newspaper Notices 1 f ilming i Embalming 1 | ving and Dressing | | | Washing and Dressing | : H | 7 ees ; : | | | Shaving {| / H eY es & I | l " H iY Ft ; { Services | ne | | i ee “ ti | ; . { Chairs Transportation Charges Use of Chairs lransportation Charges a Be arene on | i i rch Charges Officiating Clergyman | Church Charges Officiating Clergyman so Sia ier eet Tee) q | _ 1 : vane = || PR: | i i Cemetery Charge I} J |9e Amount of Bill | emetery Charges Amount of Bill eel i nat i aw | _ | | hi Music | Goods Ordered by | Music Goods Ordered by / hit ‘ 7 | | : “ 5 Flowers Qoew~ pnt or Z 'SS) Bil Charged to | Flowers Bill Charged to ) Fi : Pee ee TY Dee oe ' Se i seecenanensessn os stheneinsieenesieminsbtanshenitcananiaeiamamniteinie ! k | DR. CR. DR. ein | . : ; iF | | ; f | e | . ' | ioe a r Gr | é ee , be / ( . i nial | } . 7 ty 3] | Bu wWeZ eo hee aad ae es | J i J “ . F 4 ee | | ; Nes | ‘i | |< / | | ; Le | | | nae | | HEE -| = | | eon | i il | . oy | gis / ! | | i| | | 1 1 f i . i| ya | | | || | | | { cd I } | | | ' aca gp oe | | j=. | | 'S6U8O GY SORNTEE CASKET CO., BOSTON, Mase., 1910 ee os ee | | = . | oe Linvemcenl , ; ISSUED BY CORNTEE CASKET CO. BOSTON MAES 1818 ii hii Gae i! i qh i i ; | 8 | , ii] aif bane aT | Ma 1 edt rae ed) } ' } tii ee ae 130 Yearly No. Residence Place of Death Date of Birth Date of Death Maiden Name Birth-place Name of Father A: ‘ os 4 2 4 ad Maiden Name of Mother.. Ha ‘ he C a “f" Her Birth-place A Cause of Death— Pr Certifying Physician Place of Burial l'uneral Service at lime of Service 1 192 { ; a a 10 ear) enth) albey) : Mptha z o Bt. (a "8 “du RECORD AND BILL OF ITEMS ms pr ve geval ! __Total to date... Yu /Md, ha Aaw A. th te ge eee 7 LY ae ( 4 1 Years Sex 7; / O Months § Single Days Mapyyied c Occupation . / Miuvhace’ PDUs 4 ASK. se Birth-place A he G@ ° a a Bsr wt Rgce FEE fr AEC if tt vfs Os 2 ened imary rf .. ; Seco (La yee fi ih co : th ; / Residence ‘ ‘ - é Ltt fin” : @ o /Qte Genie A Nw Cemetery . 7 Hide Olt. hom of Lot No. SOCEKMC KM Olt SK 4 Cran Na | for every Grave in it. , . : , Burial with double dagger thus : t * os Late of Interment y* CLEAL Ol F/ oF Yon .. Section q , Designate site of monument thus: i | / / 7 r Coffin No. ALG : i Candles pained . f [ ts As Made by 14 ts VA a Gloves re | | 1| and Pillow Set No..... i| at Bearers or Porters P b=, + ‘ ity - ae 7] | le | || Hearse to Ad Lr der ee FT | | i j | | Removal 4 | i | [3 es Automobiles Selle loo | mei Wressir Chairs {'} re ! ua ges emetery Charge 1); ywhusi Newspaper Notices wot ed Aad Meh | Transportation (frags YEE psd A Tp . Mad “& lt: / Ae j - yA Yr é sci Officiating Clergyman Amount of Bill |! Goods Ordered by ik oF | eth | Bill Charged to Lt ISSUED BY DORNMTEE CASHET CO... ROBTON, wAGS., 1010 Put in the Diagram one mark like thi And mark this | / I | | | —s f. co. } 1710 A. Wh, f a? e hy | V beet be os Yearly No. 131 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Total to date / : ‘ ™ IK tA ie teas <b fur TJ MAd oe: Cr (a lcd Ct-€: Residence / A t-<* <A ¢ Gis 7 4 < r : ct ee / Place of Death ee t /- Rn Wife or Widow o? Date of Birth 1 ht . f : (Year) , (Moath) (Day) | Years Dex | Color or Race Date of Death 19 3.4 1 a en bh Age Months Single Maiden Name Days | Married Birth-place : Occupation Name of Father y. Asi 4 es . His Birth-place Lap PPS) Maiden Name of Mother Z4/ ¢ Hk «fet ~ > HerBirth-place Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial (4) \\ 4 ou“ - Cemetery Funeral Service at Lot No. | I ne mark like thi Time of Service Grave No } ! And mark @ Date of Interment Section ws z oO iI — ‘a Casket or Coffin No Candles Size Made by Gloves Lining and Pillow Set No Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Notices Embalming Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman emetery Charges Amount of Bill Music.. Goods Ordered by Flowers Bill Charged to DR. CR | | = | atc | | | | | | | | | | i tints p re ' | | i | ISSUED BY CORNTER CASKET CO., BOSTON MASE tere a ————————————— Cee oe ease ee eee. wes iE — ory me = ena AON: atti LG Net romana + 132 RECORD AND BILL OF ITEMS Tota/ to date... Yearly No. FOR THE FUNERAL OF Wed... EXEL Re Adebu: 0 Manan. Residence Lj Place of Death ie ome } C bee. Wife or Widow of. Date of Birth l A } Years Sex Color or Race (Year (Month) (Day) Date of Death 19.2 | e} 7 Age { Months 4 Single (Year) (Monk) (Bay) ‘ Maiden Name ya } Days Married Birth-place Occupation ..... Name of Father His Birth-place Maiden Name of Mother Her Birth-place Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial Cemetery . Funeral Service at Lot No. | Put in the Diagram one mark like this ; , ‘ ae | for every Grave in it. And mark thi lime of Service Grave No. Burial with double dagger thus : j Date of Interment nection 1 i Designate site of monument thus: [J shad or Coffin No. | Candles | | Sine Made by | | Gloves -— | / y and Pillow Set No.. | | Bearers or Porters F = Has | | Hearse ot le LMA eve: Ger Brve A / 8 c | Removal Outside Box or Vault | Automobiles P } Ne -wspaper, Notices hi | 1 | fe A fg. Fitts k Litt. n | D Pe ene et ces on | | [ ov the | | Transportation Charges...) 3 vi ”. 4 hurch Charges i| Officiating Clergyman ioe daa Cemetery Charges I Amount of Bill | JG Ve Music... } | Goods Ordered by | | lowers | Bill Charged to | DR. CR. | | Vi13 fst a Crue fa so |e | = aa a | |_| | | aoe comes | | | 4 | | ze me | = cs | | ee se | RR Ee NS a is ee seats | | | | a oe ares ot — | oneness dents | | | ed | ISSUEC BY DORNTEE CASKET CO.. BOSTON, maes., were RECORD AND BiLL OF ITEMS Yearly No. : T € a ae Gin ¢ Residence... . Place of Death Date of Birth cas Shy 3 FOR THE FUNERAL OF ae, Wife or Widow of pL Tota/ to date 4 a (Year) py re — ey Years Sex i Date of Death 19. 3/ 7 /; 4) | / i Color or Race (Year) (Month) Day) Age ~? Months Single é Maiden Name \\ — ’ U / ] Days Married Birth-place WAX AuULOWm (Dp ¢ ‘ Occupation , a Name of Father (4. ut Olde Li - bog Se His Birth-place Ly. eel Aas we ; ey meh Maiden Name of Mother I A LL “Le Wer Birth-place iy Cause of Death— Primary Secondary Certifying Physician fr... OA - er. Residence ¢ ’ Place of Burial Ce i. a Cemetery Funeral Servibe?: ha ology 7 | oe er Lot No. Putin the Diagram one mark like t} Time of Service 1 Ati Grave No | I for every Grave in it. And mark th : d a Burial with d ic Date of Interment / ~/ x Section r ee ‘ge Designate site of [ ] Casket or Coffin No a Candles ; . Size Made by Gloves LL ining and Pillow Set No Bearers or Porter € s ‘ ers Handles Hearse -— Plate Removal Outside Box or Vault ~~ Automobiles Burial Suit COE ca ippers Newspaper Notices ' mbalming Washing and Dressin; | Shaving Services nm Use of Chairs Transportation Charges Church Charges Officiating Clergymarf_4 ; ‘ P 5 J f rr . ae Cem tery Charges co iO! Amountof Bill Mu Goods Ordered by PE, Flowers || Bill Charged to DR. CR oT] Ty Gael. pee a+ Gl 7 i | | | | | | | ' eae snounmlarmsemnitjpntemnenennmeemennsi 1SBUEO BY DORNTEE CASKET CO. BOSTON MAGE T¥lu Renee eae brennan c one oer NE EE GOERS G RE oe Bs PSR. 134 RECORD AND BILL OF ITEMS Yearly No. AAG se fetal cl i } Residence... [ Cy 4h f Tove { Place of Death Ke eh OZ GA!NO VAL Saf Date of Birth 8 dn C é / cy Wife or Widow of... mi OQ Years Ly or Race (Y per) 4 aks (Day; Date of Death... 19.2| (Eins J / Q Months 4 Single uf ed (Year) AAA G (Day Maiden Name oe i i “4 ; in a Py, Sh Days Married eae Birth-place AY p SAI Ke ¢) 1 © t LL f t Occupation ..... ce AL ne “H ~ seaamafeers His Birth-place ; Ld WL Mer Birth-place {4 7 (} f- j Secondary. Certifying oe } as Fi hp l Residence J EY, aul thé LW SA {la y C we h 1] I fULL 9! Le 30) LAA OL1by CArg ( 1. Name of Father W ' Maiden Name of Moth Cause of Deaiu Primary. ~ Place of Burial... \~ ¢ Cemetery . a yd O 4 | Grave No. f l’uneral Service at /) i Lot No. lime of Service Put in the Diagram one mark like thi And mark ¢/; Burial with double dagger thus : j | for every Grave in it. ——y > Date of Interment Section Designate site of monument thus: Cl a oe t t t ; é C 7 i _ Casket pr f offin No.....} / Foch Candles j / f ih y a H] 140 25 p4, 6 ’ D1ZE..... df aod Made by. Bet, | 4) Cask Gloves PR a ae J | C ; f > - i i| ’ weds Le Lining and Pillow Set No... I Sh aa 1| Bearers or Porters oy f fn | / ; j | ; || ta tn fe; { - [pn C z » Handle I Hearse td CAAA Af 7 Ab} CL! “Tr te i| Removal ) ie Box or Vaut I Automobiles ASIA 1 | a I ip || al | Newspaper Notices i] Z f O|| \| x | l| | I | : i] sin I] | | | a | | f ¢ | '| Transportati charges ansportation Charges : - | ot . . , 1 Charges ; ie DL. | Officiating Clergyman a -. , © = at? ae cemetery Charges ~ |S '| Amount of Bill ELF MY Music i '| Goods Ordered by ? Flowers Bill Charged to DR. CR. 135 RECORD AND BILL OF ITEMS i} Yearly No. FOR THE FUNERAL OF Total to date Crean LJ ea b _ Pig Residence... Py sg Place of Death ¢ ~*<44-444,-6° ce tt Wife or Widow of Date of Birth l er ao i Voars Soe oO Color or Rac Date of Death 19.3] en 7 Lif Ages Months ¢ Single ! Maiden Name l Days | Married l Birth-place Occupation Name of Father His Birth-place Maiden Name of Mother Her Birth-place Cause of Death—Primary Secondary Certifying Physician Residence Place of Burial Cemetery Funeral Service at Lot No. a a Time of Service Cava Bis. : " " ns this Date of Interment Section i a a Se - Rie | | inal a ciou a sonseeninasinigusiiiaiad Casket or Coffin No. Candles Size Made by Gloves Lining and Pillow Set No. Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Notices Embalming ! Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman lath alii Cemetery Charges Amount of Bill ii iste iaaek abla Music Goods Ordered by Flowers Bill Charged to DR. CR. | x , | & | | | } y — | wall | | | ; | | { } ISSUED BY DOINTER CASKET CO. BOSTON MASE tHe eee Sena ere cea —— lt i nti Hl i i Ely em i samt ee a ee 136 / ree AND BILL OF ITEMS Tota/ to date... Yearly No. FOR TH& FUNERAL OF Ye hiefoa Alavi yi e : Pr ths - Residence J i fp ” Por reepicres Sossrneneflh —s of. 3 AL’ OM40thL£ Place of Death Mheg {44 Mere Champ , y Date of Birth 15 9] Op A / & 5 Fé Years Sex Date of Death _, aL, ZA / Fy Ae Kee Fawele/ Cplor si P= Months 4 Single Ny, tia” Hilt. Maiden Name hip Choon we A atl ae — Days Married Birth-place , Sd Ce LL“ Pets . Occupation ... sia Bc Name of Father Pew . nn YA a His Birth-place eh cee & AC Maiden Name of Mother. Lett elk Md te ne Her Birth-place ie - Cause of Death—P. rimary | J Na ,...Secondary.. Certifying Physician 4} Lhe TW f che $ Str Residence.‘ Sttluvdhy AY ' Wee th pod: Tél A fd “i, te Aas oe Pathe | hd Ape Gfré / oe heff! Fé fa Section | ho Candles Piace of Burial Put in the Diagram one mark like thi {- { for every Grave in it. And mark ¢/ Burial with double dagger thus : Designate site of monument thus: C] l'uneral Service at lime of Service Jate of Interment Made by | Gloves d Pillow Set No, Bearers or Porters Hearse to Removal Automobiles | Newspaper Notices »> a ‘ a lransportation Charges Officiating Clergyman Amount of Bill celery “harge Goods Ordered by te Bill Charged to 13 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Tote! to date snail - fa a ms ‘a - ~~ Residence t Place of Death Rowe 2 Wife or Widow of a ; irth qf > Date of Kir F: a om { Voie nee Cal oo Date of Death 193 2 J = L 3 t cea ¢.. Age 4 Months ) Single , Maiden Name | Days | Married - ‘ my + Birth-place Occupation Name of Father . His Birth-place Me‘den Name of Mother... ~ Her Birth-place Cause of Death—Primary Ginko Certifying Physician Residence Place of B urial —_ Cemetery Funeral Service at Lot No. Put in the Diagram one mark like this Time of Service =~ {4 — Grave No / se ee tigi ge — sea _ < Sumal with double dagger thus Date of Interment Section | Designate site of monument thus | Casket or Coffin No Size Made by Lining and Pillow Set No 7 earns gmap Candles Gloves $F pw 3 Bearers or Porters eo h Hearse to Handles Plate Removal . . Outside Box or Vault Automobiles t Burial Suit | i Slippers Newspaper Notices Embalming Washing and Dressing | Shaving =— Services —_ ‘ame “oO Use of Chairs Transportation Charges Church Charges Officiating Clergyman i) ah eae ae be - i >-1) Cemetery Charges ee f Amount of Bill SP a Re Music Goods Ordered by Flowers Bill ¢ harged to DR CR. : : ee ra iia 4, oie J Le Me 2 : a ¥ Jd sere sore canal a Wee ft G | F * j | » o_o goth ” ~ on il | — , ie tere if 1SBVED BY DORNTER CASKET CO.. BOSTON MASE Yearly No. Residence Place of Death ‘Yall Date of Birth 1o ear) Date of Death 19.3/ (Year) Maiden Name Birth-place Name of Father Maiden Name of Mother Cause of Death— Primar Certifying Physician Place of Burial l‘uneral Service at e of Service late of Interment hls se. Cplah Beck, Her Birth-places a Co Ae Lo, VaxeT but. belie ane thea Rexfoc Tee alee RECORD AND BILL OF ITEMS FOR THE FUNERAL OF fattochivtle ~ Total to date... ‘ Wife or Wiflo op (Dey) 77 Years 3e3 BP 5, a FT Age ye Months 94 Single a Cc yo or Race Rig (Month) (Dey) 7 Days Married .., _ Ze Oe ae : . =f cre = pi. Ga His Birthhlac rE 7 sidence Sil bts He D Dloeksvitle AL %. Cemetery . Lot No. / Put in the Diagram one mark like | ; — I for every Grave in it. And mark // LW Burial with double dagger thus : { ier a Designate site of monument thus: { A Grave No. Section | Candles | Gloves .|| Bearers or Poyters | Hearse to Jali, I Removal 7.0 Os}lek Automobiles | Newspaper Notices i| Transpdqtation Charges Officiating @lergyman Amount of Bill Goods Ordered bb bi Ahr ill c Bill Charged wo(bife ttl Ae hull TE: LL Lyk | | | | | | RECORD AND BILL OF ITEMS Yearly No. th BHO Aue 50! iP, Le) Le AMM LL Residence.. A) } Place of Death Date of Birth (Tear) Date of Death oe " ) Near) Maiden Name Birth-place Q Name of Father | Maiden Name of Mother Cause of Death Primary Certifying Physician as Place of Burial Funeral Service at Time of Service Date of Interment ba shal. ae Casket or ¢ ‘offin. No Size Made by Lining and Pillow Set No. Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers DR. Vg, fa q tty coh ete FOR = FUNERAL OF ) a (Dgy Pea (Day) Occupation His Birth-place A aa — “1 4 Total to date 4 a eat Gao. L- (veges Wife or idow of yr Race 5 ° wn” Years [se 7 berale { Pe 2 cite Months 9 Single far Days {Married “£0 A} “Her Birth-place. . AL Secondary Residence kn Ce Sf af — Grave Sectic maT Cemeters o No Mm Candles Gloves Bearers or Porters, Hearse to y Removal Automobiles tNewspaper Notices =e Ven, Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to rE core SE ae thf Ye | i 1SS8UEO BY DORNTES CASKET co., BOSTON, mase., 1910 ISSUED BY DORNTER CASKET CO.. BOSTON MASH tHIe RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No... FOR THE FUNERAL OF Total to date... { Yearly No. — FUNERAL QE Tota/ to Mrte | fay | Tifa Vilas gble, a heen fea S LU oleh. — os es rd Pau Ble f(a. FAY , 8 buy, ar *Ra \ Residence 2-44 hc. Wc pat henee le, Dt ti rw 7 tc i fe — Residence A ‘ Lap © bp ALee_ Ce Se a Mokeds Place of Death t L Wife or Widow of Place of Death Yaa AxLu \ , Wife or Widow of Date of Birth 1Z< f hor J Years [Sex.. #Z-€. Color or Ract Date of Birth 1B Ww - ee _ 1s Date of Death _— chy = g : : pone _o 2 Death ie} ; _ a = si aff. &, Age Months 4 Single ... 4- CAC ¢ Date of 2/ war eee wo, Age 4 _ Months 4 Single } COT 7, Maiden Name eS Days Married E Maiden Name 4 f ae hon , Days i / ) Birth-place . ; ACCEL oer ee Occupation . . Birth-place “y vet \s« Ce RUS Dec eee Ke ALit (4eu L410 we, * S A Keesetset—— | i s es te. a, a & f TSG. Name of Father f CAAA ED AY SG ct 9 et His Birth-place / L44A-4.40.6 C2”. “Ts . Name of Father © fous, th-place aD . ie § Ys ; 2g , wt > iba Maiden Name of Mother fe F(t ft. fhtetéery, Her Birth-place Lucleg 2-AM..C> Maiden Name of [oy gy ork Tra? t “Wh Taide irth-place £ > F Irs a , ae, + ° - Cause of Death—Primary Secondary... Cause of Death Primary ; f Secondary Certifying Physician Residence ‘esther sici f ~~ Vinee ence Certifying Physician 7“ ; atid Rgside ' ot hiwstevicrg CR Place of Burial Cemetery sci Place of Burial “ | \thM ew | & Chal] “i aN netery soe cat as aT 9 . Ag ec” | Taner Service at ~— | Put in the Diagram one mark lik: Funeral Service abn € BRGAL “se yt J a Nat N Putin the Diagr me mark like this . ® . * 0 , j ; Time of Service Grave No. | for every Grave in it. And mark a a3 ie ,y 4 £ — A re) a | { for every Grave in it. And mark this i 7 u Burial with double dagger thus : rime of Service . . rn i] is No J Burial with double dagger thus i ‘ Date of Interment Section , a ai il Designate site of monument thus: Cj Date of Interment se sid ‘ /...Section Designate site of monument thus es By ah i - s a i men ea nrrantres ea = = pao pin ree teh oF 7 . — i aske ‘ | sj 5 ac Sauer leat. « HS | Ce CTC / Casket or Coffs No. | . Candle: j Casket or Coffin No neh ae / VY. Ge Candles AY _ tie | if Size Made by | Gloves | Size Made by Gloves (Caf Lb wkd ) i a : és d Lining and Pillow Set No Bearers or Porters | | Lining and Pillow Set No. Bearers or Porters ‘ Handles Hearse to | Hi ndibe Hearse to } Plate Removal | Plate Removal Outside Box or Vault Hi | Automobiles ...................:: Outside Box or Vault Automobiles . at : j 5 | ‘ ¢ i | Burial Suit | | \ Buriat Suit— SF tis / 7.4 f , ' | Slippers Newspaper Notices Slippers te Newspaper Notices t j limbalming | | | nbalming Saige { c } \ i I | | | . | | } : ashing and Dressing i} ishing and Dressing j f { | Vas doar f t Shavi i | ‘ : j | | having / Ii | “ rr | ‘ , | se \ rvices | Joan po KAwrto?| LAOS : I | rvices | ww - , j } | Pp : a pre ” 4 4 ' { Chair i} Transportation Charges » of Chairs Transportation Chases H } i ce : oace ‘ i Chara | Officiating Clergy man | 1 aonls Charges } Officiating Clergyman ical alanis at Cemetery Charges | Amountof Bill metery Charges Amount of Bill —_— i i 1 . i} enna niece Hy lu } | Goods Ordered by uate Goods Ordered by ' ; Ht ; wer | | Bill Charged to Minunes Bill Charged to ea —— — ioadiaein sania iuaia aia iaoel : | 3 a as en A SSR . : Ssomamame | CR. ; CR. DR. } — Se = iat cee ee eee oe ogy theme econo AO AA a H zZ ge | pas a | | —ae 4 = : = ae 4 e@ 1S8UEO OY DORNTER CASKET Co., BOSTON, MASS., 1910 | j | ' ISSUED BY VORNTER CASKET CO. BOSTON MAES sere » 142 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR Pn FUNERAL OF Total to date sf Yearly No. A FOR THE FUNERAL OF Tota/ to date a Yu. Fypncey J [et et’ Loe, Grit) (Prevebhk. Nyy MLeé Cite yal Lage E Residence ’ / / a Residence oO OQ Miia tC ak. CLL aia Place of Death § etriw ko. Ae oredr “, Kh A "Wife or Widow of Place of Death Cee 0 Lem Wyteror\ ‘dow of Vg Ate C4 LL Cees Date of Birth / l . se - ( 3 Vine Color or Race Date of Birth 1 oe rod aor £ Oye i See esl rl Colpr op Rage Date of Death * { wl P.. Aget Months me Single 4) Date of Death oer wt Age 4 Months 4 Single * , CRAAL Mation Moiese en Tr on [ Days | Married i Mies Qe rr Cer tA vi 4 { Days | Married ACA MM Rirth place A Occupation Birth-place tilts & we Ae Occupation : Name of re AA ae 4 fa] His Birth-place Ss ig Nitin Name of Father Qthy, C Cull _— V His Birth-place / 4/1 cee = Maiden Name ofWlother Her Birth-place | Maiden Name of Mother PALEALL eke re — Her Birth-place ‘ Ec taix Cause of Death— Primary Secondary Cause ot Death ma. * O h ; j ae KL Secondary ng Physician Residence Certifying Physician er ee ve oie Residence e of Burial Cemetery Place of Burial Cemetery ‘eral Service at Lot No. Put in the Diagram one n this Funeral Service at oe . ae ie Of Service Grave No < va Harte} teeevtgh tap ” Time of Service en r ' | i : sn lela Section 4 till ewes oc Des of einen . Bs as oO | fs Oa Me oS. 41 a | ' j i Casket or Coft ) Candles ( et or Coffin No in \ {° wee fe Canal H. Ma Gloves S Made by ito ; Lining and Pillow Set No Bearers or Porters Lining and Pillow Set No Be Handles Hearse 49 << « Handles Hea Plat Removal Z ; j Removal 0 Box or | Automobiles | Outside Box or Vault 2 pneu rial Sr Burial Suit Newspaper Notices Slippers er ; hm balming “ ! \ oshing and Dressing aati | - Transportation Charges | t Chairs en 4 Officiating Clergyman | n bs rch Charges — } Amount of Bill | O30 k Cemetery Charges , | ‘ | Goods Ordered by | sill Charged to ‘ i f - ey | | | ISSUEO BY COANTEE CASKET CO. BOSTON Awe 'S8UE0 BY DOARNTES CASKET 6O.. BOSTON, MASS.. 1910 ‘ore 144 145 | RECORD /AND BILL OF ITEMS RECORD AND BILL OF ITEMS 1 i Yearly No. HE FUNERAL OF Total to date... . | Yearly No. F a yy a OR THE FUNERAL OF Tota/ to date Cit j ‘ ' i 7lé Vl6tun oe | CDPD AD emt Beet 1, My ¢ beh hj Epa tf LLY ) : Hl Residence L LOX -s — F Lhe wr WY: ¢ r 7 Residence ] Ky 4: CK ae 1 ; . if e P a ; T Place of Death Son A. ~ Wife or Widow ot Lia A. ci fen Meant AAS ?. bore Place of Death e, é ae : 4 — KT J F C . k om is. {} ’ , Vite-ow Widow of “~ . f wre Ce i" Date of Birth ] Petes ewe +4 & Years Sex... Fee Color or Race Date of Birth, F x aaa ' oe (Year) (Month) (Day) ie ; /, Years Sex (ot —— Color or Race ' 7 Date of Death 19.34 4 ae Le Age Months 4 Single 4 Date of Death hand & ss t } : (Year) (Goats) ”) _ ge 9 ’ Months ¢ Single 4 ; . s 2 heen ’ | Maiden Name : Days Married 4 : Maiden Nam Dave MarrieAC@6< 8 ¢ ‘ | or Lk felt, a were . : Birth-place Aa Occupation Birth-place Occupation é ti Name of Father His Birth-place Name of Father 2 lis Birth-place KH (< Maiden Name of Mother Her Birth-place acs Maiden Name of Mother 4 vy AL’ I “Lr KS as Birth-place c Layne Uh Cause of Jeath— Primary Secondary Cause of Death— Primary ss Secondary = ; | i Ja, kh’, fi ; ae Certifying Physician. , Residence Certifying Physician } t in \/ AAC Bast. ee Place of Burial. Cemetery ; Place of Burial (ene Oh UY eee Cemetery | l'uneral Service at Lot No. | Put in the Diagram one mark like t)) Funeral Service at ; GAMA ee ee - Eto No. Putin the D k like tl ‘ pis | for every Grave in it. And mark ap jon (*) ( } a in eee 5 Se ce G oO. i »rvice te - . we ’ | for every Grave in ut nad mark this } Time of Service rave N in Burial with double dagger thus : Time of Service } | , . sue Grave No J f. ee a in : . ” iy se oe > 27 ne ce ‘ ot : : Surial with ble dagger thu | Date of Interment | 7 4 ection Designate site of monument thus: | ] Date of Interment Nt = a ; — De y ac ORUMROE ee | [oe | oe ) Casket or Coffin No... } é Candles . | Casket or Gott No. / iat < HA, FO COC Candles ; ; ifr ; | a / ze ki i Made by ] A | Gloves Siz Made by Gloves is 1 ©’ MLA, Vet ll i ¢ i j . . j Lining and Pillow Set No, | Bearers or Porters i ’ | Lining and Pillow Set No Bearers or Pérters ; yt | 4 V7 | % ot - m XS i Handles | | Hearse to 4 ifia 7 le# rs Lee } Handles Hearse to\«+4+* G i, ” i P| | y | | : i) ena | Removal Plate OF:...2 ) ~ Removal f 1 i ; ; ra i; Ria . Outside Box or Vault | Automobiles Ouiside Bomax. Vault / et id AAA re CAO to Automobiles 1 Burial Suit é I. ’ Burial Suit : i 5! ss Newspaper Notices Slip; en ai News} ape! Note | ss we 1 | Embaliming a 4 C4 . ad 1 a i| | | | Washing and Dressing . | f | _ | j Sha ise A i | Servic f | ee - | i i} l'ransportation Charges | Use of Chairs . 7 oO Transportation Charge i | j i | Officiating Clergyman = a Church Charges j t Us 4. if | Officiating Clergyman cae iss j ee | : | zi <®s | 5 fi. | ] ; ) vetery Charge | Amount of Bill i 2 Zz. oa Cemetery a po ae " “Amount of Bill — nnnoie a) i a 7 i! 1 t i M Goods Ordered by | | Music i we Goods Ordered by | ; : a3 aa| Bill Charged to | | a Lo orn ose t+ _ 7 | Bi) Charced to Ati}! DR ee ce PC ee eee | — nani eae | | j ii ea: ss @ ; CR. DR. CR : i i | Reson of | i , s |“ I f . a a” "1 are i| es ' ees a ee ae os ' eA q i? ' | | i i * s oe a . &S i} | 1] 1 | h | VY a ve ae - © fe, iy ‘ : | i Perel | | ' 1 | ~ ] | | | | | | ' #2 ; | fe | | A " 7 | } 9 | 24 | | | } i} | © » i| i C | | | + <——-| Th | | | | | i 1] / 4 * —_ j : || a id * ; ¢ | ce | L ps t i | | |] i j / | = 1 - | | } | 1) i | 1 i | | i | | i } / t ' irae | | be | . | | a ay i a pf * cet | os | re | | | od | - i '98UE0 BY DORNTER CASKET co , BOSTON, mase., 1018 oe a een ae 1seUrO BY OOF rm Sere eee ern ee ate reer TERETE Err rnc ett en een er ee er ee : ee eee epee > en ree sg ag es 146 ge a BILL OF ITEMS Lif. THE FUNERAL OF. ca to date... is Wife or Widow of. po = 44 xf 4 etedy 5 7 Wale ; 15 ft Years Sex ar) (Day) , Reed J Age g. Months 4 Single - iW (ees) (Day) / X 4 Days Cc Occupation soy oy Wy His Birth-place Iueddlhe “i 9b ‘a a . ACWA toc Birth- oie Ge v vdla 4 Mf = “5 haf Secondary Lah ” Patel (eae ue Ha ae Yearly No. F4 Residence Place of Death Date of Birth Colo Or Rac e & IT « Date of Death Maiden Name Married Birth-place Name of Father Maiden Name of Mother Cause of Death— Primary Certifying Physician f KL A Residence Place of Burial Ce dt 4 Atl We Cemetery funeral Service at Lot No. | / Put in the Diagram one mark like t}:is ; : Din 0 if | for every Grave in it. And mark ; lime of Service anne AN Burial with double dagger thus : ! Date of Interment Section Designate site of monument thus 3 — Casket or Coffin No. didi ‘ | Candles | | Ize a / Made by /@ o 00 Gloves | Lining and Pillow Set No. | Bearers or Porters. | } andi. i} Hearse to 7G . 4-4 4 | bf Plate Removal ce j | Outside Box or Vault {| id Automobiles ... ............. mi : | f | * ev | burial Suit - 4 | | ippers i ZL \CO Newspaper Notices || ifi, || | | imi | We | nH | | | | | | | | | | i ‘ i } | | is | Chai Transportation C hargefQ in hal; a Officiating Clergyman GJ fi | Charge Amount of Bill ey | bee | Music Goods Ordered by Bill Charged to | DR. = . po near ae ae een aa 4 | , ae Ye fs | | i | | ! | } | } | | | | | | | | \| | | | } | | | | me | | | | Bi aad i | | rae | cw (S8UED BY DORNTER CASKET CO., BOSTON, MASS. 1916 Yearly No. Residence. Place of Death ke Date of Birth s 7 ‘ SEL (Month) (Day) oJ i / j Years Sex j % Date of Death 19 ‘ ND eee J Yad | CFS (Year) ‘] (Month)| (Dey) Age § Months Single Lf kd < _ MA Maiden Name = / t Birth-ple HB \ Days Married Lihvv ee §. a Fheurke irth-place Occupation 2 Au ie. res annie . y TET Name of Father oat” «eb aly — Hip Birth-pla SG tut v4 ? ce % Ww, i Maiden Name ofMgther i ley Sraks A, on, -place jy. Cause of Death Srimary Sacandare - SFat SAI KAhng ; : 5 - ndary Seon hl Ad nts ad. A Certi ying hysician Reside “ 4 he, ee nm 4 Ss ance . » > Lé n € - vy hic 1 Up tthe Ase | * deg ety Place of Burial hus © hel. oO dif epep Hr. bchnercm De My dermtigg ie tak, &, Lee Ml e~ OP dd org Funeral Service at Time of Service ike if “A | ; ; ; prstd. fb Date of Interment 424 / it aptneiiy’ AND BILL OF ITEMS KOR ‘THE FUNERAL OF 22% pe Sr moe | RA TA khine._Gh (ten < YL ee 10,2 20 a. ife or Widow of. . Pa Tota/ to date Putin the Diagram one mark like this And mark this dagger thus f monument thus 7 Lot No. } for every Grave in it. Grave No. > ee 4 L* “i Section Burial with double signate site « Casket or Coffin No ede \ (hdd oA COUS€ CA! Candles Size Made _. Gloves Lining and Pillow Set No. Bearers or Posters Handles Hearse to “A“<-KALEL Plate Removal Outside Box or Vault Automobiles hee ce LU Burial Suit / L, we / py Slippers SJ Newspapie r Notices a mbalming [YG \\ ashing and Dressing a aving a ~- Services | Vv hae « - - {—f— 7 Use of Chairs Transportation Charges Church Charges Officiating Clergyman ‘ fae os Cemetery Charges Amount of Bill fs ui Hf Music Goods Ordered by — Fl rs Bill Charged to DR. CR. ore ey RR aa nn es ame =, — | ra _|| a — | } — "7 } | a f coe” | 4 phe co | | | } | } | | | | a i | | i | dina , } | i| se i ISSUED BY DORNTEE CASKET CO. BOSTON. MAGS. 1018 SSS RPA at i Bt 5 SRN Re i ite eta cna tne na a ere 148 RECORD AND BILL OF ITEMS Total to date... Yearly No. ‘ FOR THE FUNERAL,OF Vy £ { : 2 Residence /| Ly ad At v ‘ 0) en Fi Place of Death ” ay ife or Wiktow-oF, a, hehe on CO A wkd < Date of Birth 17 ‘2 g J Y/ 4 idk Years Sex hin Gi a (Month) ay) Date of Death 193 ne Age Months 4 Single as (Month) (Day) 4 , bed Maiden Name fu ; .... Days Married 44 * f Birth-place Make eettly Occupation .. 3 ; 4 Name of ruhace he Ct afet Apts of _.. 2 Maiden Name of Mother Lee HACC lrrmrapaan His Birth-place Her Birth-place Cause of Death—Primary Secondary ; ob ome Cx rtifyi ing P wae” ian Residence Place of Burial ee Cemetery . ir bos ae . J o} luneral Service at. ¢ : Put in the Diagram one mark like thi f o a ’ fics I Ty¥VYatC ) | for every Grave in it. And mark (jis lime of Service st yA GA / Burial with double dagger thus : # a a’, Date of Interment . = = soa Designate site of monument thus: [ ? ros eee ea a yi | o la : Casket or Coffin No. (ee ee @.© | Candles : | “ | ) i} : g j}< Size Made by \| Gloves 4." (ee 6 F £27 Lining and Pillow Set No. Bearers “ee orters 2 = | ‘ailes | | A ssht 2 , is ilandles He arse % | oer CLA &, { “AAR ee / ec Plate | Removal «ty Gta, “el Mk tell | f | utside Box or Vault Automobiles |. f Ri, | | | | ers i Newspaper Notices | nt lp | j | pt | | | i } i | } i| | i | | | | | | hi | } | Ch i | Transportation Charges, f fous | (Charges v — Officiating Clergymankstd Lhe \ mene | , i} eee y Charge | \ Amount of Bill de . Ril ~SHthive gf Goods Ordered bys ACME CMV | } ha Bill Charged to fr 4 | DR. CR. j as a os once! Bins “A 7 \ {| e f 7 . : fie |_f 2 Cf pul DOO i | GP a3 | i | | oe || | | | | | | || } i| I | | | | me : } | } | | | | | - | | [7 | } | i} | | Eo | a | : ! | L \| | I | | | | i} | } | | | | | | |---| ba | | - _ _ bon Lites | | | | ii } i ue cee oe: i ‘ ieiaiet eesubaah caclesiaeicaloasind iccwnisaht ai kag a | | - ad J | ameumenmnte { | 1SSUED BY DORNTEE CASKET CO., BOSTON, MASS., 1016 149 RECORD ied BILL OF ITEMS Yearly No. early Me Tota/ to date Residence Place of Death Date of Birth... 1 $7 ) Date of Death a ae W ifs % Widow of ") | a 5 Years ey Coloror Race A fy AH) 4 (Year) “Months Single fed Maiden Name ; wy LP eh OE Married Bit ; ie P a soe a ? j f ‘ , Birth-place J Occupation 4 7 #-¢ ey ‘ Ran Lei / Stefi teare, ! we. /OP OC i - . f w ” > ‘ 2 < $24 os - ll Name of Father iA _—_. Birth-place- AD of RMR — Maiden Naime of Mother... ? ¢ 7 “Eber Birth-place “ Cause of Death— Primary Sanhsidiey | ' ' Certifying Physician Residence | Place of Burial Cannes Funeral Service at fs ee . | Put in the Diagram one mark like this Time of Service Grave No I for every Grave in it. And mark this : $ — Burial with double dagger thus Date of Interment Section Designate site of monument thus: col | 11 C4 + ? = SS Se = Se See emer SEEENS ST SERTE OE TE SPER Ue u ee oe Reve Casket or Coffin No LVOG@WO' Candles Size Made by Gloves L Lining and Pillow Set No. Bearers/or Porter: Handles Hearse t@ Plate Removal Outside Box or Vault Automobiles Burial Suit . Slippers i} ' Newspaper Notice PP’ a pay imbalming FVIO OD Washing and Dressing | Shaving Services ) £1 ie Use of Chairs HO?d Transportation Charges Ec f Church Charges ne Le é Officiating Clergymaniien ; eat . Re ‘ te Ks oC es emetery Charge? WiAtAAld Yet e Mia || | Amount of Bill C Ves J Music \ Goods Ordered by i p Flowers Bill Charged to |‘ ty DR. CR | oe a] | E -* ae 4 } i! : | | | | | fa , | | | | is i } a | + | ae ee | is em 1 } fv | on ; a } | a | | ISSUED BY DORNTER CASKET GO.. BOBTON masse. tete a 151 } RECORD AND BILL OF ITEMS r 150 RECORD AND BILL OF ITEMS 7 a Page ibau’ L i Wit Widow of , Yearly No. Z FOR THE FUNERAL OF Total to date.. . | Mearly No iy) THE FUNERAL OF Total to date | LE fit wd Fae Li FeAl “Ge he 62 IAMLAL 7 (lLvtde . Residence Lt i4+-- Residence . = Place of Death * s CRA , womens Wife or Widow of Place of Death Wile of f Date of Birth 1 “4 Cod Fe Years Sex Color or Rac: Date of Hirth... I 865 fe . Years Sex MK Siete Ra Date of Death 19 te — “Y Age ae Months ¢ Single .L-— Hy” Date of Death vaY WL - . —— : (feu a) an ‘Age months 9 oing (Year) iMenh) Dey \ue Months Single Maiden Name oe A / CO Days Married Maiden Name ; ae : 4 Dave Marriad Cy in i Le é ” { Birth place S oS pg ~ v3 Occupation ; Birth-place €L CAL xt VM Re Occupation —_ a Y7 0 ~ a 4 h i , *~ ’ ‘ -~ yes ° Name of Father <7 ACCA of ty eo YY ) “Se Birth- place Ak : aa // om Name of Father r AX fs | VN His Birth place a AAA OTe 1 ? ef Cr , ' — : . - | Maiden Name of Mother of Ltt ih 1 Her Birth-place : . Maiden Name of Mother AV (Att iier Birth-place tiled Cause of Death—Primary Secondary Cause of Death hy We ict . | Certifying Physician ' d Residence : Certifying Physician ‘ Vv ah j lence Got 1 a a Ke : t ba Cf 4 t Place of Burial Ht tt ‘ At CA Cemetery FP Cd ; Place of Burial CW Go : a ef 5 ‘ luneral Service at om jf j J ft wi Lot No. | Put in the Diagram one mark |i} Funeral Service at (Re tytee No Putin © sark like this i / eo ay o | for every Grave init. And mar : ; : e 1! { t And mark this lime of Service Grave No. en Rurial with double dagger thus Time of Service N a ’ ' { Los ; sat k ‘ Date of Interment Section Designate site of monument thus Ci Date of Interment J 2 ; ' Cc | ; : ; wal ™ , aes tae | oe vent LD ad ea ' = a cele eemaneore . 7 sibilities ere pat aa t Casket or Coflin No Candles i. Casket or Coffin No. IAL 2 6¢ ; Size Made Gloves Size Made by 4 > . | oe ae : . . Lining and Pillow Set No. Bearers or Porters Lining and Pillow Set No. ; earse ‘ i Hand Hearse to | eeMis wat! Ge Plate Removal | Plate Outside Box or Vault Automobiles Baie Box or Vault le jurial Suit é \¢ Seta) Suit | — Wit | Newspaper Notices | Slippe: i {| “yy Embal:: ing ‘ ne i} | | | ‘ > ue al i | | Washing and Dressing att | ; ’ | | Shaving : t Servic: } | Cha | | Transportation Charges Te of Chairs VCl Hae cl sat ee Zz é : ! | Officiating Clergyman ici Chyfe|) Charge Ay < ma nn ey ; \ Cl | Amount of Bill IO Cemetery Chathes AHL : a } : : ae i i | Goods Ordered by | Musid L t } | Bill Charged to | Flowsrs | ie cae " ae pe Een re = = E DR CR E , f i , CR. DR. oi | 4 me TN - : ‘ r r; i ei | } aS St | Silica eid ia , 'yy i : HH 7 | aj iia | athe 1 aie . | . | un 4 ; i | i i i | | | ee me B t j | | wen Bd ‘ | i -— en 4 I | ca a i : j | | | e | | | | } | ~ / | } | i : | = ae : | } " | i — | = ad | | | i oo ren penraninrinte neers — : oe I . cas 1 | ca 7 einen it J : jaieilhiieeichiesiitaiscui Bd = | | a ik 1SSUED BY DORNTEE CASKET CO. BOSTON, MAGS.. 1816 ‘ BY OORNTEE CASKET CO., BOSTON masse tere iseuEo 158 RECORD AND BILL OF ITEMS RECORD AND BILL OF. ITEMS | Total to date... 7 Yearly No. FOR THE FUNERAL OF ~ Yearly No. FOR THE FUNERAL OF Total te date Residence ADD Caw 4s. _ Residence og a < , <r te a. -— Sane Place of Death . Wife or Widow of. The ly. QQ. goa Pies Place of Death ; Date of Birth 144 } wy // st_O _ Years Sex (Year) (Month) (Day) (Year) (Month) (Day Date of Death 19.32 Zo L7 Age //} Months 4 Single 5 Date of Death 19 1 (Year) (Month) (Dey) Age Months Single a Wife or Widow of Color or Race Date of Birth... 1 ; ; Years Sex (premmnen dna Color or Race (Year) (Month) Maiden Name... B Days Married = Maiden Name L Days L Married sirth-place f- ~cotulr Af, c ' Occupation . . : Birth-place Occupation : Nase of Vater Gthe+140 6. asd. His Birth-place <2 227-2 ee fae 4 Name of Father His Birth-place | ) ; Maiden Name bf Mother Cla pa. frate_ Her Birth-place LAO a a a Co we ini Maiden Name of Mother Her Birthplace Cause of Death — Primary Q OE eer 4 Color. Secondary seesee Cause of Death— Primary Secondary : Certifying Physici: a J a = a Residence . Certifying Physician Sagtieticn | Place of Burial Cemetery : ; ] Place of Burial Cemetery | l-uneral Service at Lot No. Put in the Diagram one mark lik« Funeral Service at Lot No. i i aces ii aed eiaake. : | lime of Service jf Ft Grave No. ; L ane ee ee: Time of Service Grave No bee ; , ( . ieee this t . | Date of Interment 3-2 f: + i Section Designate site of monument thus e ; Date of Interment Section : nee 5 5 1H || fan Aa Bee © oboe Poe [oo et ee i Pi) > cle ces wv Cn- Cen Vat pe he ; a So, Peete ss eee sreuces i ; eee oes = einai sissies i Casket or Coffin No | i Candles | Casket or Coffin No. Candles fl Size Made by Gloves | Size Made by Gloves i | Lining and Pillow Set No. Bearers or Porters Lining aad Pillow Set No Bearers or Porters 4 } i Hearse to Handles Hearse $00 AAP, il | ' a Removal Plate Removal ; } i} f Hi fit : dutside Box or Vau Automobiles Outside Box or Vault Automobiles € ; j i | 4 . nee | / : I Suit | Burial Suit 4 a Newspaper Notices | Slippers Newspaper Notices tl ; eS } { ; Hl : | . J Embalming rt ad ' } aa: | 1 i | | | Washing and Dressing 4 : j } i | | : ‘ : Shaving j p i an ee | ‘ Z | { | i Services ' | I ( {| | | Transportation Charges | Use of Chairs Transportation Charges H ‘ ; ae Officiating Clergyman ~eempaprtereior: Ba Church Charges Officiating Clergyman eae eS ie bear i . . | Amount of Bill aoe} Cemetery Charges . Amount of Bill se cial eae j 4 } ) # } | foe a H Mu | Goods Ordered by | Music Conds Onlerad by / | | i is Flower Bill Charged to Flowers Bill Charged to i | o : | | siillicaiiebdieada sie csaiieenneeniineiagiiiaeimns , sande ets 4 Bik _— Te — as a = SES } DR CR. DR CR _ spnmenenenanie — ner es sciietniasiieiab ainsi _ woe ~ sora Jono nama ae ane aOR : | * fs si j ae yy | on | | } yf ALA WT rf | ea . ' cman . 4 4 1] ih oe f ; ae } ' ; ee | aa il | \| | ae | | i } i } a og | | | i | | ! j i } i] | i 1 1 / ; | i} | | ei | | i - } a ¥ | i — i : | i} | | | | 4 ‘ —| : | | | | 1 l ; } | | , f | i | il | | ; ween a , } ile 18GUED BY DORNTER CASKET CO., BOSTON, MASS.. 1018 ISSUED BY CORNTER CASKET CO.. BOSTON MASS 18'8 . Yearly No. Residence Date of Birth iJ $° Date of Death iden Name /4e} Birth-place Name of Father Maiden Name of Sites tik Cause of Death Primary. 4 Certifying Physician Place of Burial Os CA funeral Service at [ce L- lime of Service A Date of Interment — her hen hi Place of Deat! /s a j C7 oy —— i Y (C a : ch C.- Af hh Residence. LAMA U SP ——=_ Layo. RECORD AND_BILL OF ITEMS brheit fiufoer FOR ¥ z 635. (0 foe. Le Years Sex / (Gigay (Day) /Hhx eh aS. Ages . g ...Months 4 Single (Month) (Pay) Lo .. Days Married & a cm Ze cyation . s2ed 4 lp Z hau irth-place Fe C.. L4Va Hades Oe Her Birth-place le Secondary..... ) 6 ycthe ay Cemetery ; / AG Loock oe = ae on, VGH wl td Grave No £ fh. i A Cf. he S.5D f Section i Total to date... Put in the Diagram one mark like (/ | for every Grave in it. And mark ¢ Burial with double dagger thus : { Designate site of monument thus: [ } _ Ms = SES =e aa a =: j = / f : / | Casket or Coffin No. | Ne thasdnate nah i. ss | | { ar QO Gio. Made by | Gloves O} Jo0l 1 : | ts ic Lining and Pillow Set No | Bearers of Ben.” ae | | £P Q | i Hearse to , ee tASUES > j / ~ | / | “ alt Removal | / ] \), ee | to cu Automobiles ................... |. | i I Newspaper Notices | 4% eA co i J } | } 1] $ se i } | / | oa , | ee aad ; Ch i | Transportation Charges i | (hargeg | C tt Officiating Clergyman a yi ’ : | wv x - Chabfies if ~ i| OF Amount of Bill .........5 f\ ee cepa | mt hf ~ | i Mu | Goods Ordered b Ne iz LAs Ws NI - | \/) Paral ~A l/ 4— I ‘ ~ : 4 _/ || Bill Charged to. OO AL / eT Ay DR i | | | | 1 | | | 1 | { i| | | | | J i | a | | | ood | i Z 2 | ee 2 —— ; | | | aT a bac | | ennamemenn il | 1@BUED BY DORNTER CASKET CO.. BOGTON, MASE., 1916 RECORD AND BILL OF ITEMS N Yearly No. FOR THE FUNERAL OF aMarmnusk / Wor AA PFe Mite, Zé 234. Residence ~ Place of Death. #0" Date of Birth gar eas (Mouth) 193 2 } 28 Pa (Year) wean Age s ra } | é / : Wife or Widow oft oe Years oa (Day | , Kee Months ) antl yet { Married Date of Death / (Day) LA Birth- ston tl 4 am Lé t LV¢ &, Name of Fa tell bus wren ff AP mgs His Birth-place re thd. et é . Ay Maiden Name of Mother <7 > Diehl OAS Her Birth-place eth Swe NK a Maiden Nam o lL LG Days Occupation Cause of Death—-Primary Seon Certifying Physician (K€ Ge AA v ¢ i Funeral Service at GG. \ ae Residence Place of Burial Cemetery Lot No. ! AS Time of Service me ie Grave No Section Date of Interment : petresnencinreeeeereeesinee — niin shinee Casket or Coffin No. a Nous \“O:| pe Size Made by Rew Lining and Pillow Set No. Re Handles Plate Removal Candles Gloves sarers or Porters Hearse"% Outside Box or Vault Automobiles Burial Suit Slippers Newspap r Not y ° Embai: ling Washing and Dressing Shaving Services Use of Chairs Transportation Charg Officiating Clergyman Church ( charges Cemetery Charges Amount of Bill d Music Goods Ordered by Flowers Bill Charged to —_ a sai seine iinsinsianiiiaiiapeaiiiiiaimaliil 4 é ‘ A A DR. ISSUED BY CORNTER CASKET CO., BOSTON. MASS. ‘ere Tota! to date y Fisk 155 Crt "tT < Pee olor or Race CR eee 156 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date. : Yearly No. a : or o : E FUNERA / Tota/ to date f - ; \ IF ar. f hey 7 fan LaA-t LO _ L a.<y, net tTTteth .ccsescesseres ' ‘ P Ebde _ eae «Merch Residence J Ata tt of C20 eg A, & = mevennedine’ Residence a <n Wife or Widow of Vics TNA ee Place of Death Ras aree:S, , , , Neer Place of Death : é ¥ le igh — f Wiferoe W 1 prs atts : a 2% Fi Sex Color or Race Date of Birth 1dOW ¢ My) Meflie hie oe ™ lO Years Color or Race / ATI (Year) — Date of Death 19.7 .a- der Age Months 4 Single XK Date of Death (Year) ‘ Months ¢ : ‘ingle i } .. Days Married Maiden Name ; | c Days Married Uk Maiden Name Birth-place A. € ‘ Occupation. Birth-place Occupation “ f am i : . _ ~~. ; : { ay ad P / Name of Father JL ft tf / oe His Birth-place ALC Name of Father , q fS —g *CAR thse (¢ LT Fide A & Maiden Name of Mother.. Ha -e¢ op Wopphe Her Birth-place A. € ¢ Maiden Name —— le ' CSerattleReptice €¢ Cause of Death— Primary Secondary ae Cause of Death » OYE . Secondary sae Zo Ue tt K}Ktfesidence Place of Burial 7 U4! f Cemetery Place of Burial t é Cemetery funeral Service at Lot No. - Put in the Diagram one mark like (hi Funeral Service at ao 4 ) “ . | for every Grave in it. And mark / ok a Calon Ef «4 - a . Grave No. Pe : wreian ’ lime of Service ' Burial with double dagger thus : # Time of Service A ep a Grave No caf interme sei Section : nie 5 Gf Intervene et ft ae ; Date of Interment Designate site of monument thus: [ 4 Date of Interment 4 é wt Section BheLr- Walle, ld lair] spre & falta 7CL, | - camels Certifying Physician Residence Certifying Physician Caakat or Cafin No | a | Candles } Casket or Coffin No Wud AAs <x Zhi | é 0 2 Const | | oo = au aies - ae, nana ee aeureaarenenr ep y yneewet sateen tet stints Reventon ize ade b I | Gloves | Size L i z Lf Si J , ize. Je Made by “7 4m fp Gioves 3 Oe. Bearers or Poryars Hearse to ma Handles Hearse tf. We Removal — Plate con . \] i cia! ‘Sire ae | wie . : ‘ Lining and Villow Set No. || Bearers or Porters Lining and Pillow Set No. Re moval Automobiles a0 Outside Box or Vault @y7 A : j \utomobiles Burial Suit Newspaper Notice Slippe n i paper ylices Suppers | Newspaper Notices ‘mbalming Vashing and Dressing having rvices Transportation Charges se of Chai | i 1 harg of Chairs Transportation Charge Officiating Clergyman ; iurch Charges Officiating Clergyman Amount of Bill = metery Charges Cg Amount of Bill Goods Ordered by usic | Goods Ordered by Bill C a to ‘lowers AMAL OO) Bill Charged to sao aor = ro. ae ISBUEO BY DORNTER CASKE! CO... BOSTON MASH fHIe 158 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Yearly No. “= Residence Place of Death Date of Birth ....1 (Year) Date of Death 19 4244. (Year) Maiden Name Me Name of Father A - Maiden Name of Mother , p Primary Birth-place Cause of Death Certifying Physician x . ‘ OP / fé Place of Burial mg - ‘ . ‘ = A sis le luneral Service at¥ “+ he Time of Service : J ” Date of Interment ly Casket or Coffin No Size ‘ Made by Lining and Pillow Set No... Handles (Month) Ahi OAMb 2. as, He Aé CLA f Lf /q i Cath, af AAD J (Day) oOo (Dey) Ae fheD / if or Widow of...” Total to date. Years Sex Age Months § Single ... Days Married Occupation . His Birth-place Dt beth (2 Her Birth-place 66 Secondary Residence Cemetery . Lot No. | Grave No. Section | | | | | | Candles Me f ~ 1 Gloves’ ©“ whe Bearers or Porters Hearse to [/(A44.... ALLA [0 / 4 / Fd tr “ Rerhoval/ CL 4444 Lay VI ett ¢. Sout {A ‘4 Color or Ra ¢ Put in the Diagram one mark like t! | for every Grave in it. And mark Burial with double dagger thus : 7 Designate site of monument thus: [ ’ 4 "1:6, Plate / Outside Box or Vault } Automobiles Burial Suit | | Slippers ! Newspaper Notices | | hinbalming | | | | | \| Washing and Dressing I i ul i I i | | i| | | | | i | Transportation Charges Cc} t | Officiating Clergyman J || . “a " Cemetery Charges || Amount of Bill | 32 ‘ M | Goods Ordered by | | | we | Bill a to | DR CR. i a oe 1 oe | iw | | i | | | g - "| | | a | | | aia | | | el | | | | | i j | | | | | | | | - —~ i ail i | | | | cd os | Pe - | | = ! 1 ; : ree sill es einen 7 ee | | me | a on — _ | A meee i| | i| SS | Re } | | | — a | io reeves nmentmmry moe RECORD AND BILL OF ITEMS Yearly No. pe Ahn FOR THE FU LOU NERAL 159 Tota/ to date ChsdA CM kacy a bbe tly / V7 Residence J Ly, Af a Place of Death Chidd Wife or Widow of Date of Birth l : ae I f Deatk oe (Muerte) (Dey Years Sex Color or Race Jate of Death 0 ; Ay ’ y>» (Day) : \ge ) Months 5 Single 5 Maiden Name “ a ve hic 4 : P , o Zz "- e Days . Married Birth-place = AL Occupation ? 9 /4 dhe hele —G Name of Father Van Kf ca ¢/. His Birth-place | / VES ELLHL _* Maiden Name of Mothe t JEON L LA, 0 “RAK —_ Her Birth-place ha Cause of Death— ‘ae * Fe Secondary Certifying Physician ce ae Sie. ge etiee Place of Burial ue <x ‘<. oo" Cn meg ry yy 2 fh. %&% cLdg Funeral Service at Tp tad v [VRE TEE ott AS iad ie ee : Rees Tne : : ver bi WW none mark li e his Time of Service QU adie 7 at - \ PF Creve 4 ioe 1 for And mark this PR : as ~~ _ Bur l xz ha Date of Interment Yr Om |} ~~ Section / Designat nonu mer f ] RS oy py RE ge a a a iiaimamiiiintiiei 3 44 gf Cf rh (75'A0 Casket or Coffin No. / % bth Fi ay 1.2 OF SS Candies Size Made by Gloves Lining and Pillow Set No Bearers or Porters j Handles Hearse tof R24 ¢¢.€h8. 16 Nbds ‘ c Plate Removal ae Outside Box or Vault Automobiles Burial Suit fry sae 4 a i 4 : ~ a Slipper $+$-Le- || Newspaper Notices lippers a ewspaper i Embalming i ¥ |IO-@ Washing and Dressing Shaving Services Use of Chairs je a Transportation Charges (r C paset? Church Charges § yD a lg Officiating 4o an white techie fil j Cemetery ChargeY And / . Amount of Bg Lb fo i Ee ee Music Goods Ordered bh? i Cin / : ‘ “tf / 4H, Flowers Bill Charged to “yg tf ae i ssn - a alone “ DR. CR on < a fiona caren a = ame - ] 4 | “a . | —_ a ae ef i , Mad Le’ ® ed Sr | | | | | ISSUED BY DORNTER GCAsKEe! co SOetoON mane lela 4 RECORD AND BILL -OF ITEMS : Yearly No. r _ T FUNERAL OF Tota/ to date... it ‘ Sat. oe fof. Fake ex, oak, 2 ys ae”, at f sf | thik \t gu oy 4 AAMAOAALLUM 3 dow of A shite Perctke : 7 * Lae j 4 . i Date of Birth 1G as Years Sex hale solar or Race ear) (Day Date of Death 19.94% 2 Months 4 Single G Pitt. (Year) Sp ut Ar en : Maiden Name ee We A... Days Married fed th. (2 J & Birth-place Occupation .. ; 4 - ? f Name of Father ih hel A 46 JJ Ye fe. J iis Birth- oe A be Maiden Name of Mother ...4 fe a4 AM Yer pet - ¢ ?\,Her Birth-place Cause of Death——Primary Secondary Certifying Physician NC ar cscs ee ee o-t.h Place of Burial 4“ : Cemetery ‘ est . : aa ‘ Funeral Service at / : f A Lot No. | Put in the Diagram one mark like t!y. Time of Service hed te Lé Bh 7 tie? Gin Ne iw | for every Grave in it. And mark // ve ft j = ff ‘ , Burial with double dagger thus : # Jate « erme fi ey , Secti ; Date of Interment fo nee | 1 f Designate site of monument thus: . } : as l Gs eee = 5 tit la ; fit Casket or Coffin No. J G6 Candles - a :. : Siz Made by Gloves hE ity tS daa Il | at | | : ' Lining and Pillow Set No Bearers or Porters as ae ‘| oodles I | Hearse to Crriales ae ov ¥ CEs |= ‘ | Dian sa Removal iii : / |Z { H Qutside Box or Vault |... 94 | “|| Automobiles 3 ; : i} Burial Suit at |! nh Slippers a} Newspaper Notices ii Af j fis lmbalming | i li Washing and Dressir i } ; Tt] i i ; | i ! i é Chairs ae? | Transportation Charges ( r: t Ch Officiating Clergyman i i Charge | RY | Amount of Bill Ps sg 3Y i i Goods Ordere d yd lil Vj “3 i "A T jo 3 YY Xd é caNT, : } FY ¢ _ doo! Bill ¢ sharged | to ““y g Wek eT sit af a es ee = eee ar ce i at pi Ye No. early No. 4 J) Residence Place of Death -V & Ck Date of Birth 1994 Date of Death 19 Fy (Year) Maiden Nam¢ Birth-place hares Auach {ry Ac Name of Father Lite eovle,. 161 RECORD AND BILL OF ITEMS : , FOR THE FUNERAL OF Total to date VA UV Wh efaecch A_e Wa Cty 4 73 Ld an Wife or Widow of ss A, EG Years [(Sex7Berce Lit gor hp Rgpe Of AE Age 4 : Months ¢ Single te e “RCE, | Cth’, Dayf | Married Occupation wr: (fu RPgl XE His Birth-place Maiden Name of Mothe iM de Powe, ¢ ie Lid er Birth-place AT aks a Ce ath—Primary™ / ¥@riteg dees, ' OH ( S Cause of De ' ry Rphfldo (i © AeSec tide ei ee . i LA Oo Certifying —— ia rth Residenc tele. be sch ie \é Place of Buria CACAELL fh Cemetery Funeral Service at Lot No. | : | Put in the Diagram one mark like this Time of Service \ Pisce Na § for every Grave in it. And mark this N“ Burial with double dagger thus Date of Interment Section 1 f Designate site of monument thus: f ] Casket or Coffin No Candles Size Made by G lowes Lining and Pillow Set No at “Be -arers or Porters oe Handles a Hearse to se Plate SY Outside Box or Vault Burial Suit Pd ~ ¢ ~ oy. a Slippers ff Newspaper Notices, ff , Embalming J Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman sei niin < . emetery Charges Amount of Bill aa sal anditiiiiisaie Musie Goods Ordered by Ne rs Bill Charged to DR. CR. . —_ —_ | {| | | | | | | j i j 1 | i j | j } j | i i j | | | | i} | | 1SBUED BY DORNTER CASKET CO., BOSTON MASE 1810 RECORD AND BILL OF ITEMS Yearly No. FOR THE UNERAL OF Tota/ to date. Tv Vn Le ©, Whe wg Sy = A, 6. Residence 4 - Me Fy] ic aia Belg afk & Wife or Widow of Place of Death Date of Birth 19 2 of ? 0 [ Years Sex Color or Race « 19 Year) (Day) % 7 - oY se Age Months 4 Single ear (Dey) Birth-place haf Hyg : en Occupation . : vy Name of Father ‘Me he Me (td His Birth-place f ‘Go ag Maiden Name of a hv Uk { libdé 7 Mer Birth-place G ul Cc Cause of Death Prima, ¢ be Shih Certifying Physician 4%" , Lh, Kesidence “El. Place of Burial Ly, LAMTAT ci ag Cemetery f / Date of Death Maiden Name Days _ Married l'uneral Service at >I Lot No. Put in the Diagram one mark like {! lime of Service yy f Grave No. j ~ Date of Interment } A ; ' : Section eae wat Burial with double dagger thus : j ! I for every Grave in it. And mark / Designate site of monument thus: [ } see Casket or Coffin No. 7 Candles Size Made by ! | Gloves i | | Handles Hearse to Lining and Pillow Set No. Bearers or Porters Plate | | Removal Outside Box or Vault Burial Suit 1 ! moa ng shing and Dre Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by [ill Charged to eb NT aT i| | } | | | | | | | | | | | | | | | | | | | | 'SSUED BY CORNTES CASKET CO., sORTON, mMass,, 1018 Yearly No. Residence Place of Death fed Date of Birth Bb (Year) Date of Death W647 2 (Year Maiden Name ee Birth-place oF Name of Father aha. Maiden Name of Mother Cause of Death— Primary Certifying oe A Place of Burial / 7% Funeral Service at Time of Service Date of Interment fe /2 33 Section 4 a C44 RECORD AND BILL OF ITEMS L — THE FUNERAL OF Tota/ to date (lleti. ng 7A Ziur AA Pbxtrale Witter Widow of | Jo 6 C Years (Day Sex ‘ oloy or Aa e Lonime > J 402 Age 4 Months 4 Single ‘ (Day) . | | 7 j 4 A BKK JO. Days | Married Li tho a & Occupation t ~~, His Birth-place taceaccte © AC # Secondary ” Residence tlre een cf C Chueh Sedgeanie veh tee atl (A i . ia ee | for every Grave ini ! 1a 4 Grave No ; : we anat And mark thes 1 double dagger thus Casket or Coffin No Size Made by Lining and Pillow Set No lfandles Plate Outside Box or Vault Burial Suit tippers i.mbalming Vashing and Dressing having rvices e of Chairs hurch Charges metery Charges isi DR. <2 RS PE SE BEC SE ASI NET oe LEFr | Candles Gloves Bearers or Porte Hearse to Removal Automobiles Newspape r Notices Transportation Charge Officiating Clergyman Amount of Bill a es Goods Ordered by74ea~7 MA as ra) leg Bill Charged to / lI ISSUED BY DORNTER CASKE! CO. BOSTON Mree. 1818 164 RECORD AND BILL OF ITEMS Yearly No. FOR (THE FUNERAL OF Total to date. Dy 2 '- Va iis Residence od a Ceae A — Place of Death kh ied Mae Ke 0 rab ; : Date of Birth 1639 Sesser 2 f 7 Years Sex + fb ceca’ Color or Race (Year) (Month) Sf’ “guar, oY Date of Death Fiz a )bha oo Age #7 Months Single : eke Maiden Name 6 <<<442/_ a; ws 2 foun Daye Married 4 44 <02/ Birth-place Jays CVs Ke AE i Name of Father...AF EX? Lele Ticks Maiden Name of Mother. &h Ace hog <a Cause of Death— Primary, Secondary ‘x Ce yo) Ke cha es Nk < Hesidence 4 cee Ais fo ae, ARLE A © Cemetery . Wife or Widow of Oce upation His Birthplace CA 4 ohn LC Her Birth-place CLEA ay A &. Certifying Physician } Place of Burial [x ineral Service at Lot No. ‘ , i ce a sy Put in the Diagram one mark like + ey eae : . cies Nix: i for every Grave init. And mark / } afin Burial with double dagger thus : ite of Interment X“ ¢¢ €£ 7. Section : ; ae ‘il Designate site of monument thus: [ 1 Candles Tale valle [AEF Cocedl SOC OO | Made by Gloves L cs P cal Pillow Set No.. :...4] Bearers or Poste rs ) Hearse to Kineces ere 4 | | | Removal % , 64e MES COO COS "Pde pPces we “| Automobiles I © of NMR fd | Fai ft Newspaper Notices / Transportation Charges Officiating ¢ clergyman Amount of Bill Goods Ordered by Bill Charged to Se eR 2 eT ee re | | | | | | | | | | RECORD AND BILL OF ITEMS Yearly No. y FOR THE FUNERAL OF Tota/ to date Whe Prehauia Lbetl Guderton Residence 2 O} Kate St at Vex ns VOtLl Place of Death Raves Hospital Date of Kirth KS 7 4or (Year) (oan) ( . Years | Sex™ tx seks (olor ox Race Date of Death 19 Fx ce. < | Ahid » (Year) (Month) re 9 Months < Singh ’ ‘ o1 PUA Le Maiden Name Ay ir t \o bhi, Maiden Nam« PeLe 2 ¢ < a Days Married < Birth-place Le é he tee kee fd am Occupation a : eS Leo His Birth-place hufhe, ford © XL AECL MKog Mer Birth-place i ae a Ae Cause of Death— Primary Bnei Wileor Widow of Pudi fad Mee Name of Father Maiden Name of Mother lhe 7 Certifying Physician asidann Place of Burial ot >, Cemeters Lk a CZ rn CL Funeral Service at ‘ Cd Ye Na Time of Service Grave No Date of Interment i, thls a Section a biaieiiigs ‘eek iia deiascetiensiaesccapcaiiita Aisi Casket or Coffin No 7 Phe ord Candles -/2 Made by fo A aco Gloves | ining and Pillow Set No Rearers or Porters Hearse to rrr Removal iuiside Box or Vault LA ra 2 ae * Antomobiles Burial Suit .. “tippers Newspaper Notice ibalming hing and Dressing ving ces f Chairs Transportation Chaige ch Charges Officiating Clergymar ietery Charges Amount of Bill Goods Ordered by Bill Charged to A TELE CELE LT 19OUED BY DORNTER CAgneT CO. BOeTON MASE 1018 166 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. thang THE FUNERAL OF Total to date... “ Yearly No. FOR T ag d ane : ne OF Total to date Residence iF) ia tie esevyoesnennensen Residence... tf 28. pi re Ave L Place of Death Wife or Widow of...... bee oat eae Place of Death ~ ‘de Le ae Wits oc Widew af 4 aw Date of Birth 1931 J/ { Years Sex Color or Race Date of Birth 41S - r 2} c 7 i ae , . a i 2 Years co “aE L ‘ Coline Mee oath ) (Day) Year) heck (Day Date of Death 19 fk ae Age me Single Date of Death 19 Fis hecsee en Age .......2...Months ) Single Mawes WF : Ue: 4/.—.. Days Married pa assnesen ! Maiden Name g, Z © [ 3 ties “ew Birth-place ig 1 Occupation ..... % a er ae ' Birth-place cArkl b a & Desiapiih Name of Father eee His Birth-place cer lely la se Name of Father 12 LQLES , © Gro. ii. Rink J edeve & A€ Maiden Name of Mother. Mossee ne Now Her Birth-place Cotke RE ic eat Maiden Name of Mother ¢-(@ a9 a2 p WR b BY Ver widind « : Cause of Death Primary Secondary. Cause of Death—Primary _ Secondary Cortilvinns Porcine AY Cia. Mev man’ Residence Lalu hhe 7 Cr ii a ee iene ee Certifying Physician Br Saewes MN Akyacdes a nee Mtlen the ACO ; Cumilie eae ca Place of Burial 4 oakiwook i nara Funeral Service at Kee hecuge Cea Lot No. | ies Wiaalnic Wek wckale AO FP, 0195/97 cina | for every Grave init Ad wath hi lagger t} Maiden Name Place of Burial Lot No. Put in the Diagram one mark like |! | for every Grave in it. And mark / i fs ‘ Burial with double dagger thus : 3 Time of Service : ; Wh ihhi. V5/ B- / Date of Interment pean Fee l'uneral Service at Time of Service Grave No. Section Section Date of Interment : ; : 1 ) , Designate site of monument thus: Casket or Coffin No.. é tell 7 [dare i id. QC Candles y ||. Casket or Coffin No. « Candles k7 3 Made by wor 4A O | 8O.)| Gloves j ae : Inrtere si . ‘ ¥ j Bearers or Porters . Lining and Pillow Set No. | . Bearers or Porters Size : Made by Gloves ; | | Sins is Lining and Pillow Set No.... , Handles Hearse to oodles ass f ~ Sx Plate Removal | Removal Automobiles Bae hateas NBs : ; uiside Box or Vault [JA wat an ‘ al, Automobiles Plate Outside Box or Vault Burial Suit il Suit Slippers | Newspaper Notices ; Slinners Newspaper Notices 1 i balming timing hing and Dressing | | wand Dressing ces Chairs Transportation Charges : : se of Chairs Transportation Charge g thair I Charges | Officiating Clergyman hurch Charges Officiating Clergymar Amount of Bill Bs emetery Charges Amount of Bill a A Goods Ordered by, & ¢ “Mh ve ccd 2 : } Goods Ordered by ec if to, clery Charges H fa Bill Charged to Us Y LM Wid Bet c€ ag Bill Charged to | t > ee i I 1@SURD BY DORNTER CASKET CO.. BOBTON MASE tete 168 Yearly No. RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Total to date... RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Residence Ch ta) Kw 7. Place of Death / “f , 7 Wife or Widow of. Date of Birth 1 is & Years Sex (Year) (Month) (Day) Date of Death 19.37. (Year) (Month) (Day) 2S. 7 P Birth-place 21. Ae Gf (Ota ia. Name of Father hor ge 4 ste em Maiden Name of Mother4 C7 fv pets, € A Cause of Death — Primé y Color or Race Age Months 4 Single Married Days ¢ Maiden Name a7 Occupation . His Birth-place «Her Birth-place Secondary Residence Certifying Physician...“ < ee" Place of Burial @aft t P--Ri g — emetery l'uneral Service at Glek P L& A hu . i i No. CAM Put in the Diagram one mark like ti); | for every Grave in it. And mark ¢/) Grave No. ia Burial with double dagger thus : / Time of Service Section Date of Interment : ; , . Designate site of monument thus: 7 otfin No Candles Made by Set No... Handles || Hearse to Casket or ¢ Gloves Lining and Pillow || Bearers or Porters | Removal Box or \ || Automobiles surial Suit | Newspaper Notices Transportation Charges Officiating Clergyman | Amount of Bill Musi i Goods Ordered by | Bill Charged to Flowers DR. : ci : pa : — cf a Kult y DAs? 1 eee } Ca OSL” | Lae. 'ssugoO oy DORNTEE CASKET CO., BOSTON, MASE., 1016 Residence... F the Sys i cd Place of Death Date of Birth... Pa Mam (Year) Date of Death Maiden Name Birth-place Name of Father Maiden Name of Mother. Cause of Death—Primary Certifying Physician Place of Burial Funeral Service at Miicat. Ce, em. -~3co—- Time of Service a f™ Ay ie Date of Interment Yrs J Casket or Coffin No. a 3 G, L.. / Aretay Size ig Made by Lining and Pillow Set No Handle: Plate Outside Box Hai. Buria! Suit Slippe: Embalining Washing and Dressing Shaving Servi Use of Chairs Church ¢ -harges “ Cemetery Charges Musi Flower Lie Ja, See Caku-o- ok. wees eu «> —< of / Go t- “4 ‘> Wife or W idow LA Vin os sat (Day DV AX ars Sex 25 , 7 Age ¢ 7 Months ¢ Single aa (Day) a / ieee J”. Days | Married Her Birth-place Secondary Residence Cemetery Lot No. Grave No Section Candles Af fe Bearers or Porters Gloves t+ <2) Newspape! Notice ae lie i2r< 4. (2/6/42 dela te /7/ j i 198UTO BY CORNTEE CASKET CO.. BOSTON masse. tele OZ > | Zab. . Tem Tota/ to date ~~ OH jor or Race 170 RECORD AND BILL OF ITEMS Yearly No. FOR AWE FUNER OF LLL C a 2 S/des Stic. toe. —_ St- el Place of Death Kou e Wife or Widow of “= ‘ Date of Birth 1 LY Aé c / a ; _ Years Sex MALe Ciper 19 Total to date. Color or Race (Month (Day) sA4+G- 40 Age Months 4 Single ¢ ad (Year) (Month) (Dey) Maiden Name _ a 93 Days : ai . AL a ¢t . Ve Kel G 2; AC a Occupation VA AX Birth-place , > Name of Father 5 19 s/o ‘ 7, His Birth- -place ay Ze. Ce ag ZL € 2 Léa Maiden Name of Mother oc: Lae. A ae flee, r Birth-place MCLE Ae e of Death Primary & hy Secondary > fe AY © x ry. errtle Residence Ao, ¢ € <xte ” oY ‘ a a A £ Le? (<f.. Cemetery ie F Me ia de = > “ee (7 Pf Hw p AF “ ‘oro. "Mey MER Grave No Date of Death Put in the Diagram one mark Jik¢ | for every Grave in it. And mark Burial with double dagger thus : 3 Section Candles Gloves Bearers or Porters Pe) f ‘ Hearse to Cé Pecwel, A KEY £4 <4 Removal [ Automobiles Newspaper Notices Transportation Charges es : . ofc “he r Officiating Clergyman iy A, ae L£lbteg YAAVY ae | \ “Re | Amount of Bill +f : £3 QO Oey / AK of 2 acc amruomennonet Mic asian Goods Ordered by Bill Charged to 5 STS = Designate site of monument thus: { } iI | ISSUED BY DORNTEE CASKET CO., BOSTON, MASS., 1016 RECORD AND BILL OF ITEMS Tota/ to date Cea shafelgel/ Phe. C4 Ho gus ) we 2 Place of Death Wiks or Widow of Date of Hirth wi Z ; as cars =| Sex i lor or Race | ( a1 3 a “Z : Date of Death 19 CU / = | FPar tr « {de ill (Day) / Mont} Single a ge Ds CA // Married SOM LON Le Maiden Name n Birth-place " Gergeriffe Vic Atey ‘eq ny Ou Jv slch HN; f oa ee Lage a e/ (4 «shee, ; Wary Certifying Physician V Uy OO tf. De Hasee : 4 KK heo /Ssae Place of Burial a & OCic& eral Service at. . Fune . fut t hagram one mark like this en : “ hie : Time of Service on ( ony ee And mark this Residence (Meath Name of Fathée (tte 120 pe ia £2 Maiden Name of Mother Cause of Death—P ae le dagger thus Date of Interment C-¢ 4 }e at te of monument thus [ ] a Casket or Coffin No. , [tag> Sire ‘|. orm Made by Kregel Lining and Pillow Set No Handles’ Plate Outside Box or Vault Burial Swit reed Slipper FOL A - THAME vv CO€LCY Embalnny Washin and Dressing « Shaviny: Services Use of Chairs Church Charges Cemetery Charges Musi Flow: mann ae C ‘ere seeueto BY DORNTEE CASKET CO BOSTON MASS 172 RECORD AND Bilt OF ITEMS Yearly No. FOR THE FUNERAL OF yd c Fr ctitiwll Ke URL. ky eld dc bs Leaf lege ALO Residence Place of Death Kets / AdLé Cfo vk Date of Birth 1g § k ¢} i war) (Meath Date of Death 19 J 4 (Re 7 (Year) (Meooth) Maiden Name Vi uf fey a “ee Birth plac c Name of Father dps Maiden Name of Mother// Cause of Death — Primary ~ poate “4 b, SOOT ad ce 8 Le Ald ex Her Birth-place fStev Le ( Ae I. Wife or Widow of i ; “y Se / Years ex : Age of Months 4 Single Jf Days Married Occupation His Birth-place gl c~— Secondary ‘ a - Certifying Physician MV « ee Jk» HHL Kesidence CL, Valk Cte Place of Burial Funeral Service at lime of Service Date of Interment Casket or Coflin No Size Maite by Lining and Pillow Set Ne Handles Vlate «} 4 ”» . u-” Cemetery , Lot No. Grave No. Section Tota/ to date L ? At dba Color opyRace _— - kil, CW Weidice Vathewe Af i O py tisg( Miesek fove 4. mM of mn f th etifa his fie be, Burial with double dagger thus: | ; Designate site of monument thus C3 Candles Gloves Bearers or Porters Hearse to Removal Automobiles Newspaper Notices Transportation Charges } Ofliciating Clergyman Amount of Bill Goods Ordered by Bill Charged to la ————— a anamfe Mranvwe [GP <y es Gicl Arco ihe q Hele AL Q., lirlaec. I 1h: howd - kee (oleae 4 | 198UED BY DORNTEE CASKET CO., BOSTON, MAGE., 1810 ” Yearly No. Residence Place of Death Date of Birth RECORD AND BILL OF ITEMS Cor Mbh Jretth > Heel KOave's Seoul. Kal 1986 Se (Year) Date of Death WIL (Year) Maiden Name Caer Birth-place Name of Father jd q Maiden Name of Mother ihe a al 7 Cause of Death — Primary we LLL Y hype Ser oP vie aC | tof Certifying Physician Place of Burial i hewopro he d feulrg fved Chee ) om « 4 Funeral Service at Time of Service Date of Interment f, [3 2 emma Caske {< Size Lining Handle Plate Outside Burial : Slippe: 10(5Q Mt nd G05 1 Coffin No ius. a ~- va Made by ind Pillow Set No J+ S$ 60 Hox or Vault A “a Embaln Washir Shavin Service Use of | na Dressing airs Chureh Ch, ges Cemete Music Flower » ry Charges FOR THE FUNERAL OF ees Mette ona i, py Tota/ to date FEeu al ‘ Mont} Single SL” Married , ‘fle _amae of. “op. AC CBee ts OL Co AL’ f 1SOUED BY OOMNTEE € aanet co eostow, masse 'e'e PAY SS I 174 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Residence EL 441- eo a Ae 1gA€b2 (Year) 19 FA Place of Death Date of Birth Date of Death Wife or widow ot A 4 7O Years Sex 48 Aes oF Months /8 ( outh (Day) Single (Year) (Ménth) (Day) Maiden Name Birth-place Name of Father Cause of Death-—Primary ( _ = Da lace of Burial Qate se l'uneral Service at Jte-n nee BPM: lime of Service Date of Interment yp 2/7 a COft a4 a Aten now His Birth-place ae. ile. Maiden Name ofMother Fi c - Laff f .... Days Married Occupation . Her Birth-place. —@: ‘Cc, Secondary i ae —_ Residence Cemetery Total to date. yet. featadrdt Color or Race La Lot No. Grave No. Section Put in the Diagram one mark like ‘/ | for every Grave in it. And mark: Burial with double dagger thus : Designate site of monument thus: [ } Casket or Coffin No No. NagF 4 Size b/ G Made Lining and Pillow Set No. Handles Plate Outside Box or Vault T+ — sural Suit Candles Gloves by Bearers or Porters Hearse t Annr.0~_ ect Removal Automobiles Newspaper Notices | Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to A-1%: 33 | | | | (SSUED BY DORNTEE CASKET CO.. BOSTON, MAGS., 1016 & RECORD AND BILL OF ITEMS Yearly No. Residence Place of Death i) — Date of Birth l (Year) (Meath) i932, JO (Year) (Month) Date of Death Maiden Name . Birth-place Name of Father Maiden Name of Mother » of Death Primary ertifying Physician Place of Burial Rathirnt wel Funeral Service at nn eardernce 2 Time of Service 4 q-7 aces Date of Interment Mth Casket or Coffin No Size Made by Lining and Pillow Set No Handles Plate j Outside Box or Vault oy Surial Suit ; “lippers 'mbalming Washing and Dressing laving rvices Use of Chairs Cuurch Charges Cemetery Charges Fiewen Floral door nfenag DR. FOR THE FUNERAL OF Aang La fp? PALL : q A» €. Wife or Widow of (Day é) Years . Sex arm 4O Age 4 Months 4 (Day) Single } Days . Married Occupation Lonarys QR His Birth-place Her Birth-place Secondary Residence Cemetery ZAC Lot No Grave No Section Candles Gloves 76 pr Bearers or Porters Hearse H efe 2Uru ce J Removal Automobiles New spaper Notices 4 Oo O 9 50 lransportation Charges Officiating ¢ lergyman Amount of Bill Goods Orde red by 4 OO | Bill Charged to meray? ISGUED BY DORNTEE CASKET CO. BOSTON. MASS. 10'6 Tota/ to date Color or Race urk ar Putin the Diagr ery Grave in it am one mark hike this And mark this nuuble dagger thus eee a 176 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Total to date... Yearly No. cet E IN LORIE Yearly No. fhm Wire Lan cfheridh Place of Death Yo igzeo (Year) (Meath) 193 2 sO (Year) (Month) Date of Birth Date of Death Maiden Name Birth-place Cake usta Name of Father Maiden Name of Mother Cause of Death— Primary Certifying Physician Qa kens po _ jis Aik se A0- 6-32 4O- th-F2 Place of Bur ial luneral Service at af lime of Service Date of Interment Casket or Coffin No g Size OKs Made by Ir Ri Lining and Pillow Set No.. ats Handles Plate Outside Box or Vault ? ieee. sen burial Suit Shippers Eembalming L Washing and Dressing FOR THE FUNERAL OF , J 4 ne if dt a oy Wife or Widow of i ee Sex 44 Age Months Days (Married 4 Occupation . Pewee His Birth-place Her Birth-place Secondary Residence Cemetery Lot No. rave No. L Section 7 Candles OO} Gloves ‘i. re preneen Bearers or Porters < , Hearse toys... RALAS. 2 Kemoval Automobiles Newspaper Notices } Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by/tha Mhawe, choke Bil Gharged to Fike pk. rr Lf Single as | for every Grave in it. Burial with double dagger thus Ya Ay Color or Race Put in the Diagram one mark like And mark Designate site of monument thus: ie r 1 \so | | | | } ! 1} _~ i ISSUED BY DORNTER CASKET CO.. BOBTON, MASS., 1916 {| | FOR THE FUNERAL OF cat Residence Place of Death Date of Birth Rey . ae. -; ee 193 a— J/® 30 (Year) (Month) Wife or Widow of ¥ 7 Years Sex Date of Death 2 Age 2 Months ¢ Single é (Day) Maiden Name re Ley Vekeg ufy “lon. Birth-place la) aR Ria Ce a YN. e, Name of Father RK ober ‘a c ina Owe His Birth-place Maiden Name of Mother fa tt40% 2 eu fv’a rr M4 Her Birth-place Le) ro. ae ( Married Occupatic on Cause of Death— Primary Secondary WS Place of Burial GUase aur e 6 o Funeral-Service at Faned- ps Ske iP Time of Service /¢@ — Jj— ae Date of Interment tH —f, Be Certifying Physician BA. WI plc d | 1 Hesidaiinn Cemetery Lot No. a pris Section 42 — We PK Size Made by Q2.O.'| Candles Gloves Bearers or Porters Hearse i We NAPA LA’ Lining and Pillow Set No Handies Plate Removal Outside Box or Vault Automobiles Burial Suit Newspaper Notices Slippers "embalming \ ashing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman Cemetery Charges Amount of Bill Music Goods Ordered by Flowers Bill Charged to oe Sao comme 1 i) et. yl | Grave No | - 1 lor ey Burial Le Tota/ te date Color or Race Pat in the Diagram one mark like this And mark this | with double dagger thus ument thus { ] ry Grave init ignate site of mor nasmen sae ISSUED BY CORPNTER CABKET CO., BOSTON 178 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF J keen a Lemzmnelt~ RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Tota! to date. Yearly No. Yearly No. Tota/ to date sane ne cekmeamret peace ree } { | { ; ipl # 1) “ Oi a s. : Sit UY, oe Bee a Evalc a — lS i clade Golo C Wife or Widow ot Ls Fi: A Pada + ew) t Residence cn Ci « CR r re ~~ Place of Death ‘ (etre Cac! : $3 me Date of Birth 13°8 | a ' If (Year) (Month) (Day) Date of Death” . 19.32 fia 48 (Year) (Month) (Dey) Maiden Name Birth-place Name of Father TT: wf. OL koaorn— Maiden Name of Mother Ete altel Sfftern Cause of Death— Primary Certifying Physician Place of Burial Ca fee ook a penned Aiesb-. ae LST nm luneral Se. vice lime of Service Date of Interment 4) — es eg fh < Sp aia ; 3 dan~ ae carl vs s - fo Cavket or Coffin No... 4 yA ; rf Siz Made by (Iyrleter f ls Lining and Pillow Set No.. Handles l'se of Chairs re Charges 3.Years (Sex... 7. Ages. 7Q.-.Months ¢ Single J GDays | Married Occupation .. His Birth-place Mla Gasx Lb Her Birth-place Secondary Residence Cemetery Lot No. Put in the Diagram one mark like | Grave No. £ - Section Candles cos fur Bearers or Porters * Hearse iX Aor. Cid Removal KS mr C Og Cathe Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to Color or Race | for every Grave in it. Burial with double dagger thus : Designate site of monument thus os { 7 A om ISSUED BY DORNTE™ CASKET CO.. BOSTON, MASS. Residence Place of Death — 104-0 Date of Birth... l 3a j deze / Se (Day) (Year) ( Date of Death 19 3Z .. ‘ a 7 (Year) (Month) on Maiden Name Birth-place alter Cxue- an. Co we Name of ~~ Ut J al Le VA z Ler eo Maiden Name of Mother ZF a4 7 ‘lhe LIL ( Certifying Physician Place of Burial He tu ya rte ana Funeral Service at tf x Tf 7,74 Date of Interment . ie fs : 2 Cause of Death— Primary Time of Service Casket or Coffin No. 7 . Size é, 4 ‘ Made by Lining and Pillow Set No. Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music... Flowers Wile or Widow of Vertes : Connor, ‘ Years Sex ae | “2 Months 4 Single { Days | Married — His Birth-plae 2#@<+. Co Her Birth-place = . Secondary Residence Cemetery Lot No. Grave No Section Candles Gloves <— Bearers or Porters Hearse to A Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to f Color or Race 1. ar | ] | ISBUEO BY OORNTEE CASKET CO.. BOSTON MASS 'e'8 Seana amar ae oe 180 RECORD AND BILL OF ITEMS Yearly No. JAA oi &24 1a fote: ert > Residence Place of Death fia £Z o<<* Le FOR THE FUNERAL OF Wife or Widow of. Total to date... Date of Birth 1g g/ Go~t 7© 3/4. Years Sex Color or Race (Year) (Month) (Day) Date of Death 19 22 42 3aQ Age & Months ¢ Single (Year) (Month) (Day) : Maiden Name Days Married Birth-place Ae Occupation ... Name of Father His Birth-place Maiden Name of Mother. Her Birth-place Cause of Death— Primar Secondary Certifying Physician Residence Place of Burial Cemetery Funeral Service at dake. Lot No. Put in the Diagram one mark like 1!) me . - ! | for every Grave in it. And mark é/s lime of Service 1) FR/VA. Lo AnD 3 Grave No. Burial with double dagger thus : : Date of Interment Section i i ee [ esignate 8! e ol monumen nus: s SS — — Hi a on ee eee F " | Casket or Coffin No. Candles |. | | Size Made by Gloves ....4 Lining and Pillow Set No Bearers or Porters | Hand i | Hearse to lense a> As 2 | | j | \| | Removal | ut t I Automobiles | | | | | i | Newspaper Notices . | | ] 4 f 3 | 20 | | | i | | | | | F | Tra isportation Charges | ; . . | | Officiating Clergyman ; urge | Amount of Bill 3S £ e | | | Goods Ordered by | | Bill Charged to | DR Cr. | i va rrr | a mpeg —hegrsee ~— ® | | | } j ’ ' i | | | ; i ' — i cs } | — | ISSUED BY DORNTEE CABKET CO., BOSTON, MAGE., 18018 Yearly No. dasina, Chalk. Meer Tu 2.0.3... Stacklamn AL— Residence Place of Death Date of Birth Res 197 (Year) 19.33 (Year) Date of Death Maiden Name Birth-place NC, Name of Father. £2 oot Bo Lon. Maiden Name of Mother Canaleine De tintin ~ Her Birth-place Cause of Death— Primary Certifying Physician Place of Burial Cotennl 5 Funeral Service at An. P ag ee oe’ 5S. Cx Rte No ' 3p-?-- s- Time of Service Date of Interment Casket or Coffin No. Gps— Cock 4. Made by C # -B Size G/3 Lining and Pillow Set No Handles Plate Outside Box or Vault RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Wife or Widow of - 24 f 3S (Mosah (Day) Years af... Le Age 4 FT Months « | 22 Days Occupation His Birth-place Secondary Residence —— bane, Cemetery OnS Hf, Mi Le 47F7—-°3 4? Grave No Section Candles Z a¢ O° Gloves Bearers or Porters Hearse tw snr aa Removal Automobiles Burial Suit bilan Apt 4 i206 181 Tota/ to date Color or Race /3 iVWe 266 20 CR. Slippers Newspaper Notices Embalming oo 45 |0C2 Washing and Dressing Shaving Services Use of Chairs Transportation Charge: Church Charges Officiating Clergyman Cemetery Charges Amount of Bill Music Goods Ordered by Flowers Bill Charged to DR. ae "T_ loaad | | Merlo ~ f/f fi. | | | } | } | : { bole | = | seamen ame ET ISSUED BY CORNTER CASKET CO.. BOSTON MASE tere 182 RECORD AND BILL OF ITEMS Total to date... Yearly No. FOR THE FUNERAL OF PR heaia ki Aacgppaceg Lietien pe. ‘ { F Residence Lf ‘ 4 Place of Death. .....4::¢..4.%..4%.8 Wife or Widow of... ‘Dp: ¢ (77 4 ‘ . a Date of Birth l a €35\ - 7 7. Years Sex Color or Race (Year) (Month) (Dey) , Date of Death 192. / AO Age Z— Months Single (Year) (Month) (Dey) Maiden Name Af Days Married r Birth-place Me LAdts Occupation ........ Name of Father. /~-4 cf ¢ F . ~ His Birth-place Ped cs Maiden Name of Mother..//7 /+-© ¢ C-€ se f Her Birth-place 4, va ps j fp é 7 Cause of Death—Primary ~ Secondary... es Certifying Physician Residence Place of Burial cf a Cemetery .. l'uneral Service at Lot No. | Put in the Diagram one mark like thi silt aaitas / f ; f~ Cee No. A | for every Grave in it. And mark ¢/ lime of Service ' / Burial with double dagger thus : { Date of Interment Section sadist seca: Designate site of monument thus: [ j 4.’ Casket or Coffin No. BF ede seas 4-4sset rah Damen | Candles {| | Size Made by Hi | Gloves i| || Lining and Pillow Set No.. I _{| Bearers or Porters | ! Handle } | Hearse to | ite | | Removal ieee Outside Box or Vaul | | Automobiles ... ................. i | bur Suit | ers i Newspaper Notices min ) " , hanno | - £ \ ’ i yy ul | pe inches Fe. | Malo Bit ) | | fAAL A Mh C¢ wert f is | a Q pase te e of Chairs } Pi ston Charges Church Charges Cemetery Charges Music ia Flowers Officiating Clergymar rt yb iS e Amount of Bill Goods Ordered by Tt co , | Bill Charged to DR. Ky [0% plex hae LO ‘fg Lh Y 183 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date Jit bf GE. Cg -o* tL on x ‘ , . c Residence 4 es } - Place of Death Lhd! oe \ Wits eo Widew of eae—~ 4 f hes Sagal os Years Sex { Color or Race Date of Death 1933 aX i Age 4 Months ¢ Single Maiden Name { / Days Sieted Birth-place LT pe ttt eee or Occupation Name of Father [Aidan uf 2 +4 “*y_-His Birth-place = f ic Maiden Name of Motherigcc tw = Y2~ t ¥ Her Birth-place Cause of Death— Primary - Secondary Certifying Physician det / | 2°) “-tLiw SiLSffasidence Place of Burial eet eet Coens Funerai Service at 2/ $ 2 J) fot No. : RTE Ne ee aT ae Time of Service J A IP; ? _ Crave No . es ~ Grave : hm k Date of Interment a oC ‘ Section a cI ae Casket or Coffin No. > fi de 3 e Candles Size gL Lz Made by Gloves Lining and Pillow Set No. Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault. “O** J Automobiles Burial Suit K Sant Slippers Newspaper Notices Embalming es Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman roa ts Cemetery Charges Amount of Bill pil iiithhocst seapsecn Music Goods Ordered by Flowers Bill Charged to DR. CR. | > j i j a | - Lp . { ff — ISSUED BY DORNTEE CASKET CO., BOSTON. MASS 1816 184 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Total to date... Yearly No. FOR THE FUNERAL OF Total to date Residence ; wi op. ; wae (Lire im Residence . Wed 4 Lhevft WH . ‘if i 1 had itil adres tdci f . ] Place of Death 4 Wf Wife or Widow of Ae Lt ‘ Place of Death (Cdk Aeule 2)" Wite-or Widow of ates cel A A vats y j ; - > t Date of Birth :. I Years Sex... FEM Color or Race Date of Birth 18 3/ IY SO . ‘ 8 / y ae Vbcce a & . ER : ears Oex , 2 “ | gl oO ace, (Year) (Meath) (Day) (Year (Mesa) (Day Date of Death 19.33 2 = 3 Ag Month Sing] ae Date of Deatl 19 3. o p (Year) (Month) (Day) Be mena ’ rr a — — 22 : wy: / fi Age § 2— Months 1 Single , , tlé Days Married | 4 Sat eas oust Maiden Name Lanse Piacue Mer ) 5 3/ in ace hiudau } ? ‘ ry) i \ 4 € - Occupation . : Satins Birth-place ‘ Ko A€ Occupation ? 1 / ; Name of Father = fecal iis Birth-place Fosscatitnssense srasaabens Name of Father AiLu ; Mey . His Birth-place A é A : Maiden Nam other £ faret Jane —~Her Birth-place oe seeseie Maiden Name of Mother AA LQ Arcseewy,s _Her Birth-placCLELE @ AE Cause of Death--Primary Secondary. : ri Cause of Death—Primary ce h . Secondary 2 ene s s 4 4 Secondary Certifying Physician fez F- 7 1 Sea Residence sesame Certifying Physician by Lh A eho bon Residence Place of Burial aa peo Cemetery . en Place of Burial Balwood Chigehy feathery hak Hf Mtl c G ack, Lot No. Grave No. Yearly No. : FOR THE FUNERAL OF l _/ 2 os Maiden Name Bir th-place ‘) lee a : Funeral Service at Lot No. Put in the Diagram one mark like t! Funeral Service at | for every Grave in it. And mark / Burial with double dagger thus : # Time of Service lime of Service Grave No. . a <a Bi - 5 Date of Interment AI I Section. Designate site of monument thus: ~ Date of Interment Leh, im 3 Section = = = vo - = = A 4. ale ia etal Casket or Coffin No. | nee | Candles ; |}. Foss Caskgt or Coffin No.y¥/ : : be fetyel/ | {Jo QA2 Candles 3i Made by i | Gloves | sd 9 1 >by sloves 5 ze i} > j . ~ : | Bearers or Porters i Lining and Pillpw Sét No. Bearers or Porters Handles i Hearse to i | Handles LHéarse to Removal Lining and Pillow Set No... Plate Removal ‘: Plate Outside Box or Vault i {| Automobiles “Hl. i Outside Box or Vault Automobiles Ea a¢ Mee . : Burial Suit Burial Suit Newspaper Notices Slippers Newspaper Notice Re “HIP y ers Embalming | : ‘ ai joke “d Embalming Washing and Dressing Shaving Services . Transportation Charges | Transportation Charges ; : Use of Cha'-s Officiating Clergyman Officiating Clergyman ; Chyrch Charges 7 | Amount of Bill Cemetery Charges Amount of Bill | Goods Ordered by | Music Goods Ordered by Bill Charged t . } Mowers Bill Charged to ate. r, LtLA ee L337 My Fee f | i } i \ 'S8UEO BY DORNTER CASKET ISSUED BY DORNTER CASKET CO... BOSTON. MASS 186 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL .OF are 44h CL ~ tk : Leeunr’ pe onth) or Residence Place of Death Date of Birth Wife or Widow of. “— . 3 Years Date of Death Months ae Aev' Ages 7 Pr ear) 0 ht (Month) ae Maiden Nar Birth-place Name of Father ‘ace f eee Maiden Name of Mother.——— Her Birth- lace, Cause of Death Sec — Primary a - _— LL Certifying Physician Place of Burial Sex/ ZA lle’ Single L Days Married e; QD es ae 11g OccupationA” Asal, sea the His Birth-place AC < AC. luneral Service at lime of Service Date of Interment Section Lot No. wi Grave No. || Casket or Cofhin No. Candles Size ; Made by Gloves Lining and Pillow Set No.. Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault Automobiles burial Suit Newspaper Notices Transportation Charges Officiating Clergyyfan Amount of Bill Goods Ordered by Bill Charged to ee ee - Total to date... 4 Color yp. ‘ oe c ate = Put in the Diagram one mark lik: And mark Burial with double dagger thus : | for every Grave in it. Designate site of monument thus: CJ fe RECORD AND BILL OF FOR THE FUNERAL OF KK ON A £4. Residence me “7 Place of De an fake Wop kot, Drrg tlm APN ife or Widow of Jate of Birth Date o — (Year) (Moot (Day S 7 Years Sex 19 33 3 26 Ages 2 (Year) (Month) toes) Months 2uitek G h &. | & Days a areaaians Yearly No. Date of Death A 4 Single & Maiden ee tata Birth-place Name of Father a Maiden Name of Mother Occupation His Birth-place Her Birth-place Secondary Cause of Death—Primary Certifying Physician Residence Place of Burial Oakivceced_ ( oo ) . Funeral Service at ¥ AM : -— . 7". Wr. Time of Service i rave No Date of Interment ist 1/33 Casket or Coffin No Size L/ 3 Lining and Pillow Set No Cemetery Lot No. Section FG to oe Made by it Gloves Bearers or Porters Os Hearse ti Froga— or Removal Candles bo. Handles Plate Outside Box or Vault A ntomobiles JX a Burial Suit Slippers Embalming Washing and Dressing Shaving Services rc ; Tr snortation } ves Use of Chairs lransportation Charge Church Charges Officiating Clergym Cemetery Charges Amount of Bill Goods Ordered by Music Bill Charged to ee Flowers DR. ITEMS Tota/ to date Color or Race atl i } 1SBUED BY DORNTEE CASKET CO. BOSTON MASE HTS NEES TST ARNIS RINE CEI CITI oe IE IIT NTE AAD IEE Si vente . te ae |} iy { | ‘pe Be BE ; ms nti F Ai ' 1 ; eR Ne 188 RECORD AND BILL OF. ITEMS Al. OF / Ld Total to date. Yearly No. FOR, THE F ays d. Ne be. Residence CAM ULL La oz bee f th K é- v dz { N ; £ Place of Death LAVIN UA NLA bd, \ bx, icf . A, Wite/or Widow of Date of Birth 142 , / Ma, Ch d 4 s Years Sex Color er Race (Year) (Magoth) (Day) a : Date of Death 1922 i th, ‘ko Months 4 Single YA J LOK (Year) “ie path) (Dey) ‘ c Maiden Name ’ ? ...... Days Married 7 ci ; “ ? Birth-place Sati J th : 5 | - OSfE ME? Name of Father Y wad, Gite, eg , Ge cupation . 7 os Ff t A iHis Birth-place Greece oO AC oni fi = e_ ¢ Fick Ap Birth-place Lf. Ye Me 4 ve v co ee Maiden Name of Mother Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial / Cemetery j d . / c J ineral Service at ’ fi Lot No. | Put in the Diagram one mark lik: rl adi ica Nia. : / | for every Grave in it. And mar} me . » ~ ’ . . 7 3 f “ ) V Burial with double dagger thus : Date of Interment er] : Section : : , " Designate site of monument thus e ] | fi 7 ee os a ase os =7 A pie 1 aflin SN oO ‘ “ f a Candles | | | Mad Gloves | | . er , | ind low Set No ~ || | Bearers or Porters | | | we”, £ a. Hand j Hearse ¥@ 444.4 TS baw | Kemoval | | | B r Vault | Automobiles | | | | | | | | | | ; | | Newspaper Notices | i I | i| | 1 1 \| | } i i | | i} | ! | | I] } | {| | | | .~ . . » of Chairs lransportation Charges | | hureli Charges Officiating Clergyman | fe in iL?) metery Charge . Amount of Bill Musi | | Goods Ordered by | - j y blowers ) a | Bill Charged to | | sessions cman aemenmcane ae shleneunnnianienecnenennnsnes nee : | DR. } CR. oe rR AARON 2 NNER a a SNE i t da 4 fn es - 7 2- } 3H fed ea <& f | ed \ 424 (4 70 A ae | | | a 1S8UEO BY DORNTER CASKET CO.. BOBTON, MASS, 1016 189 RECORD AND BILL OF FOR THE FUNERAL OF arch, ig Sloan Residence 2 ‘ 4 ic” > y 7, ITEMS Yearly No. Tota/ to date Wite or Widow of ke). YX ° dlon ~, . Place of Death Date of Kirth 1849 ten LL 2 33 Years [Ses or Race Date of Death 19.33 “aan & hin a a nes 3 Maiden Nar oe Etlug a Days Married Birth-place Cle (A.~ae (a At, 4 Occupation Name of Father Mamusl 4o LLL: “~s His Birth-place A. rs Maiden Name of Mother ‘L4a : nel Bhiparnde “A Ner Birth-place Af: r fi Cause of Death Primary Secondary Certifying Physician Residence Place of Burial Cake. oom Cemetery Funeral Service at Wr0acL me = Lot No Sad ~ oe : =" a dec ae /O TF “Mf oS o i Grave No J Lon mark Time of Service Date of Interment * Sandi ms 14 celia saint snieaaiiabianas sani Casket or Coffin No Ar “3 Candles Size = Made by Jnop / oS CO Gloves 6 ye / 5 oe Lining and Pillow Set No Reaunave or Porters Handles Hearse & Aatnarx rs oa oc Plate Removal Outside Rec or Vault Antomobiles Burial Suit Slippers Newspaper Notices i:mbalming 24 OO Vashing and Dressing Shaving ervices Use of Chairs Transportation Charg. hurch Charges Officiating Clergyvmar emetery Charges x 9 O)} Amountof Bill lusic Goods Ordered bs Flowers Bill Charged to DR. CR aiauiei al aan sei an romana see ol S/4/36 Peek par fol. | / } | PERE | salman —_— 1S9OUEO BY CORNTER CASKE! CO. BOSTON MASE Tele saree RIG scathancnne sata ee oe meg Sate ye ene ee 190 RECORD AND BILL OF ITEMS Yearly No. FOR THE FLSJERAL or Total to date... fe C271 2144- Residence Place of Death Wife or Widow of Date of Birth (Tear) Date of Death 194 “s ge Months 4 Single e- E SG Day Married LEV FF-2>>-~ a Maiden Name Birth-place Occupation , Name of Father Yet is é¢ ‘/ His Birth-place Maiden Name a. le (Ad Yee. a of Lal Her Birth-place Cause of Death— Primary Secondary Certifying Physician \ Residence Place of Burial f Cemetery fa “| = ijets...! f-~ Years Sex 4/1 Se vee pe: Le Lot No. } uneral Service at e of Service. 7/3 ; oe Ae bos Grave No. « of Interment : . j Section ffin No, | .| Candles Gloves ct Bearers or Porters Hearse . Z i Removal Automobiles Newspaper Notices ming w and Dressing Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to Color or Race li” Put in the Diagram one mark |ih | for every Grave in it. And mark Burial with double dagger thus Designate site of monument thus Cy AIGA $--$-—-+ | RECORD a BILL OF ITEMS Yearly No. Ve oq (Se Residence ffi He Mv. Place of Death / Ne Ale, A, ac Date of Birth l \ sn (Year (Meath) Date of Death 1934 cteer) (Month) Maiden Name Birth-place (2 5 fe“ Cc Name of Father Maiden Name of Mother. ie ae sye=— Cause of Death—Primary / , sc " ahel ' 2° il Certifying Physician > T MAMMAL VWAHbHAL, Place of Burial 1 of Funeral Service at Time of Service Date of Interment Casket or Coffin No -+ Size Made by lining and Pillow Set No. Handles iate yutside Box or Vault surial Suit 2 ippers ‘ nbalming UY LK ashing and Dressihg Shaving Services se of Chairs Church Charges emetery Charges VAUSIC i “owers DR. 1S8UED BY DORNTES CASKET CO.. BOBTON MASE Then Ch ON Hig Birth-place ) THE, FUNERAL OF Tota/ to date AP? , hel Meta itis AL \) ife or Widow of d » i i sy fd Years | Sex Pod — Months 4 Singie ‘ Color or Race —“ 7 3 , At, + ba Days Married ¢f ** PALMA Vth T Cgha Her Birth-place -“?* Occupation, Secondary : oon Residence i? @44 Cemetery Lot No. > ' tin the tagram one mark like this Grave No section Candles Gloves Bearers or Porters™ Hearse to Lec Removal Antomobiles Transportation Charge Officiating Clergymar Amount of Bill Goods Ordered By Bill Charged td - 7% % CR, ——EEe Tee SS ETS ORR SERENE AA RRNA A AE AR elt detec A <P Le WIZZ 5 Smilies, . ~*~ ‘(022th te tc et ‘ere ene Geeta ance ee : — AND BILL OF ITEMS FOR THE eto OF Total to date. Residence Place of Death f- PA tthyhlers Wife or Widow of & . Ty: ree Date of Birth is LL 2/ f é/ Years Sex - f Color or Race C (Year) (Year) (Dey) Maiden Name 7 Birth-place Cabel Occupation Name of Father LL7°™ is Birth-place tadaugac.Ce- xe. Maiden Name of Moire HOP er Birth-place Lae vy ~ cause of Death— Primary Secondary ss ertifying Physician L e a. cies Place of Burial aL pg ee Cemetery Lot No. | Put in the Diagram one mark |ik | for every Grave in it. And mar} Burial with double dagger thus : ‘ (Dey | Date of Death 19.33 yy “ J. Months ¢ Single Ly f Days Married J Funeral Service at lime of Service - i — SJ Grave No. Date of Interment Section Designate site of monument thus | ] Casket or Coffin No aie. Candles Size by ~~ Made b CHA Pu Oo OD Gloves o Lining and Pillow Set No.. Bearers or Porters Hearse to rerge tac B rion Removal | Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to 2 NE HO | faxes fof 3 RECORD AND BILL OF ITEMS No. 4 Yearly (| FOR THE FUNERSL OF Tota! to Jate ty kt C2 ee kt c He —— ( Mi Residence AR L ys (he che Fe ge . , O ~ L4o , , 4 ; ’ oe : “- ie Place of Death . . KR - Wifey Widow aft Ay, Rea Wwe Ava d ) deel i Date of Birth : 4 KO 4 : oiC in , ont (t | 2 Years ( Sex JLLALAS sh (Year ad ~) ( Date of Death | 3 , 9g | } ‘ ney onths < (Peer) ‘dom Name Mare sald . | Maiden Nam ote j {fw Days Married Birth-place tg . , Occupation OMe 7 Aa ee } Color or Race | ’ Single ‘ a - Name of Father ’ : His Birth-place Aleze et. 24 ddd Maiden Name of Mother Le TCO Mer Birth-place CkLé. Cause of Death— Primary ee Certifying Physician ’ Bi ? / { Place of Burial a i Cemetery Funeral Service « Aeneas fot No. ~~ Time of Service e . ‘ : ” “Grave No Date of Interment Section = usket or Coffin No Made by Lining and Pillow Set No ndles Vict utside Box or Vault turial Suit ippers Embalming shing and Dressing iving iia of Chairs urch Charges Cemetery Charges 198UEO BY DORNTEE CASKET CO... BOBTON wmase tee RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Le Yearly No. FOR THE FUNERAL OF Total to date. Yearly No. Auuce FOR THE FUNERAL OF Tota! to date LE C2 te Cae at (eectey. aa D gclser cade MAb yc ‘ : ea ec Irrcll af SOord fh ae fits Seo > fC F132 a: . a hain Oty y : | a Le Place of Death Wife or Widow of. Jaa. Core Ze. Weiner, Place of Death the f HK Vv LF sep C he Wite-on Widow of HY _A/ C/E , Date of Birth 1gS¢7 Bs / / SS 6 Years “| Sex 7 Color or Race Date of Birth Sef Bs <7, J /S Vous | Sau te ra obe ‘ ope Ran (Year) path) (Day) a _ War , 4 Date of Death 19-3. od 4.3 Age Months 4 Single le/ Date of Doom May be ¥ § Months 5 Single ’ Bk “ee (Year) (Month) (Dey) = : : (Day) / | Maiden Name ' A ohe Days Married | #- Maiden Name : <2 A ‘ Days Married ¢f ed ge Oa eS ee ean 7 ae | Mee | | ot Se, Se nes al cs rae. Maange nie Sik ® ne Name of F: thes ; a His Birth place Name of | ather Maiden Name of Mother i cee Pus Le Ltt4+ee a. ) A Birth-place “¢ or Maiden Name of Mothe > 4 4 x fia Welstivinles tv Cause of Death— Primary Cause of Death— Primary Secondary i A Certifying Physician [Qa_ KR "ae in E Capre2—tiesidence Certifying Physician. * Place of Burial C tA fer al oil Cemetery ‘ Place of Burial . Funeral Service at AE V Lot No, Put in the Diagram one mark | ik. Funeral Service at f/ a 2 coe = 2J ee , ee | for every Grave in it. And mark ns \ —. ere . Burial with double dagger thus Time i of Service lime of Service ad Section | un Date of Interment Pike ; . : : Date of Interment Designate site of monument thus E J aes soo ned ns pueene: Casket or Coflin No Candles Casket f- y rs ) a } ; , 7 va é% 7)|| Gloves ; Size" Made by r Coffin No} s } y Size Made by i ind Pillow Set No Bearers or Porters Linine and Pillow Set No gf 2 i Hearse @ ~ £2144 ced F Hand! I thin Hariclle Plate Removal | Plat: } 4 | . > ; = tlew Outside Box or Vau Automobiles | Outside Box or Vault utomobil Gurial Suit | Buria! Suit Slippers Newspaper Notices Slipp« honbalming | Embalining Washing and Dressi: | | Washing and Dressing Shaving Shavin Servi Transportation Charges | Use of Chairs Officiating Clergyman Church Charges Amount of Bill | os Cemetery Charges Goods Ordered by . | Music Bill Charged to | Flowe: - = Be mame cv cea cn } aah b by ba, ch nob rs ) ? y, { \/ HI | { ve Be td ere 198UED BY DORNTEE CASKET CO., BOSTON, MABE.. 1810 leSUEO BY DORNTEE CASKET CO, BOSTON MASE! 196 RECORD AND BiLt OF ITEMS FOR THE FUNERAL OF 2 Pn Ee CMeuS. bn Ni LOE Dd lew CL Wife or, Widow o, Date of Birth 18S OCF Lf f 76 Years Sex Make (Yea onth) (Day Date of Death 1923. ; oy Age il Months 9 Single (Year) ( ) Marri we RO, On. 4 Zi Oc lft a Name of Father iy daurs si G His tee HE < Maiden Name of Mothér tL Clhisofel to Birth-place ht Secondary... San c fe O) Certifying Physician ae $ Mn ees tesidence 0&2 ob x = js Place of Burial O Q haood Lex Cemetery CL, — tot No. / ——Grave No. Yearly No. Total to date... Residence Place of Death Color or Race Maiden Name Birth-place Cause of Death— Primary funeral Service at j0.30 A]. Meudd, Mae * ge 1G 3 r Section ime of Service lime of Service Burial with double dagger thus Date of Interment sket or Coffin No. ..| Candles // Sing 6 / tb Made by L4 | : $ Gloves * Bearers or Porters Hearse en Removal Lining and Pillow Set No. ~ \ x Outside Box or Vault Qu \ ARAN, Automobiles \t Be ao} Slippers Newspaper Notices lembalming Washing and Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to Put in the Diagram one mark ike | b | for every Grave in it. And mari P Designate site of monument thus: T <j 1} | fie le a 'S8UED BY DORNTEE CASKET CO.. BOSTON, MASS... 1918 RECORD AND BILL oF ITEMS Yearly No. Residence.. Place of Death Date of Hirth 17 OF / (Year) (Month) Date of Death 19 33 (Year) (Month) Maiden ‘Name Birth-place [Aye Con Name of Father (rtats Maiden Name of Mother Certifying Physician Cause of Death—Primar, Ay . / Goo he. Place of Burial Funeral Service at es: 2 oe ore - ce Leh BF Ars Aer Birth-place 71 - TaeLh ae FOR THE FUNERAL OF Atte. [ Z g Years Sex 7 Months 4 Single &* —s 27 sii (Day) 5 4 Days . Married Occupation His Birth-place MH = Cl. / Secondary Residencs Cemetery Lot No. Time of Service FF on P “i. ¥ PGi — Grave No Date of Interment Casket or Coffin No. Size Made by Lining and Pillow Set No. Handles Plat Outside Box or Vault Burial Suit Slippers Embalming shing and Dressing of Chairs iurch Charges vemetery Charges Section Candle Glove Bearers or Porters Removal Automobiles ly Ot Amount of Goods Ordere Bill Cha ‘ S3-7 /33 if 2«., = ‘ Rhy L) wai iis Ver as Nilehewg Lethe Melts Cy al 7 Witeorthidow-ot- Mlle! hey Crh Wig OVA Farn. faa 4 f Tota/ to date Red Ke c? "e | Color or Race , | posse Sa: ISSUED BY DORN EE CABKET CO.. BOBTON Mase 1e'e 198 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS . bj E UN oO o a/ to date Yearly No. FOR THE FUNERAL OF a . ,_A H3 7 Z ~ ii e e. — Z 7 , r : ae WAp I "7 "a ¢ @¢-¢ Lf ya Vg ao ort nnethe..... so fame Aeu0s 2 le The, . —c* Ley ’ C Cseeety —e Naneens SET Residence / VO}. } Ali ‘ ly ax 106i 4 rr - A Kodi db Residence - " Wife or Widow of. Place of Death Place of Death Date of Birth l f Years Sex Color or Rac« Date of Birth l (Year) (M (¥ohsy Ponth) (Dey I Date of Death 19 Age Months 4 Single Date of Death 19 3 Years Year (Year) ‘ahi ge Months 4 Single (Year) (Month) Days Married Maiden Name | Days | Married & Cory Wife or Widow of Sex \laiden Name Occupation Birth-place t L : : Oveupation Birth-place Name of Father Name of Father His Birth-place E Y j i i i ‘ His Birth-place Maiden Name of Mother Her Birth-place Maiden Name of Mother H B ; er Birth-place : th-plac Cause of Death— Primary Secondary Cause of Death— Primary Certifying Physician Residence Certifying Physician . Place of Burial Cemetery Place of Burial f : Cemete Lot No. Put in the Diagram one mark |) Funeral Service at : {ot N Grave No. / f for every Grave in it. And mark Burial with double dagger thus Funeral Service at oo Time of Service Section Date of Interment Designate site of monument thus: f 7 Date of Interment eg Candles Casket or Coffin No” Casket or Coflin No. | 4 ide by Gloves é | Size Made by Lining and Pillow Set No Bearers or Porters Hearse to } Handle Removal ; | | Plate Automobiles Outside Box or Vault Burial! Suit Newspaper Notices Slipp« Embalining Washing and Dressing Shavit Servic rransportation Charges i Use of Chairs Officiating Clergyma 7 fheiating Clergyman — Church Charges Amount of Bill : Pai e e Cemetery Charges Goods Ordered by £ ae Lf We. ! Mie : | Music Bill Charged to 7: tt Ue Flowers |——_—— iw 19S8UED BY DORNTER CASKET CO. /OBTON, MABS.. 1016 ISSUED BY DORNTEE CasKeT co ees BOSTON, MASS... 1918 200 RECORD AND BILL OF ITEMS RECORD AND BILL oF ITEMS Yearly No. “ _’ FOR Be FUNERAL OF Total to date ; Yearly No. FOR THE FUNERAL OF Total to date 4 : j 7 gene { f, , Z re ¥ OL Ned [aud % (ZOLA Hat hterce is Buel C Fs. oO Pron ce Ker yerert [Mitt : Residence 0 Nesf Cech ave. Gtluyrlt, Ace Revidencdf Ads, Ads, hi » if) AAMAAS f LA A Aha, i idow of Place of Death Lak Ch « . 2 Wife or Widow of Place of — ples ¢ 4 4 Wi = “ah low 0 -— oy a 70 - i. rT Gy ay y 9 i Date of Birth 49) Years Sex | ror Race Ofor or Race (Year ' } a : 9 ) | Date of Death 19. 3 > «| J Months 4 Single, a Date of Death 19 Bd % Day ‘e % Months 5 Single = * writ (Year) (Month) Ut F- ai YY : (aT kZ Ad f ‘tan Name 2 D Miveis Maiden Name i {{4 ii * I Days . Married Be ee, Maiden ‘Nam gy hs ays arried . : 4 / o , bes oe al / fof , 2 Occupation Yon 4 ABD Birth-place Liles the A C. ecupation 7 02644. ~ (Qe ft Cn a0 ) Birth-place hk Fes d. i : k te , OP A I ‘i : é ; ni r PRS sy yr Lo is Birth-place Of OLL4Y Che oy dasian of Vilhies a tvache Dirthpluc Cherrelle Ae Name of Father il ( His Birth-place + ae a cr Nar : : ios so : Maiden Name ot Mothe r 4 ug hi : f Her Biytb-place ff C4 E 1 ULL i (e- Maiden Name of Mother Cee Culh: XK Her Birth-place vu ne SS AC é£ he aiae INE Cc I P Z a + oe . : a .; “he Cause of Death— Primary Aleorh . TA (Lye. ry Mee Ler dhece be , thela Mask G- nccah Bt & Cause of Death: imary SecShe ary ; : tie «te. Certifying Physician Residence or qt - Certifying Physician &.a. Ke Vk ty Se ae lope 7 LACE Place of Burial fl é ie Cemetery ke, Place of Burial Botwooeck / Funeral Service at F Lot No. / Put in the Diagram one mark | Funeral Service at Ye Nn. : Pe lime of Service fh Grave No. tenes fo hag a a Time of Service 1g. o-74- 33 7 : . c Section } ‘ . pan Date of Interment ee . Designate site of monument thus i 7 Date of Interment oe ree aaa ae Yasket or Coffin No. Gh J Aorna Casket or Coffin No Candles . / 4) , Sie Maule bs | Gloves | we PAK Madey Seep and Pillow Set No. Siow os Lining and Pillow Set Ne | | Bearers or Porters | Linin dneseatell ( Mie Juorv_ ake) fA 16 Hearse fo cles ‘ aaa ( eanree lo Cer+u< Ax ‘3 Co Removal - Plat« | 2 hiles a Automobiles ee, E Outside Box or Vault Ku es - Ft ‘ Burie! Suit Newspaper Notices Slippers Embalming hing and Dressing ne | | | | Scie Transportation Charges | Jse of Chairs : 5 ’ 7 { ; t j : in | Officiating Clergyman ove Church Charges Amount of Bill Be Cemetery Charges Goods Ordered by | Music Ce ee Bill Charged to | Flowers i | <ssiiestemideemeinasuauiniienainia ase ee > CASKET CO, BOSTON 'S8UED BY DORNTER CASKET Co., TON, ———- 200 RECORD AND BiLt. OF ITEMS Yearly No. Residenc diss da. { Place of De o Date of Birth 1a dv i Date of Death 19. i (Year) Pa p Maiden Name . / MLA thZ Birth-place rn Maiden Name st Mother “ / = Cause of Death./Primary Name of Father Certits Diagram Of G11) lot v4 “/ fg [ull , tt y Ath, FOR T, y FUNERAL OF ; RA Lt (tL Total to date Kev; ueret [Med : GLA W = - ¢H of ’ Ri f Years S & Steet, WY or Race J Months 4 Single > OTE , App hs | ¥*} Days cm CL LLY Occupation haf 4 ~~ AF? ta fyi bby 2 CZ His Birth-place “/ ¢ ans ger fr Her ok: plage, SP SK { Secohdary........... Residence sr Meter le NI CHOLSON FUNERAL HOME STATESVILLE NC. | | | { | ISSUED BY DORNTER CASKET CO., BOSTON, MAGS., 1018 RECORD AND BILL OF ITEMS early No. Yearly FOR THE FUNERAL OF Barelle C.° 20 ae teas 2 Residence C0 U. ¢ Lh Ce b ALE. Stleyokle Ae Place of Death Loh 9 ae? ife or Widow of , 7 Ye 1; oex Date of Birth... SFY lor or Race Months 4 Single Wile Date of Death \9 33 Tota/ to date 4 8 Days Married Birth-place ‘ : ~ ; Occupation re dae), A+. (Qe are J oy. ) a lathe; His B OShthsirMle AC Name of Father irth-pl place Maiden Name of Mother RMtec Culhy a Har Birt plac Resta th &, HW a Cause of Death— Primary Afeark Fachu VE. c, Certifying Physician é.2. Kivk dey Grency- Place of Burial Bohwoppck / , AaS kerdHtce ly ithe aud tx beak 6 ¢ ake ca Lega ea MO tte Hie ~ 3 Ie oma Casket v1 5 ‘offin No. Ge oe: _— Size (¥ ay. Made by ays / & es } SL er cs Lining and Pillow Set No. Jucread oe (tecee Jtore aL) ie eM oe Handl: Z Plate "ilseker Aeanree lm Ce+~< Fixzg JS ©o Outside Box or Vault L$ — : da Pe L Burial Suit Slippers Emba!ming r Washing and Dressing Kacy, Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers mesa a iseuEco BT DORNTEE CASKET CO... BOSTON MASS. 10 a ate ee ee eee ee ee 202 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF _ ae ley fares —— Residence alt ie = Ma. <~-<_¢ Cera Place of Death Wife or Widow Of4n040 Yel chlar eu CLCRAA ff. ClLeRe¢ Date of Birth 13 3 7 AO f ar. Years Sex 2 T (Year) (Month Date of Death 19.3.7 Ages 7.O.....Months 4 Single (Year) onth Maiden Name ti Days Married . £-— Birth-place Pacer lee, - Af: , Occupation. Breech. Name of Fr ather ae G/ i. J flrs His Birth-place X, G Maiden Name of Mother — 2tr SEDRCL Her Birth- oe... a ce, Cause of Death— Primary Secondary Cains. i PIAL EAN... Certifying Physiciz EF terrcey 2 f2 Residence Place of Burial Mi-reatlhle-c L957 Cemetery Funeral Service at 426d — Lot No. i a hice J Bre on eee 3 I Geen Date of Interment 3 a ee Section Total to date. Color or Race Put in the Diagram one mark like | for every Grave in it. And mark Burial with double dagger thus Designate site of monument thus Ci Casket or Coffin No G Ai, 4 dei. 2£0 CO. Candles Sin, 4/4 Made )\ een Gloves og? Bearers or Porters Hearse to Me fod Removal Lining and Pillow Set No Automobiles Newspaper Notices ' , a Chan. > nboalming ishing and Dressing e of Chairs | | Transportation Charges Church Charges | Officiating Clergyman ietery Charge | Amount of Bill Goods Ordered by | Bill ¢ ane od to (SBUED BY DORNTEE CASKET CO., BOSTON, MASS., 1916 RECORD AND BiLL OF ITEMS rly No. Yearly FOR THE FUNERAL OF / e ? Rs — e 4 AV Chat Ree a ( og ey a Residence ae... o- tt >». £ ) Place of Death Ay I+ 4 Wite or W t ZA, ; ife oO idow of Zit 2 Date of Birth IZDY¥6 va _, ate Oo é S 7D iis (Year) ‘ Tota/ to date —_— ~<Z ef, ern t— Sex ( rr or Race Date of Death 19.3N v4 2 a > aged (Year) ‘disecks Maiden Name . k a ar) ics led Birth-place MF i Jounete, Ds 4 ae nes oa ial Pus ee ae ee bpd € Cece eT is Birthplace - a Maiden Name of Mother > ~ Fa < Cae ft Her Ri Cause of Death— Primary Le C2 ale oe cs ‘ Certifying Physician AAZ mM. f. Ji F_ am Place of Burial 7 a Aa A i i LZ Funeral Service at - ‘2 -. ‘Tr. Time of Service. __/0..2°——— Date of Interment _% — ? Months ¢§ Single men Casket or Coffin No. Size Made by Lining and Pillow Set No Handles Plat Outside Box or Vault Buria! Suit Slippers Embaiming Washing and Dressing Sha Services Use of Chairs Church Charges Cemetery Charges Music Flows rs = coe ee sere 198UEO BY CORNTEE CcasKxet co Mase 204 RECORD AND BILL OF ITEMS Yearly No. ; — t FORT es OF L/ f / ” , / SHOVEL: Ege »NOtb het j c A Be wanes sgnas 7) O, ft, A J] —t qt: j Ai . ne j 5a ét / Place of Death. [(L-EMLUM £404 V a Wife or Widow of./ C oD pt C; 3 ¢ Date of Birth ] ~ tf ? ‘ Z (Uayy~ fl hf Age : Months (Deyy/ Rh pA. J Occupation’ é Residence y Years Sex Asonth) - ; { (hd (Month) / j 193.4 (Yeap / 7 (Kear) = , Date of Death ‘ Single Maiden Name poi Days Name of Father {' £ Birth-place a A j His Birth-place 4, , ike ; Maiden Name of Mother...’ 4 eee? ; 4 THer Birth-place - 5 Secondary...) : Ail d MA he rey 7 itestdonce Ft COLA —I fi Cause of Death — Primary Certifying Physician Place of Burial Cemetery . Lot No. | i Grave No. l‘uneral Service at lime of Service Section Date of Interment Tata! to date. Color or Race Married 4-/.4.:.i/ Put in the Diagram one mark like th | for every Grave in it. And mark ¢/ Burial with double dagger thus : + Designate site of monument thus: [ f Casket or Coflin No: Candles Size Made by Gloves ind Pillow Set No. Bearers or Rorters Lining Hearse to Removal Outside Box or | Automobiles burial Suit Slippers Newspaper Notices balming Vashing and Dressing Transportation Charges » of Chairs Officiating Clergyman... Church Charges Cemetery Charges Amount of Bill Music Goods Ordered by Bill Charged to I lowers 1@8UEO BY DORNTEE CASKET CO., BOSTON, MASES., 1010 RECORD AND BILL OF ITEMS Yearly No. Residence Place of Death : Date of Kirth // @4 (Year) (Monw) ge Date of Death 19 tA (Year) (Month) Maiden Name, Birth-place Name of Father ¢ Maiden Name of Mother Cause of Death— Primary Certifying Physician ? * Place of Burial é Funeral Service at Time of Service Date of Interment _* FOR THE FUNERAL or* Tota/ to date Watt TL, A ? % a Wife or Widow of | ‘Years { Sex Months Days Age ) ) Single : | Married Occupation “ye His Birth-place Her Birth-place Secondary Lhe unica Residence Cemetery Lot No. Grave No Section —— Casket or Coffin Noatial a4 Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charge Music ™) rowers DR. | | O¢ Candles Gloves Bearers or Porters _— Hearse to # Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to | } | 1SBUEO BY DORNTEE CASKET CO. BOSTON MAGE le'e 206 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. *roR THE FUNERAL OF Total to date... E " Yearly No. FOR THE FUNERAL OF Tota/ to date . oe hal he arn_, Fa° ‘eelrrce MPa hecfp.n awh bs MP. L Boone Residence 7 S/ sas oe ye C. o. 6 a . , ) = Place of Death ~ ip (AE fa hf. (ea thy lade Wile or Widow oi Place of Death /l4¢ — Wife or Widow ot M4 Lee Clecale-d Date of Birth / Pi 3e) bh Color or Race Date of Hirth l 8 26 Pe 2 3 r ~~ y ie Dz é ears Dex + (Year) (Moath) (Day) Residence (Month) | (Day) os Color or Race Date of Death % ape LL Age Months 4 Single Date of Death 19 3 5 2 eS ht ee ee .. ae ge 4 onths ingle 5 (Mogth) (Day) D M a (Year) (Month) (Day) } j ays arriec a Re te : ) Maiden Nam« 4 Days ( Merried 4 ore er Birth-place Maiiwille ae: f Occupation aZeaa 20s Ale Le ae -— Name of Father His Birth-place : Name of Father 4 Metirervw. x Weihugule 1s Birth-place 7 a Cc. Maidan Name of Mother Her Birth-place seserseavane Maiden Name of Mother(44>ee e« da =a Her Birth-place A <. Secondary... Cause of Death—-Primary Bea of pra — Secondary Residence . vee Certifying Physician hn Pp. PH Alia. Residence Cemetery fou: Mh Le Va iy, ms if ii } a ee Place of Burial Bake ety Cemetery Lot No. | Put in the Diagram one mark like {hi Funeral Service at PS: VOce f - PU: Le: Lot No. ‘itin the Diagram one ark itkethe Grave No. ;) rr ee ee —s : Time of Service bf thr W Grave No. c oe en it tn ath he Maiden Name Cause of Death— Primary Certifying Physician Place of Burial Funeral Service at Burial with double dagger thus : ¢ i a " ‘ BL _— [Dehn site of monument thus: [ } Date of Interment F - & /-~- J a Section Casket or Coffin No. soa Sandles | Casket or Coffin No. «+. 47- a@ Candles | ; Pi | ; Made by I | | Gloves “Fr we | } Size S Made by age Gloves 6 Lining and Pillow Set No. | Bearers or Porters Lining ‘and Pillow Set No. Bearers or Porters Time of Service Section Date of Interment S1Zt ndles Hearse to 4 Hendies Wearee to Removal “ Plate Removai ile | Automobiles sees |. . . Outside Box or Vault “Ag, Automobiles hutside Box or Va Burial See A Burial Suit Slippers Newspaper Notices Slippers Newspaper Notices imbalming > Embalming ; Washing and Dressing Vashing and Dressing Shaving Shaving vices Services e of Chairs Transportation Charges Use of Chairs Transportation Charges Church Charges '| Officiating Clergyman ie Church Charges Officiating Clergyman Amount of Bill Cemetery Charges | Amount of Bill ‘ 4 a Cemetery Charges Music........ | | Goods Ordered by Music Goods Ordered by Bill Charged to Flowers Bill Charged to Flowers CR. DR. ac Ss SS SSD | | 1SBUEG BY DORNTES CASKET CO., BORTON, MAGS., 1016 ISSUED BY DORNTEE CASKE! Co. BOSTON Mase 1 208 RECORD AND BILL OF ITEMS Yearly No. Residence ao A. 7 ies Place of Death a eh alias Date of Birth... 134 8 Date of Death 19.3.3 (Year) Maiden Name Birth-place Name of Faffier Aer Maiden Name of Mother. Dyk Primary 4 /? i Certifying Physician... «+ LA¢ Cause of Death Place of Burial l‘uneral Service at PA Pon lime of Service 2 ae. 24: fO-LEH“IF Date of Interment Casket or Coffin No. Y. /3 . A 4b ( Made by JM . nd Pillow Set No... It cof - lier le Box or Vauit Suit ning ing and Dressi biign Rerines of Chairs gee (church Charges Cemetery Charges — cpt Cw a OL. FOR THE FUNERAL OF Total to date... a, Gre. — Ch. A il oie? re i mM Be fs Wife or Widow of. ELbe2 vlalf Leon. hee erof 4 ZS... Years (Day) 4 2- Ages . 4 Months (Day) Af. Occupation .. Days lis Birth-place Her Birth-place Secondary... J? Les - Kesidence Cemetery . Sex Color or Race Single Married Lot No, Grave No. Section Put in the Diagram one mark like t}: 1 for every Grave in it. And mark Burial with double dagger thus : } Designate site of monument thus: [ j > _. fe S cof ..Z@2 Candles Gloves one Hearse to — Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to TOU . Bearérs-oF Porters Pi — ot Cd ase @ L_ 'SSUEO BY DORNTER CASKET CO., BOSTON, MASS. 1910 Yearly No. 4 = 922. Place of Death nal Date of Birth Residence ,/ 18 & Date of Death Maiden Name Pa Birth-place 4 / 2. Name of Father Cz a¢ li RECORD AND BILL OF MMe Ph tats [> (Me ase buP ) tet ~~) Maiden Name of Mother /; FAI rs t Cause of Death— Primary Certifying Physician Place of Burial * ¢ Funeral Service at Time of Service Date of Interment Casket or Coffin No Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers DR. ITEMS FOR THE FUNERAL OF Total t date ‘ io ‘ Cee Wife or Widow of b Nv Years | Sex a w | ° ‘i as Age § 7 Months y Single +" [m9 I . Married Days — Occupation er —t “His Birth-place Vu Oiler Birth-place Secondary Residence Cemetery Lot No. Grave No Section Candles Gloves Bearers or Porters Hearse to Removal € 1L4 Automobiles New spaper Notices Transportation Charges Officiating Clerevman Amount of Bill Goods Ordered by Bi ll Charged to —— ISSUED BY DORNTER CASKET CO., BOSTON. MASE 1018 210 RECORD AND BIL OF ITEMS RECORD AND BILL OF ITEMS Total to date... : Yearly No. Yearly No. FOR THE FUNERAL. OF Tota/ to date al f : : ig. ee aca es hitler leeet. Gel Ab kee ~ ) j : : 7 ~~ re w “— fy \ Residence ‘ : ae ad oy s: Residence ay Ak Twte Cbttlee ST CO Place of Death AU pe td : Wife or Widow ot AM Bar Week Place of Death + . Wife or Widow of Date of Birth , Le, rt ; ... Years Sex ALA Color Race Date of Hirth 1d WJ ay 4 1 ¥ ‘ 2 mth ey) pay. / Betep. 54 « U Years | Sex ‘ A... i Color of Rage Date of Death sss é tf . aoe Age Months 4 Single Sel bb wee 1924 Ke, GS “—— Sine! 2 Cth onths ngrte ; , (Year) (Month) (Day) : fs en) : ges wait ' ri f LE Days Married Statden Name “4 © Va /, / GUL, v ; i) ute ® f Days Married Maiden Name —e* sr Ch, » #rX to ~ NALA r i 6 j Rar ee x LOE : Occupation ee ee Birth-place Occupation Birth-placc ti I 4 } , 7 $ ~ ease hh is a Mee His Birth-place “ Ce Name of Pahu YH a4 de aan Hk, Hie natn bie ne Name of Father pvt eh ¢ ae lite, Maiden Name of Mother TMT LL Al¢ Quer Birth-place Mhleeet * seesees Maiden Name of Mother / ‘Vy? aps Piel it OAT er Birth-place PALL A Cause of Death — Primary Secondary 5 mk ccnasaea Cause of Death— Primary ‘ Secondary abn : Le of ge s = — hy f » at si ang Certifying Physician ¥. eR. e PM Residence “+ “ Ne cis Certifying Physician * ; ft Keer naidence C4 CA ) gigs Place of Burial C A 4 ¢ : Cemetery . , Place of Burial me how Led agp ss Cemes@ry gp Mak K ‘ a F. af eA —_ Ort a > reece e aaae Ke if ff Me ee j I N : i ; Ng Z at ine. Put in the Diagram one mark like +! Funeral Service at Sh, € — Grave No. P ; f / a ; / : ; Ols4 a ae £ Se Section luneral Service at | for every Grave in it. And mark Burial with double dagger thus : | Time of Service ¢ "e™ " ~ / Gtave No lime of Serv ice Designate site of monument thus: [ J Date of Interment . m ‘ Section Date of Interment 4) / # mamveniammumiinnieneaiaueas ss a so. “ a - TF OY A a oT a 8 amenuer memmetonmnein Casket or Coffin No. . Candles Casket or Coffin No. * " none as wooe.| Candles Dize....4 Made by..s. ii “ Gloves 4... Y Size Made by Gloves || ae are r Porte : ° Bearers or Porters Lining and Pillow Set No Bearers Hearse to Lining and Pillow Set No.. Handles || Hearse to Handles Plate i | Removal | Plate AB Removal /~+ i Outside Box or Vault | | || Automobiles . Outside Box orWault Automobiles Burial Suit Burial Suit Ug g J p> Shppers Newspaper Notices Slippers Newspaper Einbalming Embalming Washing and Dressing Washing and Dressing Shaving Shaving Services Services { Chairs Transportation Charges Use of Chairs Church Charges Officiating Clergyman Church Charges | | . If Cemetery Charges i "| Amount of Bill l Cemetery Charges W Music....... i} G !|| Goods Ordered by Music " ig: | Bill Charged to Flowers AY po? blowers VDA key DR. m DR. A | ‘ | ' | 'S8UED BY DORNTEE CASKET CO., BOSTON, MASE., 1019 1SOUEO BY DORNTER CASKET GO, BOSTON Mase 1e'e RECORD AND BILL OF ITEMS Yearly No. Residence. Place of Death amar meg Date of Birth... 1g © (Year) Date of Death 193.3 (Year) Maiden Name Birth-place Mata. ~th «YW FOR THE FUNERAL OF Total to date. Wifesor Widow of LO€. Ghhtaare. 18 g 2. Years Sex... Ma (Day) Color or Race 2-€ Age 6 Months 4 Single (Day) 4 4 Days Married Occupation . Name of Father true Inagy Mocs rg His Birth-place Creme © - x, € : Maiden Name of Mother. Cause of Death ay Certifying Physician Place of Burial. © a Funeral Service at Tinat Pare Time of Service. 0.1 SAM. Date of Interment \% +* 44° . Casket or Coffin No. Size Made by Lining and Pillow Set No... Handles Plate Outside Box or Vauit Burial Suit slippers lombalming Washing and Dressing Shaving Her Birth-place " myyieai Secondary. Residence Cemetery rt Lot No. Grave No. Section I for every Grave in it. And ma: Burial with double dagger thus Designate site of monument thus Candles Gloves afr Bearers or Porters 41 Hearse to temoval fren Chan Kat Automobiles Newspaper Notices | | H Transportation Charges Officiating Clergyman | Amount of Bill Goods Ordered by | Bill Charged to Put in the Diagram one mark lik: Sa | | | | | | | | | | 1] } i] | | 1SSUEO BY DORNTER CASKET CO.. BOSTON, MASS., 1016 RECORD AND BILL OF ITEMS Yearly No. shar Ans Residence / | { fe f Place of Death Ie: Date of Birth Idee (Year) - Date of Death A. a (Year) (Month) Maiden Name Birth-place ne Whe AAA Name of Father 744 Maiden Name of Mother / « Cause of Death— Primary Certifying Physician Place of Burial Funeral Service at Time of Service Date of Interment 4 Casket or Coffin No ae? Size af <5... Made by Lining and Pillow Set No Handles Plate Outside Box or Vault 4-5 Burial Suit Vs fix SHippers- (Urner Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers 4 DR. FOR THE FUNERAL OF Ad Powe, GE ex GALA SZ Wife or Widow of “+ ee ee ® 4 |... Years Sex . =< ~ ‘ 7 Days Married Months Single Occupation -¢ His Birth-place } Lae Her Birth-place Secondary Residence Cemetery Tota/ to date «Lt No. Grave No Section Candles Gloves Bearers or Porters Hearse to Removal Automobiles Transportation Charyes Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged t« cop seep EDR eta ee i wey cere (SSUES BY DORNTER CASKET CO.. BOSTON maAee gp. a or or Race 214 RECORD AND BILL OF ITEMS Yearly No. Jn Fins Le L441 ty i) saline Residence......|. 23 J & e wht Al, FOR THE FUNERAL OF Place of Death My O) +ek 1-4 one bate ‘4 ¢ 2) ~ er Widow a4 “xt hes { iS’ é S (Year (Month) Date of Death 19_.3 < Goats co? Date of Birth Maiden Name re Birth-place Mats é ‘ek, ¢ Name of Father Ln ly Laas oa... Set Maiden Name of Moth: ta. 4f ause of Death — Primary ving Physician ace of Burial sneral Service at f Service ste of Interment Casket or Cofhn No. Made by r and Pillow Set No.. side Box or Vault “oe * ples (¢ Her Birth-place (Dey) /f Days Married se Ocgupation. ¢ Hb Birth-place Secondary rs Ce ¢ Residence Cemetery Lot No. Grave No. Section j 38-0 Coe.) Candles Gloves Bearers or Porters Hearse to Removal Automobiles Kowopeped Mitices a4”) [pre Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to teed / é 7 Years Sex a, 4, 4 Age Months 9 Single h 7 haw Total to date LP Cen OA Lain ef 7 4 fA hen 4 = , ' Cyorfpr Race bokit. Put in the Diagram one mark |ik: | for every Grave in it. And mark Burial with double dagger thus Designate site of monument thus: | SR Se APE ee | | 4 198UED BY DORNTER CASKET CO.. BOSTON, mAes., 1010 RECORD AND BILL OF ITEMS early No. N y FOR THE FUNERAL OF / Tota/ to date hh hice Ch sabeed Ch, cheinelé. ~ > j oi ¥ ae re os AL enwd Ts Place of Death, CY ~A Lid, VRaL A hii Date of Hirth if lo ( flee i y (Year) ears SEX 19 | 33 Re re 4 Months ¢ Single Maiden Name a Chey Bhe fp at Fchy 7 . Days Married ; elk Lecce % cw \ a on il le sf His Birth-place A = / S. ay ovt , Ley ¥ MY §7 Her Birth-pla a / Cause of Death— Primary Ay - Certifying Physician A i i. NEV UL ALL Residence ar Wife or tor. or’ Date of Death Birth-place Occupation Name of Father 4 Maiden Name of Mother Secondary Residence Place of Burial AVL O02 jj , , Funeral Service at. / - LAMALL CK Lot No. - iy a / BOM, Mesey 1 /2P Goan Date of Interment / hicry a 4 Section o MDE ra Cemetery / Time of Service Casket or Coflin No Lt y (& Candles size Made by Gloves < Bearers or Porters fecar / Lining and Pillow Set No Handles Hearse to Plate Removal Outside Box or Vault \ Automobiles Burial Suit Slippers mbalming \V ashing and Dressing Shaving services Transportation Charge | .¢ of Chairs hurch Charges Officiating Clergyman cemetery Charges Amount of Bill Goods Ordered by lusie blowers Sill ¢ harged to meres oT ISSUED BY OC NTER CASKET CO., BOSTON, MASE wre 216 RECORD AND BILL OF ITEMS Yearly No. Z, 1 Wha \/ MAA i CRLil hb } ae Vl 2d A atu CZ 187 Reh Yper mth 19.54, id (Year) | (Month) Residence Place of Death Date of Birth Date of Death Maiden Name Les é Birth-place EL Name of Father —S ., LOF ne hap of bele/ His Birth-place 4A ht/ cle / Maiden Name of Mother © Marg ore+y Cause of Death — Primary A Certifying Physician A- id iy —s ida Chr - f P, J pansy Funeral Service at “ “nL aa beupf hee ‘- - ‘Gn yo Place of Burial o-akigod Time of Service / head Date of Interment ALLOY. t< a ‘C4 ee pcupta 4 Leky, FOR THE FUNERAL) OF MNhiky,LAIELF, Wife ox Wixtew of. LY 57 (hay, Vs Age (Day) / q Years’ [ Sex // Months Days Cr ¥_-4 Ky Occupation ... er Birth-place 4 Secondary Residence ~ 4 ,. Cemetery . Single Married O/ ‘ Tota/ to date or Rage heusu & cf @ Y /\ Lot No. Grave No. Section Put in the Diagram one mark |) | for every Grave in it. And mark fiis Burial with double dagger thus Designate site of monument thus j ] Casket or Coffin No.A47 he’ Pe ee, Made by Lining and Pillow Set No.. Handles Plate Outside Box or Vault™ Burial Suit Shippe rs Hinbalming Washing and Dressing Shaving vices Use of Chairs (hureh Charg ges f netery ( tharges V2 CALLS he ae Se,“ arp Candles , bh Gloves / aL Bearers or Porters Citef(er Hearse to ... ly Removal Automobiles G ¢ jase” ss Newspaper Notices / gk fl Transportation Charges Officiating Clergyman Bill Charged to fs Joo-vs Fy, Ve Amount of Bill Goods Ordered by Dh, het 4] Esulh or Me! 1S8UEO BY DORNTEE © SKET Co.. BOSTON, MASB., 1018 RECORD AND BILL OF ITEMS Yearly No. VO" “. 7 sh. ¥ £44 Place of Death YAN eer enh 19 04 - 1 19 Bans (Year) Residence Date of Hirth Date of Death Maiden Name Birth-place Malis b Name of Father porept}4 Maiden Name dt ei Cheer bie Cause of Death—-Primary (Aceon Certifying Physician Lv. Place of Burial Gir feu Funeral Service at at Time of Service pd fat Date of Interment Casket or Coffin No. ¢y # bi lp Made hy lining and Pillow Set No. H indles Plate Gutside Box or Vault pret Hurial Suit 4 ppers Embalming Washing and |ressing SRAaV ing vind » of Chairs Church Charges Cemetery Charges Mt ViUUSIC Flowers yn Aree CNN ey We | 4 it FOR THE FUNERAL OF ‘ ‘ ~ J Wife or Widow of ¥ ©. Years | Sex Months | Singk + Days Occupation His Birth-place «Her Birth-place ae Kesidénce , re Cemetery Married “Lot No “Grave No Section ca Bearers or Porters Hearse to Removal Antomohiles Transportation Charges Officiating Clergyma) Amount of Bill Goods Order Bill Charged 1 erecererenermmnecnaea Tota/ to date ere URN TS E " ISSUED BY DORNTEE Casket CO 2OB8TON, MASS. (ee 218 RECORD AND BILL OF ITEMS | RECORD AND BILL OF ITEMS Yearly No. FOR ss FUNERAL OF Total to date... 4 Yearly No. A] Te THE FUNOR ALyor Tuted to tae bho a) a, LB-L4A_ Ue-2 hes | (Ke | e LY CA tewcecentes at tage LL, a é; . - Residence Te Le — th ttrg CB a f f Residence Place of Death Wife or Widow of \/ a Place of Death Wife or Widow of Date of Birth os Years Sex Color or Race Date of Birth I oo (Month - Date of Death ee 4, J ; Months 4 Single k& ( Date of Death 19. (Montb) Maiden Name Days Married Maiden Name Occupation Birth-place Occupation Birth-place YUL ; : Lat ig , A a , His Birth-place E . ; cong | Name of Father His Birth-place Her Birth-place v 4 - és Maiden Name of Mother Name of Father Maiden Name of Mother... () Cause of Death — Primary Secondary . | Cause of Death Primary P} Residence Certifying Physician rtifying sicia Cemetery . Place of Burial Lot No. Put in the Diagram one mark ‘uneral Service at | for every Grave init. And: \ a 3 ap Time of Service Grave N rave No. Burial with double dagger thu Date of Interment e Section ; ; Designate site of monument thu: i “I isket or Coffin No Candles Made by Gloves Bearers or Porters yg and Pillow Set No. Hearse 6 4 Removal sa 4 i, in ; de Box or Vault / Vide Automobiles i Suit Newspaper Notices Lalming ing and Dressing ng ces Transportation Charges f Chairs Officiating Clergyman oan -hurch Charges nount of Bill Amount of Bill ' aA . ( Ae . | ‘ - , a = (,00%4 Oy 2 Goods Ordered by fen e Bill Charged to TOLA a rE AEE i ! e swe ©.. BOSTON. MAS 'S8UEO BY CORNTEE CASKET co. BOSTON, MASS.. 1010 1S8UEO BY CORNMTEE CASKE Te aa jas: sa a ote tan napcieesrnas actin RECORD AND Bit OF ITEMS Yearly No. Residence Place of Dezth Date of Birth Date of Death amd’ Maiden Nam Birth-place Name of Father hr- } Maiden Name of al? P Cause of Death—-Primary ( i Plac e of Burial \ hye Funeral Service a Lf fe, cd ae e Psy Cy Colth lime of Service Date of Interment a Coy 74 j - eas Casket or Coffin No. Size Made by Lining and Pillow Set No.. Handles Plate Outside Box or Vault jurial Suit Teta/ to date iow or. ears Months § Single sf Days Married Occupation . G,3 Come Binh. -place Selises Her Birth-place & Secondary ff, or / f, —— edery : (A lA No. Me fe. AF on No. Joh ’ f Section Put in the Diagram one mark lik | for every Grave in it. And mark Burial with double dagger thus : Designate site of monument thus i] od : Fe Candles Y, ese Z td , Gloves Bearers or Porters Hearse to V. ev (@ZL. ; st yémcs Ie theo Cece, Removal Automobiles Newspaper Notices Transportation Charges | Officiating Clergyman Amount of Bill Goods Ordered 4 | | a | \ | [ ISSUED BY DORNTER CASKET CO.. BOSTON, MAGS. 1918 RECORD AND BiLL OF ITEMS FOR THE FUNERAL OF rly No. Yearly Tota/ to date Residence ~< Cc ~ - wy ck —— Place of Death \ ~ ste Wite or Widow of l a Date of Birth. Ob ; ; (Year) (M De . - Date of Death 19 3 (Year) enth) of ire Jf Maiden Name 7 Days Married on Birth place /] itf ~ be iE ins Po J Name of Father /OW244t ears DEX Months , Single Maiden Name of kotor et Cause of Death— Primary Certifying Physician Place of Burial ({LA-484 Funeral Service at . 2— : ag Time of Service Date of Interment sensilla Casket or Coffin No Siz Made by/\ Lining and Pillow Set No. Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music i seco are eR ANTEE CASKET CO,, BOSTON Mase. 10'6 ISSUED BY OO 222 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Yearly No. ie ia 1 Tac. Residence cote sU“d y= Place of Death SOA Date of Birth l ig f ear) ¢ Date of Death 19 A (Year) Maiden Name * ( “ Birth-place wl Name of Father... al at Maiden Name of Mother Z¢ a Cause of Death —Primary Certifying Physician Place of Burial 2 luneral Service at lime of Service Date of Interment Casket or Coffin No ze Made by Lining and Pillow Set No. Handles Plate Outside Box or Vault vurial Suit ppe rs Embalming Washing and Dressing Use of Chairs Church Charges Cemetery Charge oe “a Pa (Month) ao (Month) A ~ f - = ’ fo a f , / ¢ ft Co ncmtamen / f Fr ¢ : o ; < he , («KJ Wife or Widow of. Sex = i eg Single i, Years Months Days Married Occupation . a ae ‘aan oe His Birth-place Her Birth-place ~ Secondary Kesidence Cemetery . Lot No. Grave No. Section Candles Gloves Bearers or Porters Hearse to Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to Total to date ca Ath 7K / red Ght.. dbl reg a Color or Rac Put in the Diagram one mark like t | for every Grave in it. And mark / Burial with double dagger thus Designate site of monument thus | | | | LL ISSUED BY DORNTER CASKET CO.. BOSTON, MASS... 19018 RT « thee é ror edie, ; 5 Rok oA H— SS , RECORD AND BILL OF ITEMS S » Cho Yearly No. XX Residence... f A Aha Place of Death fr Date of Kirth l s OE (Yea) 19 S bens (Year) Date of Death Maiden Name Birth-place Ke Ahi Lh Name of Father 7 Le t tf hd “~ f t Maiden Name of Mother.....-_4 Cause of Death— Primary Certifying Physician AL Place of Burial —" Funeral Service at CE< ae Time of Service Date of Interment et or Coffin No. Made by and Pillow Set No le Box or Vault CP rial Suit f ers ipalming ashing and Dressing ne eS Use of Chairs Church Charges Cemetery Charges Music > t FOR THE FUNERAL OF Total to date ere: 4 ~~ Wit ofr W idow of Ye Mont! a ¢ v i y - Ve FAME — Hh his En " gore nearer Tree ore (SSUED BY CORNTEE CASKET CO, BOSTON mate 224 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Ppa a Total to date... Residence ee Place of Death J L_A Wife or Widow of. & BDVUTA bechhed ae ets ‘ Date of Birth ] $£ i Z. Cf. f Vy a Years Sex te 2. 7 laa We ~ Age Date of Death 19 23 4 Px 4 %~ (Month) (Da Months ¢ Single Maiden Name { Days Married ....4-—~. Birth-place [: 0+ C Occupation ferli- OA 2nt- of. ¢. Cheech , / } Name of Father f bt ~F = , ¢ - ig Birth-place mt e Maiden Name tthalecouy \A- £ Fut € a et <place “At ¢ be RECORD AND BILL OF ITEMS Yearly No. Residence i j “64 Ss Wf Place of Death tale: Gish / Date of Birth... 19/4 (Year) Date of Death 9 Fa (Year) ¢ Birth-place Je j Name of Father 2 BAAN GEE Maiden Name Maiden Name of } f her CMe. FOR THE FUNERAL OF C4. Tota/ to date “ Pann Wife or \ rT on of Ys Cause of Death—Primary tL Chal th oS, Secofidary Essoe of Donth—Priaasy Certifying Physician , : ) { Place of Burial jew ] Funeral Service at Wa dA Time of Service i oe . . . f 7 £ at Certifying Physician... ¢ : Residence / / Place of Burial hon Croc : e -@* s Cemetery funeral Service at foe pet) 0*, hee af bé . Lot No. lime of Service Z f° , , #G ; Grave No. / Put in the Diagram one mark lik | for every Grave in it. And mar} Burial with double dagger thus Date of Interment Section ee ite of Intermen Dhesiguate ote Of aentinent thus: f"? Date of Interment egel ee | Casket or Cofhn No sicniteinn | Mae Casket or Coffin No. Size Made by | : ? Gloves | “ae Made lys EE I ah cay cn we , wS No panera Dinah aun | : : i Lining and Pillow Set N Bearers or Porters Lining and Pillow Set No. we x Handles } Hearse W440 L=" | ae, Plat« ee Outside Box Vault f | F i VEG HON OF Automobiles at Outside Box or Vault Plate | Removal Neen ee nnn nn eee nen nnn aa mat nc ee eee durial Suit i aiseotane } | Buria! Suit Slippers } Newspaper Notices a | | Slip ambalming {| A e-J =| j Em! ning er hing and Dressing Il ae Washing and Dressing a te | , is Shavine ae Services oe Transportation Charges Use of Chairs — ga h Charge | | Officiating Clergym: ee rg fliciating Clergyman ‘ Church Charges Cemetery Charge Amaunt of Bill Cemetery Charges Music {| '| Goods Ordered by/ ee a Musi Flowers | Bill Charged to AMA f DOT Flowers eames DR. a a 7 Sr fr Pm ie — | bs , F/ 30 o°. Sea tarnank Pia, To. dock Ne fet we ee (oe ae ete, Bera g- c. sae. a... Her esa. elaco Gece _ Le poke % Macudtacsiait pat ys aS: 70 lelagh ad HaterP “GS ak ORNS SANE see oer '88UED BY DORNTER CASKET Co., CO., BOSTON, MASS., 1818 CO., BOSTON. MABE ISSUED BY DORNTER Casker eS SWRA ee Soa YE 226 RECORD AND BILL OF ITEMS Yearly No. / f 4 ad pee ; 7 f Residence 6 ME Lewy Place of Death /h i. J i _— oe Date of Birth 1 a ¢ f . 4 ¥ (Year) (Day 192% fi (7% (Meath) (Dey) Date of Death Maiden Name Birth-place { Name of Father 4 C4 Maiden Name ofMother Cause of Death — Primary Certifying Physician / Place of Burial /, Funeral Service at lime of Service Date of Interment ace FOR THE FUNERAL OF 4 CL — fetid tie. f Wife or Widow of ( EP Years [Sex Ages Zz Months 4 Single [ ~ Days Occupation... (2-44 His Birth-place 7 j Her Birth-place Secondary tesidence Z Virtue An © Cemetery Lot No. ' Grave No. f ] Section Tota/ to date iittala \ * 7 VLA MAIMKA be ( iZ-6 Color or Race & . Married er Put in the Diagram one mark lik: I for every Grave in it. And mar} Burial with double dagger thus Designate site of monument thus 7 ket or Coffin Ne 4 fa Gd Nee Oks a | Behe | Candles Gloves Bearers or Porters Hearse to {emoval Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by A, LAU Bi: Bill Charged to _ Corvapbhy ’ p= 4 fa | AAT, pb hbahe AWC: e Ka ee 'S8UEO BY DORNTER CASKET CO.. BOSTON, MASS.. 1910 Yearly No. Residence Place ot Death Date of Birth Date of Death (Year) 1870 Fel Mal RECORD AND BILL OF ITEMS FOR THE FUNERAL OF ’ y\ y aa RLdeE UA 7 Nye) JA L Menth Maiden Name p / Ny : | OA Birth-place tke hil pru A Name of Father Maiden Name of Mckber Cause of Death— Primar Certifying Physician Place of Burial Funeral Service at Time of Service of Interment i ‘asket or Cofin NoWV M y AVY oe AH L¢ 1 Cb. perce gig eee A ; YAMA ade by v and Pillow Set No « Box or Vault out ( { ming ing and Dressing y, Chairs h Charges f I\ a pps netery Charges WY Tota/ to date 2 rere ieeuro BY OOANTER CASKET CO. BOSTON masse tele FOR THE FUNERAL OF RECORD AND BILL OF ITTEMS RS ii 4 é Jana -” 4> Sr Dome _— any Date of Birth Date of Deatn < ’ iv ving ©° Ka . Maiden ee Ie I ee ee eer fB r Place of Cer Date of | o Outsid: , Washine Slipper: Embalrr Casket Size lining 4 Han Plate Burial > havine S Cemeter Music Use of Church Flowe: DR ry /} - -~ —— “oe seven or comwras <aene” a SRS RR ~~ her a eae neem OY np te ~~ ee ie ie 228 Yearly No. Place of Death Date of Birth Date of Death “SAGA REI TERRES SOE SOT NE \laiden Name Birth-place Name of Father Maiden Name of Mot} Cause of Death—Prin Residence / i 14 (% 19 ie RECORD AND BILL OF ITEMS Me, (Year) (Month) a. Ly Sif Lae be GO of. ie (7 4 { id 7 14 (Day) a (Day) m3 At. 4 thy / Me tbe r Birth-place A CA j / for, (s/U @ / Sex Age 2 Months poe Single Total to date... - ye Ke 4 C£é VI Oh my ( Lore Race / J Days Married _ e, i i é é ¢ Zp fF His Birth-place ALU R44, ow ar , Occupation 2? Sec ST Rebeptge Alavlh AC ; Certifying Phy sician Gide once 4 i ; \ A M4 enc ft Place of Burial C ' ya Cemetery a , pd , : Funeral Service at / / Lot No. | Put in the Diagram one mark lik« j ty J ; : { for every Grave in it. And mark cae ; Grave ‘ . : ; lime of Service y / ~ OO ea rave No , Burial with double dagger thus : mG j a ) f | wt " Date of Interment /| ‘ pee ; Section a ; 5 / P Designate site of monument thus Cj somenensene aueesoneannncan amen — Bees ; Casket or Coffin No Candles | Size f Made by Gloves | | | Lining and Pillow Set No. } || Bearers or Porters | | Handles I || Hearse to | Plate | Removal lutside Box or Vau i Automobiles rial Sa py] | Newspaper Notices | | } e | | Pet nm | | | BiH | { a | l | Bob i | i || Pais eS ie Fi } i | | ae i \| | BY ' fC} | ‘Transportation Charges | j } I 6 ; Ue aoe | : : hare | | Officiating Clergyman Ps ie Phy iat tery Charge || : | Amount of Bill at Beit: | : are Music | | Goods Ordered by | 4 i | i I lowers | | [ill Charged to ‘| ; ee _aeeeeemmnenanan st a i oe ate i Hy DR. CR. hil +4. +--_—- ‘ #3) . i 2 / 4 f _ ° iii : be As ge: r4 f{) \ch arsed L Jeefastech— | a i feagtar| % “f= Pevien bon Co- | a) } P 4 ‘ | | {| 1 Moy TAY SF H; Ad barly Tilak 4 4! | | ei 7 2 f° | j a te pee a KO) IW ud y | i ee x | . | i | aa | be a ] a a la | a i : 2 dds bety ~|\6 bhuog oes || } | | | 7 (Ae, | x [ I a / | | i : | | i i | | | | \ ' i }| j i| i 1 | | \| = | | he | | j || i} = il 1 (98UED BY DORNTEE CASKET CO., BOSTON, MAGB., 1016 Yearly No. AN Residence 4 a ] Place of Death r i af Date of Birth I a Date of Death 19 2: (Year Maiden Name ee KOA LOA Birth-place Name of Father Maiden Name of iene Bz th Cause of Death Primary ‘fo Phvsici (S e J Certifying Physician CL Ce oe }1 2 Place of Burial Funeral Service at Time of Service Date of Interment Coffin No. 2 Addn ae J ih Made by y ‘ Casket 01 Size lining anc Pillow Set No. Handles Plate Outside sox or Vault Burial S: Slippers Embalmi: Washing «id Dressing Shaving Services Use of Chairs Church Charges Cemeter Music Flowers Cc DR. y Charges Cremer eu |_| er 229 24 RECORD AND BILL oF ITEMS FOR THE FUNERAL OF Tota/ to date A prea t.-£.4£ \ TET ¢. {| > Lt o% a / < Wile or Widow of (Mouth) ; g Years Sex Color or Race - ‘a Age Mont! Sing] Da M ned Occupation His Birth pla Her Birth-pla Secondary ie idence e mark like this irmark (fis | | | sion maee Hele seeueD BY pornrer caenet co Bo a en eee a Sra 5-6 EERIE aan aa 230 Yearly No. Residence. Place of Death Date of Death 19.3 Maiden Name Qe ng { 4 f Birth-place 1 ; Name of Father A a : ai Maiden Name of a fee ~~ L. /aton Cause of Death— Primary a Certifying Physician —, Place of Burial 7 ¢ luneral Service at -- : i ne of Service v rr i : Jate of Birth .. 1.68 L LO (Month) (Year) (Mfnth) weve Ur ps a [ he f2 = Grave No. Wife or Widow of... 4 7 Years Sex » Age oS Months 4 Single ge /z Days Sia Occupation Her Birth-place JZ le. Secondary Residence Married RECORD AND BILL OF ITEMS Color or Race we His Birth- olace (BHA... Lo 4 lt +s LC Lode E. CA ee Cemetery )M LAL, dead ay Lot No. | 'f .Section Put in the Diagram one mark lik« And mar} Burial with double dagger thus I for every Grave in it. os Designate site of monument thus ae ; ; chet) date of Interment Jt vee Ae | 1 it isket or Coftin No. é Z Pd . ee ne core ee ae aa oe remieerci on SRR gS Lining and Pillow Set No..... de Fox or Vault Made by.< 44% pe i| wenn} Candles | Gloves | Bearers or Porters I! | Hearse to &~. ] | Removal | | al Suit ers | | Newspaper Notices | |] | | iming. ...{ | | | | ting and Dressing | | | cis | i| Pi : : of Chairs i| | Transportation Charges ich Charges i Officiating Clergyman Cemetery Charges | | Amount of Bill 1S : Music | 1 Goods Ordered Gt Pee: er Ge oli. ee || Bill Charg ‘ we or ei a Bill harged to ta fe te. pose | : iP DR. mag ean Cee Pe eee t ee | ee + ty j ! | ; E : T Re. LO Re | i ; | | \- H oe | i a | 3 | | I ed | re 1 | {| —_ } | | ] ad | | — | - i} we rnin ! a | 1 1 oe | || i} | } ea eo | — |—j | ce uae | i : } | | - bt ld | I | } | | I - | | ce || a 4 _— | ; i] ——— a — | Peron eS ae 1S8UEO BY DORNTER CASKET CO., BOSTON, MASS., 1016 231 RECORD AND BILL OF ITEMS Yearly No. riper wee se tho J ta). Residence 7 - Place of Death Ab e22 Le ee FOR THE FUNERAL OF Tota/ to date 132m 2 .2.3~.- 2 Wite-er Widow of Shad Te Date of Birth I 6% q@ 12 23 i | ac eee | Date of Death 19 3. os ah L427 heed aot. ie 8 Single J (a) : Maiden Name [ e Pd sve Mi ee rolosarad : Birth-place Caras a2 OP Co f dl s Er ; Occupation Name of Father pores His Birth-place » ~e~* a Gos... cake a | Maiden Name of Mother Z eganrede monennhs Her Birth-place Ja — Cause of Death— Primary C Secondary Certifying Physician ow Pe Cc TRA a £ * F Residence } Place of Burial C2 Risrw ue’? Cemetery { Funeral Service at dJ hao oa Lot No. Put a lide Wi catch | Time of Service 3 sf? he er oe. ee Grave No J _ oe : a : ob gin 1 Date of Interment 4/4 (477%... “7 S ae Section r wis : ie acs oO it Casket or Coffin No 2. Mat Candles Size 4-3 Made by a a /S$O.\0©)}\ Gloves 6 q> fh Ae Lining and Pillow Set No. Bearers or Porters Handles Hearse t+ fi |e Plate Removal Outside Box or Vault tA /2-S (20 Antomobiles Burial Suit . Slippers Newspaper Notices Embalming Fi... | 2 Washing and Dressing Shaving Services Use of Chairs Transportation Charges Church Charges Officiating Clergyman 22 ae eo j Cemetery Charges 3 3 O- Amount of Bill en — Mair Goods Ordered by | DR. = z a Se eee ot ghee ae meme if | | ft es li } — mone | bee i 3 | | | | | | | | _ 188UEO BY DORNTER CASKET CO., BOSTON MAGE. 1816 ne Sener 2 aE eee ee oe et Se eee ee ee hore ake | 1 d 4 i 4 : : tl 232 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date... ie 1 Alex Adlere Sh Le )) Me w/, FhAw es 4 . b flier Orthdhlocnnen, Residence . i Vha. - tel bi $042. E “owy bas O-. Wife or Widow of a. ife or Widow of a 1G pay “ a Years Sex _ 5 or Race 19 5 oO Age - Single 4? ( ( mth) (Dey) fi i“ “ tr Lficae Kewell. Occupation . sirth-place /h AA, WV Name of Father ( tA Us 4 Tian y “ oY LCS His Birth-place acetal ey A lie, Ye Place of Death Date of Birth Date of Death Maiden Name Married Maiden Name of Mother ae im hs ¢ ©€¢4+-Her Birth-place BhenAL Jt Se Cause of Death— Primary / Secondary. > J ; : Certifying Physician c. : { - ji A Ce EO @e+Kesidence Place of Burial Watt t Et - Cemetery . ent ee g tf 7 J luneral Service at Lot No. | Put in the Diagram one inark like |) lime of Service oe PPM: Grave No. i ; ! for every Grave in it. And mark : L - Burial with double dagger thus : Dateat arian Y- Si Sect} . of Interment ee a section Designate site of monument thus: et or Coffin No. Candles | | Gloves Made by \ | : | | x and Villow Set No.. | Bearers or Porters | { e ' Hearse to i Removal Jutside Box or Vault | Automobiles | 1s ral Suit i Newspaper Notices | ‘ming \| | | tne aed 2) | oo me of Chairs Transportation Charges h Charges Officiating Clergyman Cemetery Charges Amount of Bill ld. x wend Oi Musie Goods Ordered by Flowers ] Bill Charged to | DR. CR. om rs arom pcs Ln 4 j a fA e "41 iu Yop Ce ar eg / V ¢ 2 cs P 27 | | LESS g ee -* hee | Ce. ad bm | | Po | | | Cen 1] | i ee } ant | | | oe — Ir | Bg | | | 7g |_-4 | | } | | 1 { 2 | } i| | | or a | | i I] | | | | | | —f | | fe oe | ; a ad ] I : | | ] ce ts eee —i— | | tf |__|. | \ | 1S8UED BY DORNTER CASKET CO.. BOSTON, mass., 1018 233 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF ———— eee t< SOIT LE Les Yearly No. Tota/ to date / ’ {ae [wf Ai Residence «gf ee. ) } eee . - Place of Death Le Wt ott/] af Lite natn ten Mercer Date of Birth Lax 7 a ‘ / tf \ 4 / / . oe if & Years f Sex F /y — Coltr or Race (Yeas) (Mont (Day 7 Date of Death 19 3 . i — oe (Month) -. Age 4 aa Months < Single , L4 Maiden Name L 2/ “a ence Lao ) Birth-place dix -— Ce Co Occupation (FS -+<® 7242440. EK Ll teal — 7 ; Name of Father Ekivar d he Forte Pharr i, (Pritie Birthplace 2ecuwiee® eX +. A 4 Maiden Name of Mother the CK Lovie ff Lei itr Drea : F } Cause of Death—Primary {| 324 ee~-— (Litre yet Secondary Certifying Physician \ Cf “\- CEL £04 Residence Place of Burial A} CAA Amer ening Comnmtars . ta, ft oe Funeral Service at / Udccd us Lot No. i a a ae Time of Service ¢ ret: Ws. ee Grave No B for every Grave in it. And mark thes 4 — Burial with il layger thus Date of Interment Ranitnn . wong penne alias i sini sii aicieidameineads seoiaapeaaaiiea Casket or Coffin No GF sh Candles / F : Size .lz a Made by #32 ~ Gloves 47 Lining aid Pillow Set No ' Bearers or Porters Handles Hearse to 4e—— Plate i Removal 4 Outside Box or Vault <“A& 2. Antomobiles st Burial Suit is Slippers Newspaper Notices . : i—— Embalming Washing and Dressing Shaving Services Use of Chair re lransportat Church Charges Officiating i sia Cemetery Charges c te Amountot Hil : aacicadanele Music Ge O Flowers Bill ¢ i DR CR. : - remem = Ae ” - ~ ~~ oman oe ee | i. — | | | i | } 1 | | | | } } | } ! | a 1SSUED BY DORNTER CASKET CO., BOSTON MASH ele crs " ene ea Seneca = ellitadadtineakat iiliaialmandiuarkaadainarex tadinsemeniincndiemammen aan inteieideceameattaaadae meee ea a Pree a. EN a8 S ORL DTORERE ore w lie p + seeepeetse 234 RECORD AND BILL OF ITEMS Tota/ to date Yearly No. FOR THE FUNERAL OF a uit iS ff O : 4 i 7 ty. Bel, Colne aa Residence. é YZ My) 7 : 2-7 Too . Place of Death. / tis Date of Birth 14 5S JO 5 Wife or Widow of. ne Lt’. Lia A 74 Years ¢ aie oh Color or Race (Year) (Month) Day) Date of Death 19 JF AC. | EP Age - Months < Single (¥ (Month) (Day) : ze ny Maiden Name Cul 27 Days Married # - 7 2 ; Birth-place te Ms Occupation a .t: mink. Name of Father 4 ack CA cece ll Maiden Name Sf Mother. dh ¢ 2« “f Jo rs ctchy Cause of Death-— Primary , fos e 4 tha 2A cL Certifying Physician. .#* ¢ Che te fe € - ( Mica ek... His Birth-place Pe © tfele-- “A-~ . ee “ ~ Her Birth-place CON ci rk hk eae eee Residence Place of Burial Cemetery Funeral Service : ie 7 uneral Service at Lot No. P it in the Diagram one mark } i: this Time of Service ‘2 Grave No. F I for every Grave in it. And mart. shis ‘ Burial with double dagger thu Date of Interment Section / 7 Designate site of monument thi ] peel eee? ES Neneerominetn eet ae canal " - ai fou a: 4 3 ‘ ; ‘ FT ce Casket or Coffin No. . || ; Candles fi"? mT : i ize... fg c 1 Made by... 4+ / | 7 e c Gloves | | Lining and Pillow Set No.. Bearers or Porters I : | i Handles | Hearse to | j ; Plate Removal . . isc os Outside Box or Vault if Automobiles | BurialSuit © a ss | iF Z | | 1} | ; | @ ss | | ed ; lippers i} Newspaper Notices Le MO Momafe: Sere her Aer Sanne. | | mbalming I Ir | 3 ¢ Ck Nd..4.. 34 i. Ln Mt Was} || bs a anda Var ae ‘| ashing and Dressing i} A wt 34 - ee ie v. Ki } | uC , sag hav ing i | Ae . * ¢ oft % ee o3.% t Nfl MA» a oervices | Che é . MU. a o f : j | | se of Chairs | | scacetanal Charges r oy I I F i ; 2 Church Charges i | Officiating Clergyman . ; i ee & we ‘ tery Charges I & Ist ©€ || Amount of Bill LU ¢ 0} a? Music ; | | 4| Goods Ordered by | Flowers h rT | Bill Charged to | . aS y 3 j po DR. Ib 9 Oe / S are cemeneaee a x es CR | | | Pr’ /ilit > | ty r a a? ' ’ | | | | | | Vill { { Vs / | | | I | | — - | |- ‘ = | | ud | i - —- wil pee a olay at | i] : sink pane al 5 = | } j | | a eer ee i} | | i me | | | | | Seer ee } 4 | | | | i| | | | i| — | | | | |_| nae | | | com | Buia 5 | | cal | | I — |-— ; | | | la | , ' | di get k | iI Nee f os | are estan sinsianssigalladl iil . linia i. | ij i] . seer cap een se oe J } SS oe | 4 a oF | 'S8UEO BY DORNTER CASKET co... BOSTON, mass., 1810 BSc anemnnigriees nonce mentee neon + — 235 RECORD AND BILL OF ITEMS Yearly No. : a to date FOR THE FUNERAL OF Mdeick Walke- Ahipauhles Residence — / (te isis ST 40 | hy, > Place of Dears Wf Ld AY § Mies VAAL Wife oraerbewol/ N, HAY * 1S b | / YH 1! 6 Z Years Sex / i y i Uf Color or Rac e Date of Birth (Year) % g 3 : Date of Death oe hy af. Age 4 Months ) Single < Se | Maiden Name {/ QUAUAL é l 23 Days | Married Birth- -place a i { Bgd / Lhe & Name of Father A Maw Warf ag Occupation His Birth-place Qrelll Maiden Name of Mother ? Her Birth-place es ic me es Cause of Death— Primary Secondary Certifying Physician &-/2. C1ite-La*- Ax Residence Place of Burial EAL Ub Oi c es Cemetery Funeral Service at. {S402 CA __ ee ek a aa Time of Service Grave No ede =o ose a tk this Date of Interment Section a le oO aie . Casket or Coffin No Nefah iv Cau. thy Candles Size Made by Gloves “. © Lining and Pillow Set No Bearers or Porters Handles Hearse to Plate ee 4 Removal Outside Box or Vault Lo LR (a (LgA~™ “hoo Burial Suit Slippers “ Newspaper Notices ; - Embalming tChithd tes Washing and Dressing / Shaving a Services y “ / . A an. Use of Chairs ins AA Transportation ¢ harges ; Church Charges Officiating Clergy man ‘ a Cemetery ies Amount of Bill ti es ae a Music Goods Ordered by , Flowers Bill Charged to CR. hh sili yp RE AE EERO SRN SE mn RST RRR 4 } | | } i | } ; Poa : oe ) | ISSUED BY DORNTEE CasKET CO SOSTOn MASe i¥'e 236 RECORD AND BILL OF ITEMS Yearly No. Residence Place of Death $6 Z Date of Birth Ca 19 44! (Year) Date of Death Maiden Name yt TO, 2, te Birth-place Name of Father C4 Y ¥ rf Maiden Name of Mother /tAL/ 4 {i Cause of Death Th Primary Certifying Physician LL we of Burial a ; pe yitcs at ineral Service at ie? O d lime of Service late of Interment wa om j/ » M Charvsee AE ELAL Wife or Fas Ve (Month) Occupation ......... His Birth-lace : é (Mer Birth-place 4 Secondary ERAL OF ta aan Je .. Days Total to date. Sex Single =r Ky Mavrihetr Ce “sf ¢. Residence La my f Sema Sil v ke WE Lot Nov Grave No. Section | Put in the Diagram one mark like thi | for every Grave in it. And mark //; Burial with double dagger thus : 4 Designate site of monument thus: CI et or Coffin No. Made by.. ry and Pillow Set No.... de Box or Vault urial Suit Chairs rch Charges Cemetery Charges Music Flowers | Candles Bearers or P Hearse to | i Automgbiles Amount of Bill Bill Charged to | Gloves (ape hice rs Ler | Removal Ct fa 4 G SPirdsrdl/ Newspaper Notices Transportation Charges Officiating Clergyman Goods Ordered of t oe nee... | | | we Rvcole a, f @ ALI 1S8UED BY DORNTER CASKET OOC.. BOSTON, MASS., 1016 RECORD AND BILL OF Yearly No. Residence Place of Death Date of Birth Date of Death Maiden Name 3irth-place Dy ; Name of Father © hr Maiden Name of Mothd E> Cause of Death— Primary Certifying I hysician Place of Burial Funeral Service at Time of Service St. rey Date of Interment Casket or Coffin No Size 4 Made by “““~~ Lining and Pillow Set No. Handles Pilate Outside Box or Vault Rewetirletert 11). LL < Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges _— Music Flowers gy f ; { \ . + ere 5 . Ah fA iss fe LG AAK FOR THE FUNERAL OF A eddie Wife or Widow of ? Years Months q ( Das Occupation ae His Birth-place a At ~Her Birth-place \ Secondary Residence Cemetery ITEMS Tota/ to date A_h-4 ' Sex : ta § Single | Married Lot No. Grave No Section Candles wv Gloves i, Bearers or Porters Hearse to } Removal Antomobiles Newspaper Notices Transportation Char, es Officiating Clergyman Amount of Bill Goods Ordered by —— sil] Charged to (RE TE TT iI 188UEO BY DORNTER CasKeT CO eoston, mace tele jor or Raee te 236 o37 | oS | RECORD AND BILL OF ITEMS | Total to date t Yearly No. Ne anAL OF Yearly No. FOR THE FUNERAL OF Tota/ to date ot, Sf ( r te Ze x fe ; Or a, . ~ ee ce Y LX, t & Cte ~ FE a7 4 Ls Residence , ye € f Residence ~) f 4 stds <a Ps al Place of Death a) A c 4 ? / Wife or Hi ‘of. Place of Death & ea = ae a Wife or Widow of . © 2 - oe] oo Date of Birth 1? ff + 4 / f 9 ears Sex . (Boer oe Date of Math Ye 4 Ae yr [ 22 Years | Sex — | Color or Raee (gar), (slonth) (Day d &Y t | ‘ 5") t tents) , (Day). | . * a J a a Date of Death 19.34; Wie // Age Months 4 Single , .»., : Date of Death = 19 2 F 4c end ee te eee J in (Year) (Month) (Day) hchisc (Yer) i FP (Day) 4 7 | Maiden Name yy , ~~; a Days Marri or Maiden Name a a 4 : | /) Days | Married sti { . : SHE VS HABA Bek J U : “% od y herent, Birth place IO) } » oi /\ Po Occupation . C~ & * sam Birth-place be 2 f a v4 a . : ALS Occupation \ a : ‘ Name of Father C4 L f j ee His Birth-place a v4 ale = od i Name of Fathe: L b it 4b ( His Birth-place eet : ; taf ‘ fi ard : : “a “ He _ CLLEKK : . \aiden Name of Mother H Uf ¢ f} { (Her Birth-place Maiden Name of Mothe “Her Birth-place { ‘ol 1 j Cause of Death — Primary { , ut wf , Secondary sesses Cause of Death Prima ary F Secondary Certifying Physician + Residence Cu {st Piel Ce rtifying? iysiei ian Residence Od hin | Sleavkle WE 7 Y Place of Burial ...f% wee rp i cemetary baalties : , Place of Burial ¢ hes wit » Cemetery ot . - Y p,9 4 Arde : : dA ff Ab j Sf * Zo , funeral Service at. OO. F..XS a oe | Put in the Diagram one mark like {| Funeral Service at ‘ ee i ~ Lot No. P um one mark . ; ‘ ‘ Cisse N | for every Grave in it. And mark /¢/ , so ee wy’ Y acer” fiw J fore { \ lime of Service ‘ot " ¢ aren iam Burial with double dagger thus : { | Time of Service ee | 2 errant . 1 | | ‘ ¢ = o . | ~ re . Date of Interment Nid Ent Section. ; i 2 a Date of Interment tf ; aa Section _ ae Cc " ‘ Designate site of monument thus: | ic Y : f ‘ | ! it = = — — es pm ems ST. oon — i i sialic a ee sli saieeadnai acta sinciaieinaiphiaitlaaasiaaiiinidiiaababaiilaiis er sano et or Coffin No. i| sees | Candles 4 | Casket or Coffin No | - Candles i] | ¢ £ 2. yf : x ee Made by Gloves ras WM ; / Size é Made by “~~ Gloves 7 | . | : ‘ ; ng and Pillow Set No... I | Bearers or P Ts ~— Lining and Pillow Set No Bearers or Porters | {| “LAAA ty | io jandle i || Hearse to none L | CL Handles Hearse to Plate | Removal7C(te. Ass A WE On | eS | Plate Removal | I © rb g : Vv agony . Automobiles side Box or Vault | Automgbiles lt a "as : Outside Box or Vault tA / ‘ ial Sui | | Bewwttteerrt Ly. A ee \] Ae : + rs 1 Newspaper Notices Sheers AP UAL As Newspaper Notic | ewspaper Notices Slippers. ( ning ol Embalming .... ' —_— wand Dressing | : | Washing and Dressing | | g | ek vit i | Shaving — | f? “y | , i | i= Services Hi i : ‘ . ce Transportation Charges se of Chairs i} Transportation Charges Use of Chairs I Officiating ¢ lergy man icsicecicemencicaealh aonb h Charges \| g ie Officiating Clergyman | oe Church Charges \| ; f> |\ ZL 5 / ‘ 0 of Bill |;— — Us ‘ | Amount of Bill -) A ge — Amount of Bi / Cemetery Charges Cemetery Charges if} ( A P , P00ds | de ed b j eed Goods Ordered wit te be ha Music os Music...... | | . | Bill Charged to 7 Flowers Bill Che arge od to fl [7 F Flowers ss ge Hits: epi : tt ieee lseuinglladicldeinintemnnti - an et DR. : / DR. ee ae a — y vial oe aaioes Bee | rerencineeeaigoninaarers fa ‘ He ls Le Gah | | Ce ff “ 1 MYA An ad i As Ppt eg } | — i. ey ; \| a ) aa i . K FP Ht | Z i wy Oh ti OY ttter| | ef Need 1 I 4 | j 1] | \* | ae 1 \| | . + ; | | | | i | | | | ce | i | | | | | | ' \| | | j Z 4 | | z E a ‘ ’ } ] | ij | : | i| | i | } + ' i i = = | | Le , oe | | ; all i {| | . ; -_ | ) i| j | ial ‘ | i oe me | | ; || | | i fy i | 1 : | os see j | | os we | | i ee rae | | - “1 | : | i| a Weare: Mme, 4 — - | | | J . 3 | | | ari 5 omer» at mase tele BY CORNTER CasKET CO soelton 1SBUED BY DOFRNTER CABKET CO., BOSTON, MASS., 1016 ec 238 Yearly No. tirth-place . - ¢ 4 Name of Father Jj f Cause of Death Primary ertifying Physician fe Place of Burial Fs buneral Service at . / ‘ Ps lime of Service Date of Interment Casket or Coflin No int Made |} nag and Pillow Set No VE arned le Viute tide Bo \ burial & } til é \ wand | 1 , ( i ‘ ( ss ae Mu ‘ DR er : | eh | i - Py j i. | ‘ oe 7 1] | i | ' | - | ; ; : | ~ | 4 | i | —_ al i 1 1! abs Maiden Name of Mother a AY a4 sf" Maiden Name Y : ; f 7, ho FOR THE FUNERAL OF lt / od) Wb ite ‘74 / ae P , mages Tb nth Tar £-f rt Residence f ) wi Go df LAed.....g / rae tn)>.tia : Place of Death j! LA tL Ske : Wife Widow of oe ee hele Date of Birth D..hed ie Years Sex Ahn (Year) (Mouth) ay 6 Date of Death 19.3“ ¥ A a Ape Months 9 Single e (Year) A Month) (ey) | em a Ww / A ....Days Married 7 “@ RECORD AND BILL OF ITEMS Tota/ to date Color or Rac ‘ iy ri P\ ahd! BEL / - F s : » + as of af a a y aks On cupation? oe He v y 2 ae" thF (ld , 7 + A ¢ : ay His Birth-place E4 ol - vp de (££ ‘ « © ¢ Her Birth-place “ ¢ Secondary Residence . > Z ; hee homelery tae . Lot No. Grave No, Section ererene eet Candles Gloves Bearers or Porters Hearse to Removal Automobiles Newspaper Notices Transportation Charges Officiating Clergyman Amount of Bill Goods Ordered by Bill Charged to Ah A RO YRC CE 2 om | | | | | | | || od Put in the Diagram one mark |)) | for every “Grave in it, And ma Burial with couble dagger thu Designate site of monument thu 1 a td (S8UEO OY DORNTER CASKET CO.. BOSTON, mage.. tore RECORD AND BILL OF ITEMS Yearly No. C- \ | a Residence....., J Place of Death Gs thigh acd "lly (Year) 19% a Date of Birth Date of Death Maiden Name Birth-place Lu 2 mf én Name of Seti J LL, Maiden Name of Mother 2 Cause of Death Primary Certifying Physician Place of Burial Gs Funeral Service at [ & Time of Service Date of Interment sna Casket or Coffin No Size { Made by Lining and Pillow Set N« Handles Plate : Oussidd ox or Vault surial Suit Slippers . imbalming xr Washing and Dressing Shaving ¥ ervices Use of Chairs Church Charges emetery Charges Music flowers wo cama DR. FOR THE FUNERAL OF i tee i 7 : Wrte-or Widow of } _ - ; wth) ike SSA Year } a . Ape Jee = Months é J Days His Birth plac « Ove upation Her Birth-place Secondary Residence Cemetery Sex ) Single Married Tota/ to date Lat No ; Pfore Grave No ) ie , Seelon —s ) Candles Chove searers or Porte a Hearse to Removal Automobiles Newspaper Notices Pran portahion Charge Officiating Clergymar Amount of Bill Goods Ordered b bill Charged te - oll 4o ee L 239 *s sate ~ or ant Raw t — moe mark like th Ar th th tthor: CJ CR eid epee satsae nti 19OUED BY DORNTER Case Cu eoetun mace tere 240 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Total to date “ Yearly No. FOR THE FUNERAL OF Yearly No. FOR THE FUNERAL OF Tota/ to date G ol free Check few lal esidenc ; eit : : me Residence t a Ahr < la f Wife-or Widow of Nalherine : a [Levv brake Place of Death Op f Wife or Widow of JO Place of Death . A-€? £3 Bi 1372 Date of Birth 134 Sb 4 / Years Sex Ate Color or Race Date of Birth Rhy (Mou4 (De a eu: (Year) (Month) (Daz) () Date of Pgath 193u- , ; ge Months ¢ Single Date of Death 19.3 3 LF Ages <Q. Months 4 Single os Tay : Maiden Name iat ee e Days “Married Wibocred Maiden hé< - ey pe ——Days Married Birth-place Jnrede lf Co- Sales vo Lh y “Cusapaiii Ze. mA AA B eth-place News Lp ‘ Occupation Name of Father es io len ‘A am tbakll His Birth-place enn. 2k Co - M © rh Name of Father 4 ry His Birth aay Maiden Name of Mothet- Wa af oes. CLE « A. He ‘ . © oe Her Birth-place Ceres Dhifh : Set Cause of Death oes re » es & » rete - Certifying Physician een Re a ce Cawe Z. of _- Le Ne ORIGINAL TRANSIT PERMIT Place of Burial panera Service a Prererch SHAH, E sw ) SPORTATION OF CORPSE lime of Service of ff 3? - intense oe oer : GEORGIA STATE BOARD OF EMBALMING er rite with Black Ink. f < DEATH — - — : ee aT Casket or Coflin N WAT sede. Ai¢ laf ? (Ade % Six Made WWE2¢>< 244 ining and |’illow Set No.. STANDARD CERTIFICATE OF PLACE OF DEATH G County ......... MUSC ORES i. ee: CH ero onnne QO LUMDUS . Mo 146 6th. Ste. Ward if death occured in a hospital or institution, give it: NAME instead of street and number, 2 FULL Name ........ William GeKarcher. ss 2 (a) Residence No. 116 St. 6th e8Q wor Usual place of abode. If non-resident, give city or town and state. - Registered No............,... ECORD. Eve Handles properly classified..||@ XACTLY. PHY Plate Jutside Boy Vault wr OE ae : re : ; he Length of Residence in city or town where death occurred Yrs, Mos. Ds. How long in U.S., if of foreign birth? Yrs, Mos MANENT R. ould be stated E so that it may be ae D STATI i _MEDICAL CERTIFICATE OF DEAT} gag PERSONAL AND STATISTICAL PARTICULARS ae Te ne Oe NE SS TURGED tence eens || 16 DATE AP DMATH, month, day ana year... OL EB[3 4 yo, _PERSONAL AND STATISTICAL PARTICULARS 17 N White Marri od I HEREBY CERTIFY, That I attended deceased from 5a If married, widowed or divorced 12. saereee DZ .nceranry tO B25 134 192 1s ND os sine . : ‘ah ware = that I saw h. ak alive on .......... Of 25 {34 ‘ascininiaisao ae ’ fe oR 2, a< ZB NM we Za © E <3 3.5 3's "o, & as oe and that death occurred. on the date stated above, at 3-5-4 m, poo :::n ene The CAUSE OF DEATH* was as follows: OR Bi NFADING INK—THI TH 6 DATE OF BIRTH, month, day and year MQ 3 TAGE —¥ tortie — ty 10,1873 NI te sci bei ta She aay Be hee wg | dennnde || 2o02* “yocorditis & irkate Uremia 61 st cl 14 | o Vhronic. Myoco#ditis & Brights Disease 8 OCCUPATION OF DECEASED el MO) src SOOM. sincieioamcsill (a) Trade, profession or / ° daniel particular kind of work. _merceea? ... Per (b) General nature of industry, business, or establishment nAntique Purni scien viairaietelalsinilaacecssedenetsie CANNED sins which employed, or employer” ae : oy 18 Where was disease contracted if not at place of death? (c) Name of employer 9 BIRTHPLACE, city or to / STARGIN RESERVED F NLY, WiTH U id be carefull CIANS should state CAUSE OF DEA’ Did an operation precede death ?................ ay State or country .......... Ta ad snenarssssneornsveceseecssers ||] WAS there OM RUtOPSy ? ..........cccccseccesssereneree PO ee ee ee ai ~ [What test confirmed diagpgsip)?......... : 10 NAME OF FATHER ... G@Oekarcher “aa f? 3 &|11 BIRTHPLACE OF FATHER, city or towMeecn....... s ; wt ee ry an, eh. k sirecesmmmanenne = ———— -_ - -_—- : Maryiend = the DISEASE CAUSING DEATH, or in deaths from VIO- n “{|/LENE (AUSES, state 1 MEANS and NATURE of INJURY, and 2 <[2_ MAIDEN NAME OF MOTHER .PYGNCOS. K@XNGR. |lvhckel ACCIDENTAL, SUICIDAL. or HOMICIDAL. See reverse aid — sia for additional space. Mary State or country &/18 BIRTHPLACE OF ra State or country : ‘ “19 PLACE OF BURIAL CREMATION or | REMOVAL 192 14 Aires 116-6th St. ho i a Liisa Sinecect sta: male = Wha: “werner! DA Striffler Iie. ies Columbus Ge PERMIT OF BOARD OF HEALTH OR REGISTRAR This Permit, with above Certificate, must be presented to Initial Baggage Agent, and delivered with body at destination. ; _AEZUSt..26,1934... ee the body DATE of BURIAL item of information shoul N. B.—WRITE PLAI Permiggion is hereby granted to remove for burial at MY Nali<... itleeocreiaotiniet Wi CE came he Liam -GeKarocher wesntevsineetenenenaeenseunerenenansuns covsserneng WOVE described, if pared in accordance with the laws of this State, printed on the back of this Pormit, ee aS x) . ~ } mS. ee Heo Health Officer or Registrar. 1 is made in Detach above portion of this perforation, and hand to passenger in ch delivered to the undertaker at destination. Tf buria y or this State, the sexton or other person veperintendinn, murt ound thie permis ae eas "Beare of Health in ten days, unless burial is made in city © m where death certificates are Permanently filed. | eee : _ & \ « - . ee ss, a # wiles ~~ : : , ¥ OORNTEE CASKET CO BOSTON masS o iseuEo '98U80 BY DORNTER Casket CO., B@BTON, MASS... 1818 240 RECORD AND BILL OF ITEMS Total to date * Yearly No. RECORD AND BILL OF ITEMS Tota/ to date 241 Yearly No. FOR THE FUNERAL OF aid FOR THE FUNERAL OF Residence 5 5: ‘ - ais Residence ? < Place of Death an a= Arp la f Wife-or Widow of. halherore aA ¢ [Urvbreky Place of Death Li, Wife or Wid : Date of Birth 1 34 hn 4G 4 J Years Sex Are Color or Race Date of Birth. l b lv da okay 22 i r ( Sex ; Date of Death 19.3 Pe a Age i © Months 4 Single () Date of Death 193u- " ba ' as aE . | a i J es ont (Yea Mpnfa) — : nt ingle Maiden Name ff Days Married Wb gered ston ral MhAKA S\4 ‘Dave M i Birthplace Predell Co- Skee LEM a Ze. ~ 2 : (6 dye dely 4 hey rts arrie Name of Father ae cf aaa? Nam beh His Birth-place La he Co = L < oe Name of Father Y Ww His ite , ce — “4h Maiden Name of Mothe(//f/a Uf Kou Chick te > or oe Tose oe on ee Cause of Death—Primary, 47ce ++ Dua fh Ser Leen 3, : - = as Certifying Physician Y. F a orcle - Re /ae eh iit Beta. oe We?) ORIGINAL TRANSIT PERMIT | Funeral Service at 220A sf aE. Lo 5 < <4 4 io Set No lime of Service rment Date of Int Lyon ze ining and | Handles t’hate ide Koy lt AM ry ond des Bb. Oo vhay ) 2-5 |\€ i | | 4f Oo | |... fh | = DR ee 2 } |i | } _| | | I | | | | | e | ae | | | kay | ee _ j a SPORTATION OF CORPSE GEORGIA STATE BOARD OF EMBALMING O0 PERMIT OF BOARD OF HEALTH OR REGISTRAR This Permit, with above Certificate, must be presented to Initial Baggage Agent, and delivered with body at destination. the body aT don Cr to remove for burial at................ Statesy a Nel.c..... seanessenscasesssessoeneess the laws of this State, printed Karcher Me Oo oes at: er LZ) — ere 7) ( I Ho gE Health Officer or Registrar. 3 Detach above portion of this forati d ha ' ty or tn tae OS ; perforation, an nd to passenger in cha: be delivered to the undertaker at destination. If burial is ma le dy ER cortiticates’ cre en, superintonsing, murt send‘this permit to (Me State Board of Health in ten days, unless burial is made in city or Pls psedonenn itaaice eta Wk Se cee as 4 * s i. with Black. Ink. : ———— ’ ‘ é ee ee SS ener a —— ras Bes STANDARD CERTIFICATE OF DEATH a @ PLACE OF DEATH e * = "oS County Use Ogee Ga. s 1 = State..... iil dsdbtpensentanieclbaboen - Registered No... ccceccpecsesascs.... ome s % OF 3 City... Columbus No 116 6th. St, oa If death occured in @ hospital or institution, give iis NAME instead of GK Lad ee MS 2f2 rou xawe ....\Williem GeKerchar a Te BB a is om (a) Residence No.................! 16 ii Z fl 3 rad ates -_ ee oii eset ae on a As md wer-seconntannuanssnestanvveesreneetutenes:teesereanseees aed > a ne ie oy f non-resident, give city or town and state. 3 $ & esicence im city or town where death occurred Yrs. Mos. _* How long ia U. S., if of foreign birth? Yrs, Mos Ds, > PERSONAL AND STATISTICAL PARTICULA pale saiaeenecre a. a AL AND STATISTICAL PARTICULARS MEDICAL CERTIFIC:! as & 38 SEX 4 COLOR OR RACE) 5 SINGLE; MARRIED, WIDOWED, || _ aie —— ne CERTIFICATE = "8725 Ts, - Sass OR DIVORCED (write the word) || 16 DATE AF DEATH, month, day and year _ | ee oo os = OE nnn nen rrnnweecsonennne AOD. a Bo 17 = ae o MN Wht te Marr4 ed I HEREBY CERTIFY, That I attended deceased from . ata esse: pepe oF Bisa If married. widowed or divorced _8/25/ 34 scieaais lucd > eh BL 25/34 192 wae E (or) WIFE of that Tsaw ha AMO. alive om en ff BM 192... > 2 ’ : and that death d, h ye, at » Of oF 8 —~— The CAUSE OF DEATHS ae ae tenets MOVE At BE Om | Sa § DATE OF BIRTH, month, day and year May 10,1873 Qa hd 4 || 7 AGE Years | Months Days IF LE than 1 ||----; omen eereme anne teas eanacrstnetnenenaceseovesrnnenarnervennreaninertestee BZ Ss 61 3 14 | ate ] ASE ecordi tis & Mette Urenia rn @ orm! =| Chrondoa. Myocc 5 : m i pam ame Nic. Myoco@ditis & Brights. Digeass MD <t esti cnictnetiastiaalibbiibaessiad ND cticeierc NMS sciscesccscsnc RMD ccochancsasuen sill (a) Trade, profession eo pe Particular’ kind of work... M@PChant CONTRIBUTORY PO f (Secondary) z fx, Sr, (b) General nature of industry, usiness, or establish Sal EZ rt a ae be ment inAntique Purnitur odiiehinaiena AM, So a =z 2 (c) Name of employer 18 Where was disease contracted hr BH obinctinibi UIE ABSA a if not at place of death? ....................... — Re Se 9 BIRTHPLACE, city or hs ryland ../|Did an operation precede death ?................ Date of Sas State cr country .... ry 2 Fre UN. Ue I arias cacciseneestaineteoiliinigtcd ces nielericiennnacerounimsiiasiods 8S z 10 NAME OF FATHER ..... @.2 eneeenee wet ee oy x ae . a S —|\(Signed) ..., (he PA Pow Gc sue 7, @ M|\e/1l BIRTHPLACE OF FATHER, city or tow? cecescoscccocssosecoooee. oa] Ride Via ron y Bantam Address . ha AMA hatte L., , a Ex : State or country Maryland bite om fee ne ee a eee “a a Ble 7 Sha | eake ERE CARRE DIATE il ROAR” a’ * Sho, state “ mm oO a ° Ay S| ¢|!2 MAIDEN NAME OF MOTHER Frances. Kertz_. whetlet ACCIDENTAL, SUICIDAL, or HOMICIDAL, See reverse side “ pies adlionenanineincoanhiesaisraece One acaeE oe. itional _ f‘yo2|%|18 BIRTHPLACE oF MOTHER IR OF got oes SoS St a abhi ssh dbl nal semplincatniienipesiineneiaapaneseisacimmnslnniliont thas fe Ex OD OU RD eeceevncosdtnsbadenincntssirtarategnedinesbiaigaresssentaocbecascnthsouinoes 19 PLACE OF BURIAL CREMATION or ote 7 “informant .. MA Ly. Karcher. ee [ee eveesenneceecnccessrsscsusteses 1 192 : Add 116.26 th eSt et 2 oe 80 5 -Q - ress sevessvesssesnsesvsursces ote. ~.2. nee || 20 UNDERTAKER ADDRESS Registrar. || DeAeStriffler Ine. a Columbus Ge oe r Notices n Charges 1¢ mark like this And mark th ( lergeman sieaie sal endian ee ' ; ‘ t , ee epee i. ‘ 0 _ x ax 4 mamgueennneEen | — mecca {| | i | i} j i | | name ee 'S8UEO BY DORNTER CasKar GO., BEBTON, mags. 1816 iseuEo ' BY CORNTEE casket co BOSTON MASS tere ao 240 | 241 | RECORD AND BILL OF ITEMS : Yearly No. FOR THE FUNERAL OF Total to date . ly Ni ike rly No. . ; i| aay FOR THE FUNERAL OF Tota/ to date athe Check Vn lel , l . ths Residence . +4 " al Residence , 4 SO ne igo ,raplas ite-or Widow of Aa LA er tree 2 Ms Jf. | | Place of Death / ° of Wifeor Widow of .7£G [binbabe Place of Death... / ager Ga ” r o Wile © ‘ NV OL Date of Birth ] aay JO Sb 4 / Years Sex . Of* f Color or Race Date of Birth... 1g72 (Year) (Moath) (Day) (Ygar) (Méuir4 a Years | Sex | Color or Race Date of Death 19.3 3 / 7 Age a eo Months 45 Single (Q) Date of Death 19 bu ‘ a Paes (Year (Month) (Day) ; = a al é (Yeap) (Mpnth) * (ve Months Single 2 | Maiden Name £ a Married —Day Married : c lZ é : j si : ays ‘ ec Birth-place Dre ds Lt Ca- Stel. of y "Occupation. cL ans | Name of Father ie pas i igs Nam beak His Birth-place oa. =. ui E ) e f+ ; . ? . z a Maiden Name of Mothet lia af Kou c Le che Her Birth-place ................ssdheen i Cause of Death—Primary 4f<4+ + 17 ES Secondary ee Rules for ibe Transportati fi f H De d B dies th St { G : % 2 se | On of Human Dead Bodies in the Sta e 01 eorgia Certifying Physician eas 7 si . . Residence.................daggeus 3 - ( Rule tt vulations Regarding the Tran hoot ; Ag \ a ; 3 ansportation of the me ad.—A copy of the orici? : Place of Burial C a fee <> oo _- Cemetery .................qigieparens 1 the standard certificate of death fo rm, s ied by attending lysicial res if le : } y ave! 1Cl » permit of local | . ‘ Zz > registr anda transit lahel signed hy thea ¢ inning fu eee a Sag aah Net hes a : QO} nie Service 4 J) 2c J 4 oO : = : ; Laie pple t ‘ re 1 and initial DARL AS oy n luneral Service at Voc LL 5 Z fe ae Lot No. seesenees crong white paper, supplie d through the Georgia State Board of Embalming by the public ae Put in the Diagram one mark lik lime of Service Of ff ~ 73? Grave No............. Bae a4 seer e, r the trans portation | y con mrapy arriers of bodies of persons dying in this State. The leath ec } for every Grave in it. And mark ; : as icate shall con tai n sac h infor rmé ation as is required in the standard form of dea ertificate, if obtain: Burial w | lager ' . i ; ; 1} } 144 f is 4 : : : : rt i ’ ) uneab Date of Interment SS / & i Section......................aaa : Health offic = ee regis Ve ar’s permit shali authorize the tran portation of the body describe: Bs , ian's certificate. The shipping “rund dire tor shall state en the sitar ese Ted di Designate ‘ ument tl [ ] Bere d the ke at aggage agent shali state 1 the route, name and.address of: escort | r ARSE a Se Lhe pl lysician s certificate and dead ota: OSL re: gistrar’s per en to the rt to bed i sine — Casket or Coffin | 5 eee lt Je Fé fap * ? (ad? wu!l Candles .... ee. abe 7 dl with the I ody at destinati ion.” ipping label shall be securely a ta hed to the outside case. If t} ody Is sent by express, the p yhysician’s certificate and the permiteshall he at£ached to the express way-bil] Size Made ye 20-< cid | ; CO Gloves =. ind delivered with the body at the de ¥e. otis shippine labed piel! be attached { tside case ining and i’ ill Set No.. || Bearers or Porter _ ransportation of bodies d * smallpox, plague, Asiatic a, yellow fever. typhus feve Porter } i| thy Us Croup or dintheret } t}, scarlet fever (scarlet rash or tflatina) ewsine! Handles | | Hearse to ....2..... ; Re thre bh BCBTIEL LEVEL (SCat ‘ ae ‘ ery : | an Ss! +r the follow:ng conditions: the iy hall be thoroug : Vlate | || Removal.......2358. oe a ; pga t a ! orifices shall be cl ae od v th absorbent « he body sha } . i | | € Was 11Sin al , enveloned in a sheet satt urate l h the I al ¢ } . 3 . t} “of ) fe ei ai Al : 1 ' : ; | Jutside Ko alt M1 } OVIL as AF |\0o2 Automobiles 32° tit hic tall be immediately closed, and sy os hire’ ge containi biles i the same, sha 1 be metal or metal-iined, and hermetically an at sealett. ial Suit Escapes: | ' | \| Rule 3—The transportation of bodies dead of anv diseases oth ; ’ } a dae ee Aa ‘ } i li ‘ | i se . ; ule tran Y l mes dead any a ases othe} i ner ) | 7 - 2. shi = , se | | Newspaper Notice be permitted under the following cont na per Notice ‘ J . OO! (A) Wt lestination can be reached within twenty-four hours after death, the coffin ; | | be inclosed in a strong outside box made of good sound fumber, not less than seven-eighths of an in ee | ; all joi ts must be tongued and greoved, top and bottom, put on with cleats or cross-pieces, all put i . J A cogetner,: al { ehthy closed with white lead, asphalt varnish or p rafiin % nt. ; a rubl asket pnlace« — } ij 1} i on the upper « between the lid and box; provided, however, that caskets eco i balmed I ‘ Ht i he shipped to points in this State in tirht ordinary casket boxes: and provided, further. that bodies addr i | i stntnees to the Anatcmical B ard oF this State may be received for shipment when prepared i h m: I I State Anatcmical Beard may direct. rtation Char Transportati a \ WN : tay: ' 1 sportation Ch (B) When the destination can not be reached within twenty-four how thorough!y embalmed. and the coffin or casket placed in a strong well made | : | | | | | | Officiating C > : ; i Cas% -aced 1 ng a OUutSIE nippit , ae | oe iciating Clergyr (2 ac I s Is ©}! Amountof Bill Rule 4-—No disinterred body, dead from any disease of cause, shall be transported by com rriers a oe ae : i | ? , ; i i c Mu H nos unless : ved by health authorities havin: arenes at the place of disinterment, and a 1 it permit, Irdered | aT + | | Goods Ordered by and transmit label, shall be required, as provided in Rule 1. The disinterment and transportation of bodies | i! | | Bill Ck 1 of diseases mentioned in Rule 2 shall not be allowed except upon permisSion of ¢} ealth authorities, at bo red t i / 1 s Te) . . . . 2 . " } c a ~~ [a ae places of interment and the point of de ation. All disinterred remains for tr: tation shall be as = on 2 in metal casket or metal-lined boxes, and hermetically sealed; provided that | ‘eceiving vault wl CR prepared by licensed embalmer, shall not be regarded as disintered bodies until : r the expiration of 30 aa ; . — - . a acme ie i RCN NETIC: i | -~ re : . . on : } | i tule 5—The outside case may be omitted in all instances when the body is t ported in auto o I | ss fas drawn hearse or funeral directors’ waon leo | 1} tienes a —_ Rule 6—Every outside case shall bear at least four handles, and when over five fe si ches in length wit Hl shall bear six handles —| ‘ Rule 7—An approyed disinfectant fluid sha!l contain not les an f per cé i I the term embalming 38 employed in these Riles s hall t equire the injection by a licensed embain t } | than ten per cent..of the body weight for bodies of persons dead of diseases in Rule 2, inj terial | | . ‘45 tan + Tt it} ther J i] addition to cavity injection; and not less than six per cent: of the body w ght injected arterial ul othe! | | cases in addition to cavity injection. 1} | | — {| — I | | Rule 8—The attached form of death certificate, health offic : ‘ i} | _ scribed herein, with these rules printed-thereon, bhall.be used in this Statesfor i bodies a | || ; : | I} herein provided. ' : (9 | | | | | ) | | | bam | I | | | - | os | | i | ™ : | | J} | | \. a Secale anes ' By obese ; | | : = I eas YT | } i | . 1 a 7! oc | | | iI | ) — — | | : | j @ | | | ee Fonsi | 4 | td ! | | | ‘ while —-+ 1} | 3 | | i ' | i st Sarna i i3 , { i ’ | | ec | or jeeUED BY DORNTEE CASKET cO.. BOSTON. MASS e '@8UEO BY DORNTEE CasKkat CO., BEBTON, MASS... 19818 Peni Eee rs eat Nae <i PRS hte aT itis anise Rpeenensoerereerenrey ‘ itis ili tai 4 ips necivgtanite.artei a 240 | 241 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date a Yearly No. FOR THE FUNERAL OF Total to date God frsey Ciel Weegee Lym G. Ke. di Residence ; : : z baat Residence fy / : 4 Place of Death ton 4? Airapp a f Wife-or Widow oi Mathertrre LAE It ail be Cs be he. / Place of Death Wife or Widow of Date of Birth l 349 - JO Sb 4 / Years Sex Arx Color or Race Date of Birth... 1 — —_ (Year) (Month) (Day) Og af Muang * | a —f...veure { Sex . Color or Race Date of Death 19,3 3 Lz. Age ow Months 4 Single () 2 ay Date of Pgath 193 oe £CG..| 2 kent Months 4 Single J orn (Year (Month) (Day) WW a tne SY b (Yeux) A ‘ Ang) (Day) Be Maiden Name ip. “Married * oseret srenntheay Maiden ame Ly, 1s PEE Ben -"Davs | Married i é - Pe A; j Birth-place Jrede tt Ce- ales sr ble q Spin 7 th, whee ” “Birth-place heyy pane ; Occupation Name of Father PAs lees Nam beakt. His Birth-place a. £ Co - mM als Fj oe _ J, is Name of Father cof 4 His Birth-place lo rs a Maiden Name of Mother- Ty aA af Kou e LE. Cc es Her Birth- -place : i | Maiden Name of Méther....././ 4 Her Birth-place . wf Cause of Death—P rimary t } ene Huff Secondary Wneeenunnanansternencnssenensiseerasabnnescesdosseguahes Cause of Death Primary Secondary Certifying Physician se fl ae * Residence : : ‘ Certifying Physician ‘ Residence Place of Burial Q. a ] tere <8 Cemetery a ; Place of Burial fet Bi: emetery Y f . A l'uneral Service at hioack 3 J DUE S ® Lot No. | Put in the Diagram cic inark like this Funeral Service at Me. C4e fot No Pat in the Diagram one mark like this s ; : 5 : s ! If 1 Grave in it is i y * i | for every Grave in it And mark thi lime of Service Yt ff. - P37 Grave No. J i bint cee oe ak aor = Time of Service . i Gl " Burial with de lagger thu Date of Interment Ss 43 ad Section ts of Interment fe aati ae ’ i I > Designate site of monunieit thus: i Date of Inter “9 Designate ne a | TT . TP 5 gp are mc aa =< so sixteen neces neeeses en a ~ = a vemiam panenee Casket or Cof!i Madea he Ih Ziela ? (AW % ., Candles \. Casket or Coffin No. { | | Pos Size Made wVderc-< cid | ’ | CO Gloves Pa Zid 2 Gis, Made by 1 j . . ining and Pillow Set No.. || Bearers or Porters | } Linine and Pillow Set No. Bearers or Porters Handles | Hearse to .. 4S | 00 Handles la | Removal } Plate : / S | I At , ; AY OMe ass (PD |\OO' rxomobiles Outside Box or Vault_L4 \utomonGes | Burial Suit | Newspaper Notices | Shippers bial: } i| | 7-5 a Embalming i| j | | vt miaaee See Washing and Dressing } / eee | i = o Ew | tera eS ee ee ‘ ha i 4f 1? o | Transportation Charges eee | Use of Chairs ' i| ee lerowm caliente egg] commen Churei: Cha I , i Officiating Clergyman : gonil _. Church Charges ) ; on os wemetery Uhary gs ©} Amount of Bill boyd ’ J Cemetery Charges ite AKA UM Sh to a i \] fous ; I r Music | Goods Ordered by | Music f | , | { | Bill Charged to Flowers Aeeth eens - ct eee cee ae os CR. DR CR DR. gal ii pee fasaquememmamonensen AES RAS SR SA > cue ae Ss ; ae . aerate acon cs = . } i a | es |__a £4 3 ARI GA wy F CfH-S. 720 O8 | Ses tian . the | | | | | — | | a | | nt | | 4 . | Be } oom oe | ‘| | || si sles inhisipacann | j - < en | | 2 al } | | | ! _| | | | | | 4 | I] — — i =) | | Bae | | 1} | } | i i| \ | i | I i i] i } | | | + | | ) | } ‘ | i | | Co | | | i} | ‘| | | | | | | | | | | ; |] | ' est || iabiccieds ; ; | | | \} | j | <ciyiaanitinsesieatteenienenaieniiaaal A et 4} | | | || | 4 { — — ~ i] — “ i i at | | ie Se counties — ISSUED BY DORNTEE CA Kner co STON MA « s Bo ele sree ATTEN Yearly No. : Se! "LED ce bs iP Wate hece Ce - GG kL, 7 Residence Place of Death Date of Birth (Year) 1 (Day) Date of Death 190 Aik le (Year) ahr (Day) Maiden Name 2 , > (Vb r¢ ' L YW B rth-place v as Ca a KLeceas/7- , ce ic Aw, Name of Father, Maiden Name és Mother Lk Lec polit 4 Cause of Death Primary Sn a .. Certifying Physician Or: 4 ae. Y- Sof A HA Place of Burial fice) LE (aeeg Chfer CA C Rie c GK // Qtr. €OCL/ go luneral Service at lime of Service Witsoe Widow of Cetere, 4 LT Age Occupation . His Birth-place Her Birth-place Secondary LP (Zs ts Residence Cemetery srt... Lot No. Grave No. RECORD AND BILL OF ITEMS - THE FUNERAL o Total to date. 2 - ; c SA 41 te el fea -_ Years Sex Color gr Race Months single, @ Ake te, Days Married ? may BELL LP Ae — 2 Pehid @ Ke g ta is | Put in the Diagram one mark like (} | for every Grave in it. And mark Burial with double dagger thus: / : PaO. / AY er Date of Interment G- Coz f Section [ Designate site of monument thus: Ci SS a a - anes a . ve : =| ket or Coffin No. a | e . Candles ‘ |. | | , | Made by I} Gloves | } Lining and Pillow Set Ne Bearers or Porters, y - | C ¢ / -~ d Zz } Hearse to | | | Removal ia pee | whys Cn A ( | \ : J Og rw fp ALT | utside Box or Vault Automobiles nit ( : | surial Sui | pe i || Newspaper Notices i i | | ilming i| | | | | Washing and Dressing | . | Snavin | ; | : | | Ser es | Use of Chairs | | Transportation Charges | es ‘ hurch Charges \| Officiating Clergyman I 7 ie De > Orwy Cemetery Charge | Amount of Bill.) A cnalnaineiaainenn i] y 4 }’ (7) j {| . — JY t } Mu | Goods Ordere K wu f | | wers || DR. | af SCAG ' oo Pa Aa) I | AT fe Kel. | ae C4 ~ | 1 3 A/S LA LtaGoSs j 4 Sa Coe aS | & ¥ | l LAS || # 1] | | | | | | | 1 } | } | | | | | | | - | a a _ 19GUED BY DORNTER CASKET CO.. BOSTON, MASE... 1016 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF dawn BS thle AU AZO rar “—s ly No. Yearly Tota/ to date 7 LOeta ft Residence.. Place of Death Wife or Widow Vifary Ee Date of Birth 1 Chan 22) ¥ | eo a (Day * 3 a Years | Sex } Col Yate of Death 19 - I ate oO (Yea (Month) (S \ce J Months ; Single s Maiden Name I A Days | Married Birth-place Seemtete. Co . oe Name of Father ye a Can i oredy upahion QGreliti Ca nein Rirth- pli ice cm © kel Pte oral 5 o 243 it a Race‘ Maiden Name of } roll cr yo Mek (é . Sie Birth-place {O44 > Ca. - Cause of Death rima Secondary Certifying Physician - pr< Ele» “+ sf att ia Place of Burial 7 Gyek Ce € R 7 Cemetery Fune: al Service at s oe . oth Putin the D one mark like this sis : wf rd me this Time of Service 2 gen h og | ; O-~ tg SS. - i i ark th F dagger thus Date of Interment 7 wit ” © a a ae Casket or Coffin No FE a Size Made by Mote - Lining and Pillow Set No. Porters Handles g Plat: Outside Box or Vault Burial Suit .. Slippers Embalming Z Washing and Dressing Shaving Services L Use of Chairs Church Charges : ! Iz ‘Ge Cemetery Charges . iiss Musi Ee Flowers ar e CR. DR. . oe TOOT 28 REET ee or eernesememmmeerraet ere aes WL3 Sb, fBq Coad F 40,00 ie) 2-6-3] ~~ FU /4 Se oe “] 2 4 3¢ - AO +eCO = 7-36, ¢ | 20 62 ae a tf B/S {#0 f J ei = Oo | 4 4 facie 19 7S” ' X Pe, \ + Wr) its J \) | YP : | )> ath eal Gi en 1 » wMaee. te 1eeUeEDdD BY poRNTet casKxet co sosTd ae co 244 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF lias Clr. i Zod Zz “Lire Pe Le Or MEA an > Residence P wa = 5 a. Back..A4 - hi e co y Place of Death »2-“<t-~2 Moree t ape Wife orWidow or a4 Cha rAonr 4 : Total to date. Date of Birth _. life o of JF. Years ean Color or Race (Year) (Month) (Day) . Date of Death 19.74 SAO Pa FA Age LA Months 4 Single (Year (Month) (Day) 4 Maiden Name L don Days Pee ” ~ > Birth-place DEE ee lee Ce —- Occupation. aes d Name of Father elon. Lh. Je = BLirce Zodis Birth-place- 22 late Sa Whe. Maiden Name of Mother Acteln cule wap Airdier Bi:th-place . oe Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial id te feo cee LO : Cemetery Funeral Service at / a ‘lt tts an : Lot No. Put in the Diagram one mark like! | for every Grave in it. And mark / . » of Service lime of Service é Burial with double dagger thus 33. ae Rea * Grave No. Sf a ee Section Date of Interment Designate site of monument thus . 3 nad jovenanweiniinnioeeiiai Casket or Coffin No | . Candles | Size Made by GE a... | AS \G@., Gloves .. 3.2 | Y) IS o Lining and Pillow Set No.. } | Bearers or Porters | Handles | | | Hearse to .4- : Ji igo Plate Removal ai b Outside Box or Vault Ot 4C0 \8© | Automobiles sieeaans \. burial Suit I | Newspaper Notices lippers } : “lt linbalming 25. \0°)!| a Washing and Dressing I | | Shas | } | | -_ e of Chairs I! '| Transportation Charges h Charges Officiating Clergyman 5 -= { ery Charge ] 8B Jo | Amount of Bill Wf lo? Musi | Goods Ordered by | Flowers | Bill Charged to | DR. CR. | = | | Gy Cache WL LF 7.00 Lg.o é ‘ | the |_504 00 | Ud” |O° | 20 | ee |_ %é {22 | | | | | | | i | | | a ———t aes _ oaescdiaeiie lies ad | ie lo *> % 4e\e-- RECORD AND BILL OF ITEMS early No. Yearly FOR THE FUNERAL OF Tota/ to date PELICAE YC Rf { ( } . Residence j Rion : / er ace of Death ie c P.> r Place a O Kk j Wife or Widow of Qich oe a eta aya Date of Birth.........1 OO 9 / ) : (Year) / (Méuih D Years f Sex \d t : y (Day : U AA | Color or Race Date of Death 194 Lie Gf Pe r . * (Year) (Month) — pe Age Months ¢ Single é Perr A Sing : faiden Name Maiden ! Qhus Days Married «7 ‘ Birth-place y AL ¢ ’ i Occupation ik Name of Father 1 Unset LA yyy, Maiden Name of Mother./¢/ + rae Cause of Death—Primary is ee cata j Certifying Physician & Y > 8 Place of Burial ; One Ka Funeral Service at . (< } een 7 A : nt , one mark like tl 4 b- Time of Service ae oe, cece e : Date of Interment o- y si Tf , ca Casket or Coffin No. Size vessentee. Made by Lining and Pillow Set No. Handies Plate Outside Box or Vault Wh. Buria! Suit Embalming Washing and Dressing Shaving Services Use of Chairs Church Charges / Cemetery Charges Opies ff Music ¥ Flowers CR. DR. — ie ine } } | | i - | . ore sever BY CORNTER Casnet co.. BOSTON. MABS 246 Yearly No. Residence “J Place of Death ~/ Date of Birth — 193 Date of Death \faiden Name Birth-place oflin No. Casket or © Size Made hy and Pillow Set No. Lining Outside Box or Vault Burial Suit ppe } mit 1 it I iil ' Ss ‘ Cha 1 Ch ‘ ry Charge M Il ! DR L1e¥ 7 mis. (i.2ea— V RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Ll ols ee 1A * em OC acta — Wife or Widow of. Years Sex (Month) (Day) dd Lb Age Months 4 Single oth (Dey) .. Days Married Occupation . Name of Father bf SOs I - Mba #¢€ ++. His Birth-place 4 teehee... Maiden Name of Mother...2 ley [4 hy Mh Wh tt Her Birth-place td Cause of Death Primary Secondary Certifying Physician Residence Place of Burial Cemetery Funeral Service at Lot No. | lime of Service Grave No. Date of Interment Section Candles Gloves Bearers or Porters a Hearse to BPLAL-——> Removal Automobiles ................ Total to date. Color or Race Put in the Diagram one mark like ‘|; | for every Grave in it. And mz Burial with double dagger thus Designate site of monument thus f "y | ; | | | | Newspaper Notices | j i j | | | a = | | || | {| j ij j il | ' | Pe | | | } Transportation Charges | | | Officiating Clergyman ae i co Amount of Bill | Goods Ordered by | || Bill C ape * to CR. ot. TT 3a ltrken« G& djdve oon CLK 4 , ¢ | LV S Ces Chced | |_f ty fi eg Ctra tr ee o I ; " l ISSUED BY DORNTER CASKET CO... BOSTON, MASS., 1018 & RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Yearly No. Jur 1 Pi [hs Residence Tota/ to date Place of Death U Lod oc.’ : Date of Birth l BS C cf | os | | Date of Death ag F an J i. ae - Maiden Name ie aie Birth-place t dc (Sy Lee a. . Name of Father Wi Qiu LAN His Birthepla Maiden Name of Mother... Her Birth Cause of Death— Primary per a ees Certifying Physician Place of Burial @ fA Funeral Service at | we ho ‘Sarai Time of Service | 0 3 | Date of Interment [ a Casket or Coffin No. #j + Size J Made by Lining and Pillow Set No. Handles Plate Outside Box or Vault Burial Suit Slipp« rs Embalming Washing and Dressing Shavin: Servi Use of Chairs Church Charges Cemetery Charges Music Flowers ais a sn a RS SEIS DR. mace e'e 1eeUto BY OORNTEE CASKET CO., BOSTON } — vor or Race my | Hy Fi i i | re Hi | ai | on at | Py ' ti ree ere ee ene 3 a ee een Dera, SS - _acsamsiinecm unineme steansatan aston eanlipair Ratan: meat: oe eh Hi if H ra Re ait Hil Bi j 5 B iH mtn talaga ee tt eine 248 RECORD AND BILL OF ITEMS Yearly No. i Bis bj Place of De ath‘ \ fe f 213 Date of Birth (Yger) 19.3 4+ Date of Death y (Year) lif s Maiden Namef- MhhMAhk Birth-place r/ e - f Name of Father SL As Maiden Name of Mother Wi Residence......./ , Sf, Cause of Death — Primary Certifying Physician Place of Burial. ter Panty ( pect 1h Me Tp. ‘a Z hw [pr fonth) LLG Mont V2, 2 Ne Me: es FOR THE FUNERAL OF oxy <f see Total to date... Z Wife or Widow of. a Years Sex Color or Race - ay a”) Age Months 4 Single (Day) 4 — “Days Married ” Qo i eo _ ‘ica Oration... = 4 EVE? a A Ory His Birth-place A cl! Affer Birth-place Secondary Residence Cemetery. / ce y wis Gi Ahtr+ fog funeral Service at”. aie Ap | at No. Put in the Diagram one mark like thi £ Ser J Ait AS “a a “4. a ae | for every Grave in it. And mark eo *rvice / G « . . as : f 7 / Burial with double dagger thus : { Date of Interment / He? : f r Section | D nate site of tth CI esig e site ol monumen 1us: Sa , f ald ’ RY heii - Y zs , _o f : } et/for Coffin No“ j | es Candles fr f ane | / | &¢ or HP FAsh eserves 4 Gra -] Made iby Gloves ....0/f." 4 and Pillow Set No... Bearers or PUrters r| 4 Bao Hearse to /. | | Hate i Removal | | | utside Box or Vault Automobiles | f | rial Suit é | i | : | slipper o N »wspaper Notices | ie | imuing {| ij | i se | | , f fsa t Ay d Vashing and Dressin | a Ah 5 i) Vit | “4 | | | | | | 1a | } j - I \| i : Le 4 Mt tre € Hie L; } C} i. | | Transportation Charges | | 1 Cha ae Officiating Clergyman c i : k Cog / : ry Charge I S| | Amount of Bill 4 iisaicniiaahestnictett Maile 4 {| | | icy hn al Li Nhe Foe. hd \I | | Goods Ordered by * PuterR | At | aes ris /, Ce | Pier eae - “}/~ || Bill Charged to vie —— — == =a Sea = Se aa |. DR. CR. hace pond. a Aik | i — i | ] \| \| } | | i| | i} i i | | | | i| | Fae oe | i} | i | i I ea | i | 1 | || | | 4 | 1} pee ee | | = | {| | } | | | | i sl aoa — i | | | | | } eae | oe § RECORD AND BILL OF ITEMS Yearly No. Than. S ’ Residence ee f — Place of Death fv. Date of Birth... l (Year) : Date of Death 19 (Year) cM Maiden Name Birth-place Name of Father Je. tek a Maiden Name of Mother ./. /.)i4+ Cause of Death—-Primary Certifying Physician Place of Burial Ga Funeral Service at bef Time of Service Date of Interment [- 2 Casket or Coffin No Size Made by Lining and Pillow Set No Handles Plat: Outsi Buria! suit Slip; Box or Vault Emba!u ng Washi Shavin ‘and Dressing Services Use o Chure} chairs (charges Cemete Music Flow. 1 y Charges 1e8UEO BY DORNTE FOR THE FUNERAL OF \ or W f \ i ' \ve Month Single j Days Married Occupat } His Birth-p Her Bir seco. : oe ree « CASKET CO,, BOBTON masse. 10'6 Tota/ to date 249 —_ Color or Race =a ee ad Neen een ee ee nnn nn mmm mmmmnemmme ame nepam meme . = 7 . , LEE OE EEE OO 8 ~ anaheim adele tat tye Bi pm Sct SNES ICR SS Ree 250 RECORD AND BILL OF Pro Goad un 4 Rode Ree Yearly No. THE FUNERAL OF Residence Place of Death ) 6 } g Years Date of Birth 1Y{ Year) - (Duy) Date of Death 19 VY Age g Months (Year) (Day) Maiden Name [ b. Days KY Oce upation .. sirth-place Cobh, Pre dce & ‘ Beedle tap! Her Birth-place - Cause of Death——Primary Secondary Certifying Physician bite fl k Aya Place of Burial Name of Father Maiden Name of Mothex Residence i Ce maiery ITEMS Total to date... re Sex tee mie”... Color Z Race Single ; Ot ncn eee Married nae His Birth-place Licihe, @ a cr Put in the Diagram one mark like i | for every Grave in it. And mark ; Burial with double dagger thus : / Funeral Service at a ae say Lot NOI a Fa aff lime of Service helene. eZ Soave ibe ce Date of Interment * i Section | 3 3 Casket or Coffin No | (ep aa Candlerene Lee Cary eee 2 haw vies,” Designate site of monument thus: C3 7 f NS . Size Made by \| Gloves Lining and Pillow Set No. Bearers or Porters eA | Handles | Hearse to PY Saas nak | Plate | Removal | | Outside Box or Vat | Automobiles | , | ya) 1/ || | Durial Suit £ yA ee, tirkoy || ldeo | | | | 1 j i P | slippers | Newspaper Notices {| | lumbalming \| | | | | i | Washing and Dressing i } | t t iI | i] | Shaving il | |. cae } | | = as e of Chairs | lransportation Charges | rch Charges Officiating Clergyman | 4 f | aes Ee me tery hatges {| Amount of Bill Von Og Mu i| Goods Ordered by l'lowers | Bill Charged to | DR. | | | j = | | i| | i ® | | 2 | pd | i | | | | 4 | Ce i | | | | | | | 1S8UED BY DORNTER CASKET CO., BOSTON, MAGE., 1016 beim RECORD AND BILL OF ITEMS FOR THE FUNERAL OF UA » iaegs ae ee 167! _ Wife or W idow of -_ UP: 7 ga 2 (Year) (Month md é 3 Years Sex | 9 37 J At (Year) (Month) ly No. oo Tota/ to date Residence Place of Death Date of Birth Color or Race Date of Death Months Ae Days 5 Single Maiden Name Birth-place Bees ’ Lo, Name of mee oy Maiden Name of Mother - am Primary S Married Over upation His Birthplace Ay Ge -r Birth-place - ¢ Cause of Death ondary Certifying Physician Reeth ais Place of Burial Ca Reeve el Cana Funeral Service at / ie a Lot No | i ie eh cm ia JI! hue — a f= 3S c Nien a eve bah om it And mark this Time of Service Date of Interment a3: 2-5 oa 7 ond ae 3 ] monument thi Casket or Coffin No. g- a Siz b/g Made by A+ fLo oe | 4% Iining and Pillow Set No era of Porters Handles e to Ait 1068 Plate Ovtside Box or Vault smobiles Aorta Suit lene. resem f Sf oh pers per Notices Embalming Vashing and Dressing Shaving services Use of Chairs insportation Charge ' . ting Clergyman Church Charges ' pres er Cemetery Charges Musi Bi ed by ViUSIC ‘I Bill Charge te Flowers - Accum esses - on wovenaar DR. | ww } ror et ’ 1eeUER BY CORNTEE CASKET CO.. BOSTON MASS. 1h e es i a) 258 55 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS | FOR THE FUNERAL OF Total to date Yearly No. as FOR THE FUNERAL OF Total to date. ie ae ; [Kes (Prizgel, 24a, COA h i AOAM 216 Loy. Wea Bit h5 EG ‘a PEA M . Residence : nN gt Ei ailliaas oaes a | Lecce. e or Widow of Place of Déath C£4£€ Ce Wife or Widow of Place of Death ff hat Wife or W Date of Birth ] 86 65, Years Sex Mew Le es or Race Date of Birth (2 Fs a (ies Years _ =e (Year a | Date of Death 193 Date of Death 19 3.4 Ave Mont} y (Year) y \laiden Name Se ae ees Residence f. sake aii ETERS TENE IEG TTL i cca 2 ARE SORT (Year) (Méath) (Day) Months 4 Single LG. ... Days Married 6f,04......... |... — Maiden Name | i : Birth-place fore a 7C ce Occupation *..2......c4e-0... gee ean. Rian cucdent Birth-place _ c i ee Bl ; Name of Father Capf CL /hatlal His Birth-place : “Ge ALE Name of Father = a thf His § | ; Paes TF . Conia” ; Birth-r Maiden Name of Mother (Ler p An lok d- Her Birth-place s 2 - Maiden Name of Mother... Ya 7 i A Her H Cause of Death— Primary Va - ; : 4 Secondary. tee shsst fee Cause of Death— Primary ary { } f Oe t ee : . fe sici = nr ie Certifying Physician KY: ( fe of eee Residence GL Certifying Physician i Place of Burial Gatewood Cemetery e Snide Place of Burial .... {0.4.4 Sas iaisaiaenicianiilt } Lede. Ca ; SL ie aetihs if F Funeral Service at /Ce r . Lot No, . Put in the Diagram one mark jike this Funeral Service at a i PS as oh ibis He: a ' | for every Grave in it. And mack this ~ . Coe P j i ae 1e of Service Grave No. i Service he : fe Ime of Service rave No d Burial with double dagger thus Time of Servic c § ; i : 1) . j “rme Secti iterment ~~ ss ie / Date of Interment ection | Designate site of monuient thus TJ Date of Interr ; | ioe. Casket or Coffin No Mika’ pleas ao wee | Candles a Caz iS Casket or Coffin No Size Made by Gloves <f-@> Va 3 : oe | Size Made by “** | Lining and Pillow Set No.. Bearer%or Porters I. lining and Pillow Set No. Handles | Hearse to a : Handles Plate . Removal wv ‘ / Plate Outside Box or Vault eet oa | | Automobiles ane 2 f | | Outside Ecx or Vault ee ok Yip fy g2,Ll4 600A 2 || a sUrlap,_Suit Cece her 7 “Lo ea . othe. Zz Soh athert Ay v dent = Burial S: Jura, , wt ie i ‘“O °F WO op. Kanes & | eg i, Ce ae a Slippers ' i | Newspaper Notices “4 CAS he — Ae ae Slippers | : | i} } 7. | | é . Embalm / | } . iz and Dressing | | Washing and Dressing ' win ° | | Shaving A | i] 8 (/C+ UC Ce, | | : Services . ° | Services I | ies Use of Chair Chay i] | Transportation Charges Use of Chairs sideline aie Church Charee ij | Officiating Clergyman Church Charges 4 i ssp | oJ inieienaipl Geaniiionmacnnns athe ges : 2 ne no bese Anite | 8 a Cemetery Charge Caos ae FO | Amount of Bill Pe igi sie - Paton Rill Cemetery Charges E j J | y a | J ee M ] Goods Ordered by Prewlek A | Musi oes Musi ,00ds re :. : Pull os a usic | | Bill Charged Miusde ch trates | a | lowers sill Charged to Flower: _ q icine ici aiaigliasiiecasiaca ee : a “i CR. | ij | DR. DR. a“ —— —— ny “ itileat sieht sian a = ae since iii Ss : = Be | | | R cg | eo} ae i -- i } | | iy } | | psn } me | +: | } | | } | | | A | , | red | | | . | | | | | | | ee TE ae eee iat illite | oeton sere pDORNTEE CaeKet co., BOB'S Amey '®8UED BY INTEE CASKET Co., TON, MASE., 1016 me Pane, siabseds scence ie ct ee z ue ad aia : way. 254 RECORD AND BILL OF ITEMS Yearly No. Ly » CY, Residence LO \a- ner 193.4 C (Year) a 19.3 0h (Year) Place of Death Date of Birth Month) Li arselill Ce - Name of Father tid fh Jt CH Maiden Names« ~ sa {¢ 1Z | Date of Death Maiden Name Birth-place pa Ruckaned Wi “hed FU ak” OF (Ht Wife or Wigow of. ALLL Hs. Years Age Pal Months we Days ~~) - mh ~ i g a fees te" His Birth-plac LOfaet tap tsHer Birth-place Occupation . His Birth-place Tota/ to date Sex Color or Race Single Married ee ef Cause of Death— Prim Secondary . . ' f Certifying Physician a . e-G se Residence © « ae f A oS q%.2 { . Place of Burial £ Cemetery Funeral Service a F024 d r. ¢ Lot No. : : Put in the Diagram one mark lik« this lime of Service // 4 7H fé Grave No. } oe es Seno te. Anh mn ‘ Burial with double dagger thus Date of Interment ; / Section | s y es f Designate site of monument thus se ' Casket or Coffin No. / Candles / fx MH ner Size... ¢ / i. Made by fd Gloves “— Lining and Pillow Set No. Bearers or Porters - 1 Handles | | Hearse to i s | Plate Removal | Outside Box or Vault </¢ // b Automobiles ee | lsurial Suit i] i Slippers || se Notices : | i a ohifemes | hinbalming L- I | Je i ~¢ ttt Lg | | I} | - i| | Washing and Dre ssn i| i C 4 e-t-« “<C| | i i} | j having | | coh | | | | | s¢ of Chairs i || Transportation Charges irch Charges i Officiating Clergyman oe | | si I | emetery Charges i | Amount of Bill fs Font 4 M } lc usic 1 || Goods Ordered by " " ‘ i | | “h, , / oo blowers j AS Bs af AD | Bill Charged to (hehe. fr g Jo | - a ‘ : lias DR. | | 1 | 1 } | i | | | |—— } _| | | | | | ! | } | | } | | | ‘i il | | —_—-— =“ } on | | ' ‘ 19OUEO BY DORNTER CASKET CO., BOBTON, mASS., 1016 ¥ we tickles 255 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Tota! to date < 5 e s % “Hh yc : Lh , é beer 64 tet oe \ Meera see Residence ae ALE — , il Place of Deat): {Ce Wife or Widow of Date of Birth ST oe eo en a2 _ 4 ee ce | Chen us Ge Date of Death 19 Fad f a Age 7 Months 4 Single 4 Maiden Name a Days Married Birth-place Ak x lo: Occupation Name of Father A f / - _ His Birth-place J Cd m= Maiden Name of Mothers Jaalle. toe i a (Her Birth-place Cause of Death— Primary Secondary Certifying Physician L Vv Kk. AA ’ Residence Place of Burial LR é ‘ FY AA — Cemetery Funeral Service at PULA Lot No. | rin tie? ne mark like thia Time of Service yy i re git Grove No ac - 2 a Date of Interment S Section Deatanate nent thu 7 . 3 Casket or Coffin No Candles Size Made by r I Gloves Lining and Pillow Set No Bearers or Porters Handles Hearse to Plate Removal QuisideBor-or Vault Aa} fi ag Automobiles Burial Suit Slippers Newspaper Notices Embalming a Washing and Dressing Shaving Services Use of Chairs Church Charges Transportation Charges man a a Officiating Clergy Cemetery Charges Amount of Bill aie inet Music Goods Ordered by Flowers Bill Charged to nr satin = CR. DR. oe ceca pm = NN armen ow ; s | | | } Pree rien | | | } | ! | | i j | | ISSUED BY CORNTEE CASKET CO. BOSTON MAGE ele en EAN ULES : a i ry ‘1 ie atti rth ; i ‘| ; ii j 1 i Yearly No. Residence... Zz Place of Death MLL dh. o Date of Birth. iS B/ Date of Death (Month) Maiden Name Birth-place Name of Father Maiden Name of Moth P ee i /) Certifying Physician Cause of Death Place of Burial l'uneral Service at Ke aft er is 2 Time of Service ALK tf ef IV / f Date of Interment 4/ Bt, Maer te ay el ( Cae 2¢ lo ALL Ogcupation . 4 Zz Ment a= (eet Aevath Pls 5aheZ. Se j OEE sss AE. a CL eC <. oe BILL OF ITEMS “a “FUNERAL Ps a Ove oe Wife or Widow 7) AlisBirth- -place a Secondary. Cemetery oe. an Lot No. i | “Grave No. 6 Section Total to date. t ‘.. Pepeevs f jon Mtn. -place AL alt Ge AK... Designate site of monument thus Color gr Race Put in the Diagram one mark like (}is | for every Grave in it. Burial with double dagger thus : And mark ¢/ _ bead . . . Ak i o y | Casket or Coffin No. (EEA, AY oF Candles ak , fl ~ 3 Size Made by Gloves JERE [Ni hoe Pv * A - | ; ; . | | Lining and Pillow Set No.. Bearers or Porters | | it ( —_ | | na wal Handles || Hearse to CELA, pi | Plate Removal | a i Lb Ontside-Ber-or Vault | Automobiles ke ‘ nl Burial Suit H slippers i} Newspaper Notices i} i lmbalming ps | | | 1 Washing and Dressing ] | Shaving | i| i| | Services i II | se of ( | | Transportation Charges hurch Char I | Officiating Clergyman | . we |) Cemetery Charges Ht | Amount of Bill a tt Fs ve aati | Musi 1 riowers ae | Goods Ordered by Bill Charged to i as Se 'S8UED BY DORNTER CASKET CO., BOSTON, MASE. 1016 257 fF RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Tota! to date —TAA ‘ o q ; . : ai ‘ Ms, |v arthvem terith . Borie Residence +o Ate LC WM ‘c ; Place of Death 1 ie lo en ee Wife or Widow o? = -Cui j ~ CL cei Date of Birth l S fl a } ij y x a ta rate ase (Year) (Momth) (ody : | ° rte ace Date of Death 93. ~ Se. xe Age , ~ Months é Single Maiden Name s Days Married Birth-place ~ hero al es Occupation Name of Father Ken “2 Ls AME te His Birth-place 2 a 4 Maiden Name of Mother(A/U ‘“Her Birth-place Cause of Death— Primary ; Secondary Certifying Physician b’ Residence Place of Burial . \WLera--44-*+—— Cemetery Funeral Service at " ; Lot No ere Time of Service © at ip Grave No | t Ap ark OF pg a Bu t} ger | Date of Interment \ / 2 Section a * oO a: ® Casket or Coffin No Candles Size Made by Gloves Lining and Pillow Set No Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Noti Embalming a Washing and Dressing Shaving Services rs | Use of Chairs Transportation Charges Church Charges Officiating Clergyman — pirinnintone Cemetery Charges Amount of Bill se wo alallin ted aetna Music Goods Ordefed by | Flowers Bill Charged to DR. CR. i, lL i | | | ISSUED BY DORNTER CASKET CO.. SOeTOn MAGE ene ia nee ae 10 a / a i vt Ca ie 4 i ia + ——- 258 RECORD AND BILL OF ITEMS Yearly No. Residence ot Z 3 Place of Death Wife or Widow of Date of Birth 19 3S 3 Ye Coe oud ( ‘onth) {Bee or oe Date of Death 19, = & “5 = Age Months ¢§ Single or (Moth) d q “ r Maicen Name oe / ZI a ¥ 4 Days Married Birth-place o ‘ : Occupation . . (L Z ale ' oo / Name of Father & ft 7 AA € aid His Birth-place once ——————— Maiden Name of Mothe UAT T hd ‘ (4 ¢#lbe-Birth-place LARK 2: > Cause of Death— Primary f Secondary ( Kes: Physician. Residence { ; ‘lace of Burial Lt i Cemetery . funeral Service at Lot No. lime of Service Grave No. / + f -_ Date of Interment 4 af y™ Section Total to date... Color or Race Ate Casket or Coffin No. 4 i Candles Size Made by | Gloves Lining and Pillow Set No. Bearers or Porters Handles Hearse to Plate | | Removal Jutside Box or Yawk Automobiles pper || | Newspaper Notices Jiminy I | Vashing and Dressing | i ae 2 | | »of Chairs } | Transportation Charge: Church Charge i Officiating Clergyman smetery Charges } | Amountof Bill a Music | Goods Ordered by ta fan ba Flowers | | Bill Charged to ————————— ————_—__=_—_—_——_— Put in the Diagram one mark like |/)is | for every Grave in it. Burial with double dagger thus And mar Designate site of monument thu» [j TA EO TNSAIO ESE EN SM RA NRHA Sa I mmeareeceee: SS AEE UN Sa Se AN AE ETT SN ORIEN UREA RE > AARNE ee ] FFA fi / ry, | coe oe | | | | '88UEO GY DORMTER CABKET co., BOSTON, MASG., 1810 i | senna | | + RECORD AND BILL OF Yearly No. FOR THE FUNERAL OF Residence Place of Death ve AKoege oa ad 492) 8 e 25 ITEMS Tota/ to date Mawrie Basiuke Wife or Widow of Felorwa rd ‘Che Date i Rirth $7 uw, wv 4 2-—Ye lee Sex J ( aan aces Date of Death 93S WF, 2.3 Ages © — Months ¢ Single , al Maiden Name 2-2 Days | Married 4 Birth-place lbetaatl, ae & ’ Occupation Name of ay i, z- LJ doliscmanck— His Birth-place 52 ela a. Ww. ¢ Maiden Name of Mother eee Chitthad 2 Na thine, ten. Ge - wv Cause of Death Primary Secondary Certifying Physician Residence Place of Burial itil saamiilln Cemetery Puseral Service 0 dideahgannd Clack laps PEENo D rk tik Time of Service / O 774 6/247, Grave No ty | with doul ao Date of Interment é a ee. oh A Jo section nate site th 7 weenie mae TS AE AS ROTO antec oneaRS Casket or Coffin No ‘2ye0 WE JI 2d Ris: Made by dleeae - Candles Gloves & harg Size “V3 00 Lining and Pillow Set No i Bearers or Porters Handles Hearse @r— Plate Removal Outside Box or Vault Automobiles Burial Suit Pen cl namennee i ah Shc 2 WW Slippers Newspaper Notices Embalming Washing and Dressing Shaving Services — Transportation ¢ Use of Chairs hei y Church Charges Officiating Clergyman Cemetery Charges é oC? Amount of Bill iaccicabicaabeniaaaeh asi : Goods Ordered by Music Flow Bill Chary ged to Lh latibesr t Cam pote dc hiOwcrs a CR. ‘i aiiiidiminipieniinmnin sisi aisiiiiiaeaciniiminiae _ eres eneamen renee Sa SSSESSSSSESS q wa , on on 4 4.) wnathe , é as! i. bp ise Geer jap) ¥ =) r fe | | " | | | y é | | | | | | i | | 19BUEO BY CORNTER CASKET OO., BOSTON mame ‘ere 9 rere hJowdure | 1 i 260 RECORD AND BILL OF accoeing Yearly No. Residence. Place of ie Date of Birth — pergpicl 1% b 2. (Day) Date of Death 19d 0h - O (Year) (Méeth) (Day) Maiden Name Birth-place Sukibl op Name of Father oD, ee Maiden Name of Mott 2 Al Cause of Death Primaty Certifying Physician a . 4 , Place of Burial (2 « i ¢ <7? treet l'uneral Service at PY Lf Lee Time of Service Date of Interment we / 2. Pe ee a. ss Casket or Coffin No...-¢ hb . | s b, . x Made by Pog | Lining and Pillow Set No.. | ang JO FOR THE FUNERAL OF Total to date vy ss ~y oe oF : = Wife or Widow of ee Ala < PO Lg Years Sex Ages . OY Months 4 Single Days Married ’ His Birth-place Pere tue ae wd CoS r Birth-place Secondary - 7. Woy 7 43 4 Cité ling Lot No. | Grave No. Section Occ upation ... Residence Cemete ry el <2 zacke ae | Candles Gloves 7 Bearers or Porters Color or Race 4” A ste «Shs “7 4j <P Put in the Diagram one mark !! And ma I for every Grave in it. Burial with double dagger thus Designate site of monument thu BPR NAL CJ Ha Hearse te Removal de Box er4@iult Automobiles A. (ae L— j | Baste | | | P| ‘ | Newspaper Notices 1} | | ilming f || - J | i | | ing and | i * l| i {| | || 1} | | | 1 4 i | | / focae i | | t Chair A iH | Transportation Charges i 1 Chars | Officiating Clergyman tery Charges 4 | | Amount of Bill M Goods Ordered b¥ | | I lowers } Bill Charged to DR. | | | ZUBS By J | C | | } (4 i | i| I} | | i CF ee | |__| l | Poe {| | Ze - | | | 7, - l | Le 7 | | | i] |} | i} “5 | } | | | = | | 1| 1] I 1@8UEO @Y DORMTEE CASKET Co., BOSTON, mass., 1e18 RECORD Yearly No. FOR THE AND BILL OF ITEMS NERAL OF Ries hatkely Ane Residence Place of Deat ALA negli C. Ma Tel ae A iy ee: or Widow of Tota/ te date 261 Date of Birth | cu Vea Ss. ! R (Yess tHtomn) (Dey 10 Py : ears | Sex for or Ra P ot } - « | Date of Death io Jy Hb AS “fem ha 5 ail (Year) d (Mens) (Day) . . Maiden Nam Days Married Birth-place ” RMA : _ Occupation + ~ Pe of Father PVA war His Birth- -place £ / a a hos oe wer idv oyr< (¢ WAL ry Maider on Name “ MotKer "=. \ -— Her Birth-place pte ‘ Cause of Death—- Primary ‘be: ney Se »condary Certifying Physician Residence Place of Burial eee Cemetery Funeral Service at \ ' Ne if A VA ot No ; : eee ‘ ; { A Time of Service — Grave No Date of Interment ~»**44, ~~ ~ Section : s a ~ a x . snasieenannntinse serene —— on sane Casket or Coffin No. _ f Wak a 7 Cee G4 Candles 5 , Size Made by Wife REE e » Gloves ff 7 e , 4 -_- . Qo 9 i] tf a . Lining and Pillow Set Ndé* rvtele, chads ahd a ecococed Bearers or Porters . ) *, Handles [Hearse to cence ae tee Plate Removal Outside Box or Vault é ©Go co Automobiles Burial Suit Slippers New spaper Notice Embalming 5 . . fa Washing and Dressing > - ssp Raf, Shaving / Services b Na... _ On « Tes of Chairs ’ Transportation Charges 4 gi 7 leaJ ‘ Church Charge Officiating Clergymar J ahhh she £ 5 ‘ . y OlC¢ / Cemetery Charges Amount of Bill e<4 ‘emetery Chary : ot Music Goods Ordere os hanes y % yy Fl oa Bill Charged to A *T Wins hax <¢ ft Beng owers Mise as Fane | Dae oa wail, punaaleapersannamrenaigtaion Dr , CR . Vv ¢ « © t OD : ¢ . | / | | } } | | [ i 18OUED BY CORNTES CASKET GO, BOBTON. MAGE 1016 262 Yearly No. Residence “ht S40 ie Date of Death 19. Place of Death Date of Birth Name of Father Maiden Name of Mother ee eee Cause of Death Primary Certifying Physician . es MonyS) j i Maiden Name | | isos Bet fas zB (icy hed typi $i RAL OF ‘idow of. = Years x) Ages ...9% Months / 7 Days Cs Occupation Lh His sididtose Her Birth-place laalie lc Gee RECORD AND BILL OF ITEMS FOR THE F Lae, Mee We eh Tota/ to date... hh A he ry CG Zz or ae siciteaitte; Single And mark this Casket or Coffin No. a aon ainn aTaaat Size Made by ie Lining and Pillow Set No... a ai ‘ Handles co ies ; 7 Plate eo yt Outside Box or Vault i surial Sui ' Lippe rs embalming : : | Vashing and Dressing 1 sha i } t vi e ol Chairs n ¢ charge s Cemetery Charge sl a BS er em RE SARE Eo Candles | Gloves Hearse to Removal | Automobiles Newspaper Notices | ASlog | | | | } : | ! Transportation Charges | Officiating Clergyman Amount of Bill | Goods Ordered by. | | | Bill Charged to | | | | | | Place of Burial Cemetery i : Funeral Service at petedeuee +m No. ‘ : Put in the Diagram one mark |)\e this i lime of Service Grave No. I for every Grave in it. - Burial with double dagger thu : Date of Interment Section : — Sy Designate site of monument th: '@8UED BY CORNTER CAaKET co., BOSTON, mAse,, 1946 Yearly No. Residence Place of Death Date of Hirth Date of Death Maiden Name RECORD AND BILL OF ITEMS FOR THE FUNERAL OF teujll, Cha, ©. Mee ta Resor Wteahketiee | A tes fh Al Wife or Widow of l 4 ; Het he aM “f Years | Sex 19 - = {iloash) 79. i Age 4 {/) Months ¢ Single (fk. Pho | Married Birth-place Name of Father Maiden Name of Mother Dhevgoveh é Cause of Death— Certifying Physician Place of Burial. Funeral Service at Time of Service Date of Interment Casket or Coffin No Size e Lining and Pillow Set N é 8 fw! atl ye rf Plate il ED seers Outside Box or VYeult Handles Burial Suit Slippers Embalming Mlrw.© foo, Primary Ht “a f . ar Oce upation a His Birth-place » e bo2e G we hate Co | feels, Her Birth-place Secondary Fs oe Bak mene Cemetery Residence Tota/ to date a — Ae” A C2 ee Ly SYM ies $b. Stat No. r ¢ / y Grave No / Section Poa a 5 “Aa 126 ore Made by Candles Gloves A ‘ Bearers or Porters Hearse to Removal! Automobiles Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Fle ywers Transportation Chargs yr Phhciating Clergyman _ Amount of Bill Goods Ordered by Bill Charged to pA TE IY ICE 263 Color or Race one mark like this rk thas DR CR. ry | SVL ya a . + a | 7 | 1 | ' ; | - | , | nit | i wt ate 1 ome | Be | | due i pe | . tele 19BUED BY DORNTEE CASKET CO. BOSTON maw i ae ace 264 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date... Mh 44A ey LA Le ta ee Residence. = Place of Death Wife or Widow of... Date of Birth ] = == . a a Years Sex Color oF Rac ear) (Month) (Day; Date of Death 19 Age Months ¢ Single (Tear) (Month) (Day) Maiden Name Days Married rth-place feceatee- le -Al &. Name of Father Occupation . Ao L- ML. His Birth-place OMother Her Birth-place Maiden Name of — Cause of Death— Primary Secondary... Pees sige Certifying Physician Residence Place of Burial Foe £ icaeny £ ff, ee a Cemetery . fe an te J rg luneral Service at A Lot No. Put in the Diagram one mark like this I for every Grave in it. And mark ‘his Grave No. Burial with double dagger thu: Time of Service ao" at Date of Interment Section Designate site of monument thu: i ] 7 Casket or Coffin Mo. Candles Made by Gloves Lining and Pillow Set No... ..4| Bearers or Porters Handle | || Hearse tg.........°™ Vlate Removal... #-- Qutside Box or Vauit | Automobiles | Uurial Suit | | Slippers | Newspaper Notices | Embalming i] Washing and Dressing Shaving l| | | | se of Chairs Transportation Charges hurch Charge Officiating Clergyman : i Cemetery Charg I | Amount of Bill | Music Goods Ordered by i | Bill Charged to ZF Oo, |OoO he ome Ae MN Ve crn AUB a ie ¢ OW cK < Chet A aie yh W Ths_B Ae ft 41> r BAe | 7 Ge: — — es —— 265 RECORD AND BILL OF ITEMS peony Sor FUNERAL OF FT 3/ 2 {ved 129 /O ‘, ly Ni Fonny om Tota/ to date Residence... Place of Death Date of Birth Wife or Widow ot Minnie. Cm AAOUre) Frown (Year) (Month (Day { a7 Years Sex | Color or Race Date of Death 19 GF eee 2 daa od: jo Age » Months § Single } | l | Maiden Name per Days Birth-place (pra 2... Aa Occupation PauweZe Name of Fathe Guna Fon. His Birth-place J “of Mother har0 raha. — Her Birth-place Cause of Death Certifying Physician C-&, ALer A31-fhee” Place of Burial Funeral Service at Se — +f J°- por Date of Interment tas Jf aie Section | fg. , cy penetra mite FSA | Married i Ta dee. ee 0 SI, ars eh en dita Ho - ' ae < / Maiden Nar Primary Secondary Residence Cemetery Lot No. Bic tn sha amy Time of Service Grave No SS se AN EE 4 Casket or Coffin No. a é<., Candles # Gloves Bearers or Porters Size Made by Lining and Pillow Set No se i Hearse to Handles iL Af : ( hndiedltns * | > Plate Removal wey ; , on ims, she : / : Outside Box or Vault “debdecddhe PAS I WAPI Sd / ' Automobiles Burial Suit Slippers a Newspaper y Embalming Washing and Dressing Shaving Services ..... Use of Chairs Pransportation Charges Officiating Clergymar shaieainmonsd seemviiaaiies Church Charges P — ount of Bill Cemetery Charges Amount of Bi \ : Goods Ordered | \iusic Bill Ch arged to Flowers DR. | , | } | i ener: ' ISSUED BY CORNTES CASKET CO... BOSTOM, MABE.. wre RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Mla tick a silent. Pens wee ii em Yearly No. Residence Place of Death Wife or Widow of Date of Birth iné - - 7? ©. Years Sex som (Yer) Oe (Mgath) ts Date of Death 19439~I = a Age Months 4 Single (Year) (Month) 4.2 Days Married . # Maiden Name Birth-place ie Haare Cu a A Name of Father Sle erev ¢ Maiden Name df’Mother A 7 MORI ee Cause of Death— Primary Certifying Phaysision nes £7. Me ee te Place of Burial... Bee Crectv Fusecil Sevvioe 0 ee Zo 2 wm, ae asf Occupation Secondary Residence Cemetery Lot No. | Grave No. lime of Service Date of Interment Section Total to date. Color or Race “fy. : ’ . e EE cst inite te Birth-place Wren Ge < he e ¢ Her Birth-place Leatee LL Cam wc X. £ Put in the Diagram one mark }ike this | for every Grave in it. Burial with double dagger thus Designate site of monument thu: And mark shis CI Casket or Cofiin No. + | Candles | Size Made by ] Gloves & 1 | Lining and Pillow Set No. || | Bearers or Porters 1 Handles | Hearse #——. | {| | Plate | Removal ee | Outside Box or Vault } Automobiles | | Burial uit I | | “tippers 1] Newspaper Notices j ‘ i} pay | linbalming — I Zd Oo || io. I | i| Washing and Dressing || | | | I pd Shaving I i | | seTVICes e l| | | } | | | | I of Chairs & {| Transportation Charges a | rch Charge | Officiating Clergyman | ” | ery Charge | é © © | Amount of Bill f SS low Hi Goods Ordered by | | 1 | | Bill Charged to secaeiaialtiiaiiaiatiesipabadliinieaa # a a ; a bd | j | i | | Ge RECORD AND BILL OF ITEMS Yearly No. OR qHe FUNERAL OF Tota/ to date 7 Pete sl calla 4 fh Lap Dae ae Vet ober] Minis. Deferrrutlern Residencé... (2lee ra. cl o Place of Death are 5 “A a. at Wife or Widow o? Date of Birth 3 Bae (Mouth (Dey Years Sex f Color or Race Date of Death = 19 FI ~ Z z Ww ia (Month) (bf) AM LO Mews § Single 5 JLi®) Days Married Maiden Name Birth-place ag fee Name of Father tom ee -¢ ag mr Maiden Name of Mae Primary CL. dh a < Oce upation His Birth- Pacg ft A a 2 aide Ce er Birth-place C @¢ ee . Secondary ei Cause of Death Certifying iniaien 1. . Residence . Place of Burial Ray e i- o-2-€__— Cemetery “une Service at | I uneral ReNee a Lot Ne Putin the Ma one mark hke this Time of Service Grave No I for every Gray it. And mark this Date of Interment DB 2 ~ oe Section | | i » ‘ onument thus { ] Cash et or Coffin No. Candles Size Made by Gloves Lining and Pillow Set No Bearers or Porters Handles Hearse to Removal Plate Outside Box or Vault Automobiles Burial Suit Slippers imbalming ashing and Dressing having rvices f Chai 7 yrtation Charges Use of Chairs Transportation Charge i { ) o Clergyman . iat Church Charges Officiating \ ‘ ; 2 Ce Cet 1 Ch . Amount of Bill 2 a emetery Charges oods Ordered by Viusic . Bill Charged t« riowers ul marged to re oe uta i] | | | ul | ' 198UEO BY DOAMNTER CasKET CO., BORTON, MASE. 10'8 a ie } { 4 Ef FRI A PORES ETS anh ee Reh 2p AACE Ng Ta eee late 268 RECORD AND BILL OF ITEMS Yearly No. iad Residence Vihes Place of Death Date of Birth ...1 i (Year) Mon Date of Death . 19 ie J ig ear) nth) Maiden Name Atti, ne Birth ert ager ig fo Name of Fathe ae L Aa Maiden Name ¢ othér it THE C YY, SHh. Primar aT _ . be C0 .) oi ae Certifying Physician CAhking u ADDY. #S lime of Service ~~ Date of Interme io te oh Y, ar a Cause of Death Place of Burial Funeral Se Casket or Coffin No i £64. hain Gi — ko at Papen Bask ec! heck Cpe (CA FOR T' THE FUNERAL OF Total to date... ie leit Cofor or Race Married (Lad m a pelts Ce a WG os a C4 be a 34 .. Years (Day (a Age Months 4 Single (Day) 4 ©... Days HM € Occupation .. Z, yp His oe Her Birth-placeSae~ ' RY ge Curstidence Cemetery Lot No. | Grave No. Section Put in the Diagram one mark |i} | for every Grave in it. And mark Burial with double dagger thus Candles Gloves Bearers or Porters Hearse Removal Automobiles Newspaper Notices re S| oo = Transportation Charges | Officiating Clergyman | Amount of Bill } Goods Ordered by Bill Charged to Designate site of monument thus: [” mead Size Made by Lining and Pillow Set No. Handles i} Plate Outside Box or Vault burial Suit slippers i inmbaiming | Washing and Dressing | Shaving I i - | ervices | | tse of Chairs i : i Charg i I Ceme y Gl lj Mu | I r | DR. . — | | | | | } | | ' | ' 1 * i | | | | 'S8VEO BY DORNTER CASKET CO.. BOSTON, MASS., 1018 - Ao RECORD AND BILL OF ITEMS Yearly No. Wea FOR THE FUNERAL OF FIL AAs j }a iy. ¢ Ld. pa titans ~ MRA sis cad : : Wife or Wi 8B, i a 52 .Y ( Ses Residence... Place of Death Date of Birth Date of Death In’ nF Ss. f. ; a 08 Maiden Name a cae Birth-place Calan sees ma ‘ Occupation Name of Father ALN £ { { y His Birt! ok . Maiden Name of otheraarid (Ee Birth-pl s Cause of Death— Primary ani. Certifying Physician a R, Place of Burial... Vis.aal—C. Funeral Service at [Rew faa % Po Time of Service Date of Interment EEE Casket or Coftin No Size Made by Lining and Pillow Set No Handles Plat Ouiside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving services Use of Chairs & Church Charges Cemetery Charges Music Flowers 7 ‘ ——_" DR. a... | | } a | | | ee am | | | | Tota/ to date % wh \ amen , ore. 1SSUED BY OORNTEE CASKET CO Boston, MASE art a ee i fo Ties een Sat 5 a hi seni: ee 270 Yearly No. 7 Pian net, Ecye. OoLtyr+y,: Residence --< Place of Death < wt Date of Birth Si (Year) Date of Death 7... (Year) Maiden Name Birth-place Name of Father Mya ‘lt RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Total to date... on fees ,. Mu. C= Sherr os , Wife or Wid f * EEF Years Color or’Race (Month) (Day) ‘ i Age Months 4 Single CL E. (Month) (Day) . Days Married ! Occupation .. be ele ee ee ck ee ee Ct Cone His Birth-place LA wd ts ORB ben Bech L é.. Use of Chairs Transportation Charges Maiden Name of Mother ..@«-t-¢' 7 A tt b Her Birth-place ef Cause of Death—Primary Secondary £ - ‘ Certifying P hysici ian \.. Residence Place of Burial Ae? old f fs oft H. J ¢ COMORORY 1.5.2: Scsserctereis : T luneral Service at Lot No. - | Put in the Diagram one mark like 1! as Cente No: | for every Grave in it. And mark //; : _ ~ Burial with double dagger thus : { Date of Interment fm ae PF AD Section ‘ ; Be Designate site of monument thus: e t a - : ie : nN nee Nad i ba 7 a al ae . : Casket or Coffin No. 7 oo || Candles Al | Se | Size Made inf se ot 2 i] Gloves | | i | Lining and Villow Set No.. i| || Bearers or Porters Handles | '| Hearse to ee Re ‘hk Ch bee ¥ | | | —-— | | Plate Removal Cj | V Outside Box-er-Veatt | Antomobiles | | Liurial Suit i | | || 1 Slippers I | Newspaper Notices a] | ° | i | embalming , | 2 ui Ce | i| | Washing and Dre “sing | SHavilh | | | ‘ | i | as | | HI i} rch Charges i Officiating Clergyman Cemetery Charges } Amount of Bill Music } || Goods Ordered by SE Pa As Flowers | | Bill Charged to Ihe. Yi? Z YON Octet. DR. i a , aye o: c gcse LH2 Fem %. fae i i kt aah erie = |/e2 te lt | ‘ BML 4 fF MCs met | | | | | | PLA co K 40m, —" one | | | Yoh 7 eM pg aks | Ble Paice We | | oud | | | | ie =. | er | sll | | iA ee 7 Daasal } | | ; | a is | | | | | aa a | | | 4 ares oo * HN J 8) co os | Sd | 1S8UED BY DORNTEE CASKET CO., BOSTON, MARS., 1916 ZtS |e - de RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Faassh PP ti Ms , FF 3 sa Lf : or W 1 8G ife or Widow of (Ygar) Se 43 | oi Y \ ears i 9d A LO 3 Ages 7. Months (Year) (Month) ie o Days Ovi upation Yearly No. Residence Place of Death Date of Birth | Sex Date of Death ¢ Single (Day) Maiden Name Birth-place Dried el Q Co —- ee Name of Father OAR irre Orb, Gath Married Hie - Her Birth-place RE wee His Birth place Maiden Name of Mother Cause of Death ng <4 Secondary Certifying Physician P= fie P sgh (P tates tony bi Place of Burial inet ao Funeral Service at Ria bas a Time of Service 2 ee, we OE oo = uti Date of Interment fof't | 34 burial is Casket or Coffin No. Size Made by LOS \e0 joe Lining and Pillow Set No Handles Plate Outside Box or Vault Burial Suit. #2. S0 Slippers Embalming FT sae a! os Washing and Dressing Shaving Services .....A—. Use of Chairs .-— Church Charges Cemetery Charges a Musi Flowers DR. ee mec - ase te ieeuED BY DOANTEE CasKeT CO BOSTON ™ 271 ] Tota/ to date Color or Race Yiagram one mark like this nit And mark thi ceases emeeeeimninaeate cteistetininiiies stilted a eect 202 RECORD AND BILL OF ITEMS Yearly No. Residence ‘ Place of Death Date of Birth Date of Death : 1LgST / 6 (Year) (Month) (Day) 19 34 KB oe Oo 4W@G Name of Father (Day) Maiden Name Birth-place Maiden Name of at ape nna oP Birth-place Cause of Death— Primary ( Certifying Physician ha: SY, Tova Place of Burial luneral Service at 74, r - ch, oO —_— lime of Service 22 pore LOE AG 3S M0 of 7 Date of Interment Casket or Coffin No. Size Made by | | Lining and Pillow Set No.. I Handles Plate Outside Box or Vault FOR THE FUNERAL OF Baa... Trawirar haven Uturrctl Cakau ter Wife or Widow of. Z & Years Sex Age ¥ F al Months 94 Single =< Days Married Occupation . My . ss As. 2 A © ok His Birth-place Secondary Residence Cemetery . Lot No. Section Grave No. ro. | Aso 2.Q) Candles Gloves &~ Bearers or Porters Hearse te——. ... Removal Automobiles | Total to date... Color or Race Put in the Diagram one mark like this | for every Grave in it. Burial with double dagger thus : } And mark th: Designate site of monument thus: C3 lsurial Suit | lippers | | Newspaper Notices ee I “lo inmbalming I ws oO i f WW ishing ind Dressing a | | | | Shaving | | ee | | | : Use of Chairs Transportation Charges a hurch Charges Officiating Clergyman J ee erg ce ee oe | | * \ Cemetery Charges & I Amount of Bill < Musi Goods Ordered by | @ Flowers | Bill Charged to | CR. sl nie iii ian nie - eamaianan 2. 4 La = 7 a (esr par hia heey | | | I pa mains " a 1 ee om 1S8UED BY DORNTRE CASKET CO., BOSTON, MABS., 1916 sass ee RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Tota/ to date wi Ae re ign ekpws idow of Yearly No. Residence... Place of Death Date of Birth l (Year) Moath) (Day) f QO Years Se | olor o ce Date of Death 19.3 . é - 1 a . : : me — (Year) Meath) Age Months ¢ Single ; Maiden Name 1. Days iteibiin Birth-place Wiklrea Co - Occupation Name of ee Wanker His Birthplace 4 cL [rm Co - Maiden Name o other. Celelarre Phovr2— Her Birth-place cf _ Cause of Death— Primary Cite Bak, Cece Lasfoadary PLra¢ bes oie y. hazk, | ee te c Gertifying—Physicim Pte horn mse + 3. yehnmpaanalm Aiprusk aD>~ fps Utena? Wheat, — Place of Burial ee , Cemetery Funeral Service at : Lot No. | ica seein | itin ‘ lagram one mar tke thts Time of Service 2 27% ye Crave No | | for every Grave in it And mark this ee a S Burial with double dagger thus Date of Interment Ae sd 3 Section Designate site of monument thus C. J Pr Lrymenf — Rurracee Mnarkpur — See epee KE ME. | | A ee Made by Casket or Coffin No. tf Candles —_— Size Gloves Lining and Pillow Set No. Bearers or Porte: Handles Hearse @a07 Plate Removal Outside “ae Vault Automobiles Burial Suit Slippers Newspaper Embalming Washing and Dressing Shaving Services Use of Chairs Transportation Charge Clergymat /oojes Church Charges Officiating Cemetery Charges Amount of Bill Goods Ordered by Music Flowers Bill Charged uch fete ritrak Firma c2_ Ladd — DR. CR i s a Lu 4 | | | | j 4 me | | : | micah | | r m | a - ; | i | i ISSUED BY DORNTEE CasKET CO.. BOSTON. MASS. 1016 272 Yearly No. FOR THE FUNERAL OF fbn. Meririre Latrslagtne aha etl Cekau tea LAL l / Residence Place of Death Date of Birth VI Pe Wife or Widow of. 1857 / 6 Occupation . Birth-place Lredell Co e 4 CG Quali. Name of Father His Birth-place Maiden Name of Mothes/Aecalerce- PUY Le0 rer Birth-place Cause of Death— Primary Secondary Certifying Physician Ly- FF, Lore a & Years Sex Me Se i Residence c abner tn (Year) ri (Month) (Day) Date of Death 3 LE 8 Age + E Months 4 Single ear, ont (Day) Maiden Name __ Days Married ) | Place of Burial Cemetery i funeral Service at 4, r - ch Lot No. [ | k lime of Service 2p re - fJOS/d-3S a Grave No. | Date of Interment . ches e Section 5 cs - RECORD AND BILL OF ITEMS Total to date... Color or Race Put in the Diagram one mark like t}i | for every Grave in it. And mark :/: Burial with double dagger thus : Designate site of monument thus: . t i | | ’ i aeaiiiacatacidaaiiidaieaiaaiiaia ee —— - Sa i ' , Casket or Coffin No. I ae S$ oO 2 OQ) Candles | Size Made by Bie et | Lining and Pillow Set No.. Bearers or Porters | Ai bd Ales Hearse te— | d Plate i Removal. &<...... eel: ik Outside Box or Vault Automobiles .................... ¢ I durial Suit I | 1] | 2 i ippers | Newspaper Notices Bae Rachelialiia | 2s leo] \ imbaiming i| | } Washing and Dressing @ i ei | Bad ; laving || | | a. — | of Chairs i lransportation Charges et { 1 Charge | | Officiating Clergyman ! + ? fe ; id 1 Cemetery Char L \| | Amount of Bill 4 a AF be ie P | | eae Music || Goods Ordered by ) Flowers Bill Charged to DR. CR. = we eee ee eee = ree | | J ot : | } } | | | | | ; | i | | | 2 i awa cece _— | if ba ISSUED BY DORNTER CASKET CO., BOSTON, MASB., 1018 ~~ cecilia sincideiauiliiaiaaaoiin = 273 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Residence Place of Death Date of Birth Yearly No. Tota/ to date Tce ean ee Widow of Bs (Mc —-s <e GO Years Sex Pike se Date of Death 0345" “a 1 a ror Race (Year) 42 (Day) Age } Months } Single d | | Maiden Name Birth-place W rk2\r24 Co - Name of — Wanker His Birth-place 1 ch [ne ln = other QRdehnr. Jnoer2— Her Birth-place ee Fe Cause of Death—-Primary ep ae Aect Larsfondary Baa tirnstite qe Baki, Cen oth Minn salle c - wrens badd, gene eg i pencgageale Aaprusl; ahir~pa Uterine Wieofy - 1 tw. { Days | Married Occupation Maiden Name o Cemetery ~ . , Funeral Service at Lot No. ; 3 Pati ieagram one mark like thi Time of Service 2 22, ne Grave No I for every Grave in it, And mark this ee , I with ible dagger thu of Interment J G13 1) ronument thi Pnfrrment— Raseneee .. - Nese Hope Dee “ne a7 esignat - 7 = Casket or Coffin No. G ‘fe Size b/s Lining and Pillow Set No. Candles Made by Gloves “~~ Bearers or Porter Handles Hearse @07 Plate Removal Outside ws Vault Automobile Burial Suit Slippers Se Embalming Washing and Dressing Shaving Services Use of Chairs Transportation ( Officiating Cler Church Charges d Bill /O20;00 Cemetery Charges Amount of Music Goods Ordered b Bill Charged droll ait ww fte ritriad Fes PUZee C2. aad} — Flowers DR. CR } ISSUED BY DORNTER GasKET CO.. BOBTON Mase tele RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF fue , Residence Place of Death Wife or Widow of... His Birth-place Name of Father z LAV LL on) CA. Doorek.. Total to date... Date of Birth 1§.7oO d/ fe [ b 4. Years Sex (Year) (Month) (Day) - Date of Death 19..5§ a id Ages . J/ Months 4 Single .. + (Year) (Month) (Day) y Maiden Name 4 4- Days Married B rth-place ~d_dh ae ei Fe SE Occupation aM Bate adeiaticnll cs wate ac: ob. he (Ccrcarchagsdeacd: as ies *" Color or Race Maiden Name of Mother.444<~-{-4a~ + Her Birth-place Cause of Death—-Primary Secondary i Certifying Physician. Ka — a 42+ Ate i ~~... Residence ; , Place of Burial “4712. ¥ re Kh {24 _ Cemetery Withee giih% beeen biases if ; = ore off a Le ial J | ! Funeral Service at errs: a — ‘AdLot No. Put imthe Diagram one mark like this ! 4 lime of Service of Ms. AA af Imma Grave No. ee dt for every Grave in it. And mark ‘A . . a Burial with double dagger thus : { ‘ Date of Interment ..7/—/7 - - ¥ --—Fi_ armas... Section Wn : ‘ i | De: te site of 5: | j 7 signate site of monument thus: [ ] L : ' = eS === — — — ~~ --~ -— ae eee . i Casket or Coffin No../ , JV. + | 250 2.0 Candles . 4 te K ‘ | 4 Hl Size [La ditsct&... Made by // Gloves i | Piha Lining and Villow Set No.. Bearers or Porters F | : Handies | Hearse to \y neem KA... bho | — c ie | : Piate | Removal fl Bt ‘ 4 Outeadte Boxor Vault - ca 4.1 € © | Autémobiles » y = | ) eEtil i burial Suit \ | i fe lippers Newspaper Notices 2 kemb iming #5 I mf ifn 4 ‘ uF Ce. ES fy i LA A Le . Washing and Dressing ] | 1 7 | | am Shaving {| | 2 i| } i 2 Sa) , L | | es | se of Chairs i| | Transportation Charges | te rch Charge | Officiating Clergyman | } : i { etery Charge ) i ae Amount of Bill Cs PF / | Music ‘ | | Goods Ordered by t if | | i hlowers | Bill Charged to ome DR. CR | /2/3 (ay re 373 Hy j ! . f——1_a TC oO} kK . | oF ‘ | 1144O-£-|A . 4 er i i | | ij 1] I " il i | i | : | | | | i , } 4 | | | | | a | | Ce | I | | } | Liss | oe 'SSUED BY CORNTEE CASKET CO.. BOSTON, MASE., 1018 4 1 — Yearly No. Residence... Place of Death hadioon Date of Birth | xb 8 Date of Death 936 ss Maiden Name q Name of Father Maiden Name of Mother Cause of Death— Primary Certifying Physician 7 Place of Burial Funeral Service at —. Time of Service Date of Interment Casket or Coffin No Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault (AS, _ Burial Suit Slippers j Embalming Ak y J Washing and Dressing Shaving Services Use of Chairs Church Charges Cemetery Charges Music Flowers DR. REC z Birth-place Grrr aury z Co ~ V. “ e ‘ Ox 3 Pa —~ II - Bm 5 Grave No Suerte cy rere ee , Sunal with d ble d RD AND BILL OF ITEMS FOR THE FUNERAL OF Tota/ to date Rev. Wall}! Wirlig WR 1 L") Years f[ Sex AA. 26 Age Months § Single < Days | Married upation His Birth-place Her Birth-place Secondary Residence Cemetery "yn. cE. CDR ior No. Pisin thin Diaeran one mark like this And mark this dagger thu ie Section [ . nument thus: [J Candles Gloves Bearers or Porters Hearse to Removal 180. ©O © Automobiles Ne wspaper Notices Transportation Charges Officiating Clergyman el el Amount of Bill RacMickd deena Goods Ordered by The Loh ypernnclir. he 77 We Bill Charged to CR ss siaaiaiebin stage nar gt - WV * 1@8UED BY DORNTEE CASKET CO., BOSTON mace tote 276 a a RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. T FUNERAL OF Total to date... “s YN ; res y Mesd Moa. oany Me » | ; FOR THE FUNERAL OF Total to date Un ad ss if" A: sees acehensennennenasconsapenseneosacenonnanesrseresanesnsensoessnesonesensssesees . a } Wy (fe Ai f U 4 f - my ee g fs fa ie Deas wk rv ' \ v 10 a 5 ote . y> ey a Ag q. Jenedd sr dee ey : Nae ae iets “4 b Xs VAY Le Le oe —t “A Place of Death ZEN Wife or Widow of... ' ee re eee en cee Place of Death Next AL Bie ernment a Wife orAWVidow of Date of Birth 1.6 4 ¥ / 2 Years Sex Pt. a Color or Race | Date of Birth te lid 1% fp 2 ‘ i , (Year) (Month) (Day) | fy (Ygar) / h (Mperh) (Day) _— / / Years Dex ~ ALA, Color or Race Date of Death 19.3.6 2. J2 Age Months 4 Single .................... gee i. eo j Date of Death 9 Ae : ap P ri Vy re é (easy (Meath) (Dey) | a Poceea™ my pr” "ons Age i] Months § Single 4 Ce’ TCL . # 2 | ' Maiden Neme ... Days es one 5 Maiden Name 4b i alley‘ : ws ; —_ | tects 2 Birth-place — a « ON eo hu ee sa Birth-place i hy ti; tae uh (Ce iin Name of Father Solent R/. ela A His Birth-place AC . e . wtnsiandaonasens Name of Father LO CK His Birth-place oe erenw, ie ssf Maiden Name of Mother.. Her Birth-place A. C . tieeeteteesasseseeseeens Maiden Name of Mother ..... ¥¢ hex ud GA iif Her Birth-place | Cause of Death— Primary Boater I ss eenecscccsmne “ seteeneanereetearenaangees sesso Cause of Death—Primary ee f Secondary ne { ‘ AL - Va } “ . ye Certifying Physician / de Residence . wensensusasnennsenonsnonsenese Certifying Physician ‘Ae oe ee Ke eo Residence een ) ) a ; : : \ t / ’ ~. ~ 4 Place of Burial e akir—~ el __ Cemetery . seeveeees om sseaseeeeersensessnecnensncs Place of Burial a Chu, ee. Cemetery ee ‘ 2 J ZY ta 7) ; 1 f A : hale i l'uneral Service at / “tee ey - ot No. . | Put in the Diagram one mark like t}: Funeral Service at ~ “8 he IVA oe Lot No, Put in the Diagram one mark liket! Bein | : “ “ | for every Grave in it. And mark (}/: . ; J aA “yr, a 2 Ze pee oy ee oe 25 ' ; ee lime of Service LS Fs Grave No. fected with double dagger ei: Time of Service ve DIC/ LIV ae —(_D~ js Grave No. : ; a =" : ey ie x sae Rip / Date of Interment 42-72-28 Section | | Designate site of monument thus: [~} i Date of Interment | A. 4 2. Section Ricsianiin aie cb eae Cc Tat j . / ! ree eso ny i > a Seen (MCP ce, fe! | aoa CL hee ecae 8 Cc) Ese oh 6 aA car oY MM ta Na WA aa is of Bein on | : | ; i | 3 = | ; | | = = See = = FEET RTE 2 Hit | Casket or Coffin No. |: 8. Sha | TLC .€0.) Candles .. Il. ; ‘ Casket or Coffin No. the) ...0 : Candles | { | ™ ae Size oa Made by . L) I | | Gloves a | ee al A Made by ke CL / OO Cloves if ( \ on Lining and Pillow Set No.. | {| Bearers or Porters Lining and Pillow Set No. Bearers or Porters Handles || Hearse to de = | j Handles Hearse to | : t, Plate | Removal | Plate Removal : | + \! | ie es Outsige Box, or Vault Oh awh. a | A Pleo i Kein cl tettneces lend frw | Outside Box or Vault : Automobiles oe 144 Css ~<« 7S ~é | [po~o | z . Lurial oho ofa lee (2 | 2-|\S8 | Sani, Flere pom 2s Burial Suit i | | ial ey ippe we | 7 [| re Fia—le she | Slippers New spaper Notices fee | - -— ai, / embalming I : Aw : eo | Qa. r. tele Bc -f- Me Ly See - I Embalming | 3 | Washing and Dressing | Srrw (frm Whh cond ae é | Washing and Dressing {i Shaving | | a La “Camb o PN. & Shaving % | Ww 2st | | iB services L— | -Ff. Cowell. > me SSE gute j Services 7 - es Lo-. SF aeeod Fe | is wail “Ls T ro Charve i Use of Chairs #7 | Transportation Charges || S-\ed Use of Chairs ransportation Charges ia: Se / { Church Charges #7 I Officiating Clergyman Church Charges Officiating Clergyman viditibibteeii ctnbiacian i a | ape ; A ' : : | Cemetery Charge — | Amount of Bill oe , Cemetery Charges ——— Amount of Bill pectin i ; | i Music | Goods Ordered by Music.. Goods Ordered by i | | Bill Char » log Mea ie lowers | Bill Charged to Flowers ill Chaz 4 es i ae OSE ee ee eee ne ; F ee ee ; Lard ta-< i DR. Dk. i - rae inion ‘ ea | ial aecanenaneneenaat 2 sas | | | La ‘ | | Wy Lhecfe July / 20, '90 7 Ps eyeh cohol tH Sibel 40,00 | | | —/ agp SL, ! | re oe pee 126) % cane” — /0.00 | a | |_| 29 ea / 0.00 | | | | =| | J B- 2 26] » "Sc /O-Q0 ’ | j | 2 et re / > IO { | 47 3-/0 3 ¢ me Ad | | ‘ / » ; | | f +f QJ Gi | | |-—— | : | y 1D H 7 om ie a ‘ ' J joo io b 6 ; : fe ($-2- 36 “4 ia J |Og | ae | 7 eae J” CO j | , } od 23 S00 | | ; | 20 " c " | £0 joo j i ; a =e ; 72 jd | | i | 4 @ eC : | i snes Cama } (oleae ; :, | i i| 3 | | Lm a | Ps sane | aoe wie 'SSUED BY DORNTEE CASKET CO., BOSTON, MASE.. 1016 ISSUED BY DORNTER CAsKE! CO. BOSTON lalate meee eiietl nieenniaten eee et pp ian ID NIT 7 Coreen eoendorteenseie ae RECORD AND BILL: OF ITEMS FOR THE FUNERAL OF Total to date... Yearly No. C7 J 7 Hen, T x a / ’ f 74 Fk" enna whe /- eh.Ss ; cs ssrcniad nica eee cnbaanaatieet ap cien Residence a . C < ; Sted ~ f 5 ae o ss f. ar Af Place of Death ...4..¢ oe Lf- , ie Wife or Widow Off #466. 4.4...... Chee cnetahee Fitypec Cube L “" et « / Date of Birth 1 eS. ihe... 2 g a 2... Years Sex Color or Race ee (Month) (Day) Date of Death 19% UV . Age Months § Single (ay (Month) 4s 8 8 Maiden Name Days Married 4 » 7 Birth-place laa C** : 4 eae Occupation ....... care LA2 (Lt oe < WoT ey ee Name of Father Le ¢ 94 rs “ His Birth-place , ie A Maiden Name of ae i ha C2 a tebe Cea Birth-place : xl ~ _ Cause of Death— Primary Secondary Certifying Physician / , Residence A, Place of Burial. .“id-€" 2. et hte Ofer Cemetery . , / Funeral Service at / . ] ine Lot No. | Put in the Diagram one mark like tli a ne Gaius sir é ne I for every Grave in it. And mark ¢/, Time of Service .... —_ Grave No. Burial with double dagger thus : / Date o° Interment Pid fs emt Section ] r Designate site of monument thus: 7 Casket or Coffin No. I <&e| Candles I ; i} | | Size St Made by../ ‘i | | Gloves r | ‘ | | Lining and Pillow Set No.. I || Bearers or Porters | Handles | | Hearse to /~ | Plate ] | Removal \| Outside Box or-¥entt \ Automobiles Burial Suit | Slippers i I Newspaper Notices 1] * | Embalming | | | Washing and Dressing | . Shaving | | i services | | | e of Chairs | Transportation Charges } hurch Charge | Officiating Clergyman : | ppt yn Cemetery Charges | Amount of Bill ao : || ety Music...... ; | {| Goods Ordered by Flowers i | Bill Charged to | DR. a = % ~ vi —| | -| \| | ° | | ! | | | a } | a | } | seni | | | mee | | | j j | pinnae \| } | al | ; | | Ps | on J . | 4 - ‘ | | | . aaa tie-in | od | ce = | : | | in ial i sicaaerploesioerineallll carob oncsigll | | | | 1S8UED BY DOANTEE CASKET CO., BOSTON, mys... 1008 NSS renga, ag ene tte ALS > 279 RECORD AND BILL OF ITEMS Yearly No. ty No. FOR THE FUNERAL OF Tota/ to date | haw : ais Went eee C7 — Ach - Ce jes * eee Nee “ — Residence: [oar SF eis tie Cot ae os “~ iwe4, 7, 4 —_— . . é Place of Death ity sy ~ Vu ss dt a Tem Wife or Widow of ~C +t et gj 14 fs. ig - ee Date of Birth LAS ? & a / ' ‘ If y ss Date of Death os a — os —s Sex | Color or Race aaa (Moath) (Dey) \ge , Months 9 Single ; oe Maiden Neme — { Days Married Birth-place CAV O—CLL , ) \. Occupation ~ He Ji Name of Father YIAA AB Pubes His Birth-place i Mai.’2n Name of Mother 2 oe ; 4 : Her Birth-place “ Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial (S-< ¢—-7 0 Cemetery Funeral Service at als i AS < ~ {ST No 7. x ; - ; Putin | mark lik Time of Service oe Cesce Me “ ‘ Ar k gh Date of Interment SR ah ee J -& Section Miner are : rif (des ela Mea acct A al Mt a dicbiiieaidineius Casket or Coffin No Candles * Size Made by Gloves Lining and Pillow Set No. Bearers or Porters Handles Hearse to Plate Removal Outside Box or Vault Automobiles Burial Suit Slippers Newspaper Notice Embalming Washing and Dressing Shaving Services. p-~ Use of Chairs Transportation Charges Church Charges Officiating Clergyman sik ol ou Cemetery Charges _— Amount of Bill bol all senha Music Goods Ordered by Flowers Bill Charged to DR. CR ae ere soe dd S54 sa Oo it / 3 a uaenth Ji 90 ISSUED BY CORNTER CASKET CO. BOSTON MABE 1016 sa teenineil ical F sconainaetieeceniaceemehielinetcannetieeneioniticehiaateesneeeneiamnnainemnemntatanatiteeniininaaiaainidie olimetiamdaad rene REN Se Seat gem a PNR 280 RECORD AND BILL OF ITEMS Yearly No. Residence... ee kdabe 4 / = — r Place of Death Date of Birth B83 (Year) (Month) Ry 3G Date of Death ion Fo Go. ie ' Maiden Name Birth-place FUNERAL OF Total to date... % r Wike or Widow of. ice Mae 3iF..Years [Sex Age Months § Single Days Married Occupation ....... His Birth-place Di secshin Color or Rac« Name of F _— ees a “i 7 Maiden Name of Mother. z Her Birth-place conan atti @ a 4 x €. Cause of Death ies Secondary... é eer Certifying Physician ae teiien Residence ace of Burial sae Pe - — > Cemetery . + luneral Service at Lot No. | Put in the Diagram one mark like t/ Hea AP Gin cetnin (casa No. i for every Grave in it. And mark (A: Burial with double dagger thus : / Date of Interment .A-.— &- 8 4 Section i ‘ / a Designate site of monument thus: [ J ( ( LA ies Ler £1 ef Pro) L | F Sasa : : asket or Coffin No... | PS charehe Candles +}. i .. Made by. i Gloves I. i I } Lining and Pillow Set No.... I |} Bearers or Porters | | 1] ss | Handles l | Hearse to et | i Removal le Box or Vault I Automobiles rial Suit i 2 /pers i| | Newspaper Notices || | ibalming... i 4$.. eo | Washing and Dressing i | —e | | | | } ervices | i e of Chairs I i Transportation Charges hurch Charges | Officiating Clergyman emetery Charges | | Amount of Bill zo O; Lo + ; | Music.. lI | Goods Ordered by j | | | : Flowers } | Bill Charged to DR. CR. SWAl pa Z, Loh c : | q = nck : | Y | | Tt | 4 | i {| | en | 5 i “Hh | j =| ! \ ee / =| | {| a vs } > | | | \| || 1 ] : / ] \| | | | | | | I} | ‘ | i | i | | 1} el | | ag : / | : | a oe fs } | 7 | | —— a a sibditikinusiia ii aisle | | j {| ete eee ee ene eee te mes 7 | a — —. I i } -_— ——|| —_—_—__— | } 7 a | | 1S8UEO BY DORNTER CASKET CO., BOSTON, MABS., 1910 RECORD AND BILL OF Yearly No. 4, FOR fine Residence re}. LD. f ‘ORF Place of Death h c Kode hess, Ce .— Date of Kirth <&} ss (Year, (Mouth (Da Date of Death 19 3 7. é (Year) (Day) @ ; Ces vktie AC D (Qrew lad. hla ore Q/3 ‘tO O-8 f i eee ___ 30 Om’ 7 36 Fe Maiden Name * Birth-place Name of Father Maiden Name of Mothe U/ Cause of Death—Primary Certifying Physician A BLES Place of Burial Funeral Service at Time of Service Date of Interment Casket or Coffin No Ls thad ” Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault Y Burial Suit 281 ITEMS THE-=UNERAL OF Total to date | ying I F Aeatel — cl V ife ¥ Widow of of Years Sex Phases: Te Color op Race foe . Age 4 I Months « ) Bach aure) “ € t | Days . Married Occupation i BD " ag / WT. a ao Stila rite Are His Birth-place ‘ Her Birth-place Secondary Residence S — Cemetery f Lot No. P i Pulir tiagrar n Mark like tt { aa Grave No ! : A ae Bu h doul ¢ Section r I ate site nur hus 7 Candles Gloves Bearers or Porters Hearse to i temoval Automobiles Slippers le Newspaper Notices Embalming a ¢ Washing and Dressing Shaving | Services Y Use of Chairs ” ransportation Charges Church Charges Officiating Clergymgn ee siscacidaia eae: Cemetery Charges .: Amount of Bill ones ama Ze 7— ee Music ” Goods Ordered by Flowers IO 977 LONG a Binh ¢ harged to DR. CR. wa sores = : y = | a Laity | | | | | | ISSUED BY DORNTER CASKET CO, BOSTON MARE ARON at, apaepeicons: ea een nega a 282 RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Year ; ly No FOR THE FUNERAL OF Marg OL SL JM Duley Prakeeg Tota/ to date Residence Place of Death Nea Date of Kirth 146 _ g ia Wife or Widow of (Year) (Month) (Day) Years r Sex i Color or Race Jate of Date of Death 19 3 6 ao Ape ¢ Months ¢ Single (Year) (Month) (Day) 5 e: ie ) Yearly No. FOR THE FUNERAL OF Total to date... a y ee 4 A1¢ 4 : . a, Y €t mas. ~ AA ez \e - A+ gy jasstniakinnnadiiiiandadiniike Residence N Ba f wf f i . se UY ; Place of Death ~ = al Wife or Widow of... Mp ).L4 ba A hd. ithe ‘. . . «® -_ * j cr" Date of Birth 1 - 4 ~ = ¢ ( bat oO Yuin Sex V Colgr or Race ear (Mont day Date of Death 19 2¢ S 3 Ag Months ¢ Single (Year) (Mouth) Wey) — ee Maiden Name Days Married Birth-place N iit Occupation ....... 3 : ee ‘ ec Name of Father 44 se (\(.4) His Birth-place .<<¢-¢ A £2 = Tks ~- . Maiden Name of Mother f .....Her Birth-place .9f. Ztacrcsw. KFS... EAA a Cause of Death— Primary y PE iescce en ce ee ee 5 Certifying Physician Residence a Place of Burial C Cemetery . 4 is ” oh rt Te ke Funeral Service at Lot No. 47 + . | Put in the Diagram one mark like |); Nia ol Gasina Cisce Sin. | for every Grave in it. And mark //i; lime of Service ; “aie eO Burial with double dagger thus : } Date of Interment ob Secti : ae ee / — ] Designate site of monument thus: 7 3 L A | OE Or CIEE ac Acie hee ecient oe accesses Mapa ee hae Candles Size Made by Lining and Pillow Set No.. Handles Gloves | Bearers or Porters Hearse to Plate | Removal Outside Box or Vault | Automobiles ..................... urial Suit | ee ippers } Newspaper Notices iembalming | a pt | Washing and Dressing | | Services se of Chairs | Transportation Charges hurch Charges | Officiating Clergyman Fee Cemetery Charge: ¢ SO | Amount of Bill : i i Music | | Goods Ordered by Flowers sill Charged to DR. CR. | |_ DJee | |. #.leo : | eyrar oe maz ( | | 2p \0¢ | | } I al | } | | a | | m |— is - nt onan a. | | sieialiichliesal = iolliceaaicadeiddaiia ase i 1S8UED BY DORNTAE CASKET CO., BOSTON, mass. 1018 Maiden Name Birth-place Mododintl, Name of Father LU. WH - Yrle Ecbva_ Maiden Name of Mother a. Occur Days | Married »ation His Birth-place Her Birth-place Cause of Death—Primary Secondary Certifying Physician Residence Place of Burial Qaleuroirs_ Cemetery Funeral Service at Jt — Lot No. ee Pat he Dia one mark like this Time of Service a ~ Pr — 3-22 “36 Cra No I for eve ‘ rit And mark thes ‘ ol oe es ™ , Date of Interment Section Q Designate site of monument thus [ ] Casket or Coffin No. @ -¢€ em H4621/ Candles Size Made by Gloves -— Lining and Pillow Set No. Bearers or Porters Handles Hearse to #7 Plate Removal #7 Outside-Box or Vault Burial Suit Slippers Embalming Washing and Dressing = Automobiles Newspaper Notices F. Services Use of Chairs uu Transportation Charges Church Charges Officiating Clergyman i einai ice Cemetery Charges mo Amount of Bill od - : ne aaa Music Goods Ordered by fi Flowers Bill Charged v4 A DR. CR. cae | scenes | | pane | \ o Voth wthi*y aI enddh /ce.co oF "749/236 0-39-36 1SBUEO BY DORNTER CASKET CO. BOSTON mMaee 30-36 '' bY-9$ "eh /§04 (00,00 Mine |- 26," 6809 "21246"7A /00.00 " SIST “32d.3S/7¥ 100\90 *£15> "/9.29 seen 76815? GISS “2923-1848 /7O° CO “WSYID “SIPPWM-/00 CO ‘S673 42563 IQhy / O}Vo “5471 ' 2739 J0eE\C © 7-1-|36 /0-1-26 J/-30-3e hin ee seme ate ee ga apa ” oe eae Uhdmieenealdaemenaneke te eteotonatnes coeatat a tO: on i tara ee ee ee RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF _— “Genes ae RI ae Residence Place of Death Mia osc Mie Date of Birth 1 g t oD 2 g Wife or Widow of... Ps b Yea Sex ...... 74 Total to date... Os. ieee co ( ae or Race (Year) (Month) (Day) Date of Death 19.36 we. . 3d Ages . / Months 4 Single (Year (Month) (Day) Maiden Name 423 .. Days Married &—_. Birth-place 4 C . Occupation ......... Put in the Diagram one mark like | 1 for every Grave in it. And mark ¢/); Burial with double dagger thus : Name of Father. Gg-Zzgt- 7 ‘ - His Birth-place £: Maiden Name 0 hie C oda Him) Her Birth-place AL ' 2, Cause of Death— Primary Secondary... Certifying Physician Ly wt ty i ad Residence Place of Burial. CR ace 2 2 Cemetery .... Funeral Service at ae _ Lot No. | lime of Service Grave No. Date of Interment | pe é Section Designate site of monument thus: 7 7 = Casket or Coffin No..... Candles | Made by | | Gloves — | sand Pillow Set No... | Bearers or Porters j : | Hearse to#&—~ | ul Removal | Jutside Box or Vault tS - e Automobiles ... ................... rial Suit ppers | Newspaper Notices ioalming cai | shing and Dressing | vices | se of Chairs Z | Transportation Charges turch Charges Officiating Clergyman ciel Cemetery Charges . 4 Amount of Bill moma] og Music | | Goods Ordered by | Flowers A « 2 I re o7 | Bill Charged to DR. CR. : | Chal. is we | sip Yf- 7- SE O76 (Dew, Pinin! Le) af oo| f Om | eee | 100100 J = | “ Carh, | fa | ge a | oA, If Arh | Ww Cleasle | ey | jo ] I] 7 Ean | | | | . 7 : a | ir ee ; | + = |-—| | . wa \| | | | A | | | | 7 cS | | | e ae | aie | ae : ae | - —~ | | * enn a — . i ee | a ae | | ; . Bd wt a —_—-——=- eae ~— | en | | nn | = | 1SSUED BY DORNTEE CASKET CO., BOSTON, MASS... 1018 RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Kitked MM ibbn. - f° afar (Ror. - Lo - “" Piha 4e ref ae Yearly No. Tota/ to date Residence Place of Death Date of Birth Wife or Widow of Aba ti o> — Ca oy Years Sex 285 — oor of Race (Year) ks (Day) Date of Death 36 Pe ae “4 igs ; s ik Single br Maiden Name JS oss | Mtawied Birth-place flora ca. & &. i Occupation A Picilinin taste Name of Father cet Ly) La. >a ae His Birth-place Rete Co . kK _€ : Maiden Name ofMother orl Jo u er Birth-place ‘, . Cause of Death— Primary Secondary Certifying Physician Residence Place of Burial Harof Cate Cemetery Funeral Service at Lot No Phas ey bs otal is es ae wk Time of Service 2244 ne Cece Me ! es re ve is i se Date of Interment 7Ay ae Section r CO Casket or Coffin No gael Candles Size ¢/L Metely. 9.6.64 Gloves ~~ Lining and Pillow Set No Bearers or Porters Handles Hearse to & Plate Removal Outside Box om¥ent™ | Antomobiles Burial Suit Slippers Newspaper Notice Embalming Washing and Dressing — Shaving ee Services an Use of Chairs Transportation Charge Church Charges *€* i a Ke rae Cemetery Charges Amount of Bill Cache Noone Wasic Goods Ordered by Flowers fn J7|AS || Bilt Charged to DR. (iit iirlannicebtce aaa ae “ ra a Mx ful 6, vy Af Le / ~{ ‘ ISSUED BY DORNTER CASKET CO. BOSTON MAG te e es a eee eee ne ee ee RECORD AND BILL OF ITEMS RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date S t Yearly No. side ik diduadindia- sie iia 4 W ahlace msmagisai ee eae tin St eh... os Residence ( a ae iii Sif. s. ene le -. ss : 7 Place of Death o cn Wife or Widow of icin lt Mails S ee ae x Rha. alte Date of Birth Years (Sex ??¢ Color or Race Date of Birth ! ; D ' : ep 9 36 (Month) ae — - / * . i ee a a, 2! j 6 7 Years Sex (olor or Race ate of Death nat Age Months § Single th. Date of Deatt 19 } } | 19.3 «aide a Ke 0 el o \ a lb. 4d Ages... 72 Months ¢ Single | “oo Maiden Name Days Married Maiden Name | ot Days Married *& ' le | Birth-place 7 Malt, {> cel, Occupation ; Birth-place Lrectelll Lo. Y eC siete Name of Father b] Qamevd Ww. fp ALR A. His Birth-place Qe ChlEe. la > M £2, ‘ Name of Paley i 7. His Birth-place 4. fo on i : other . te e s a a Maiden Name oft other fa “ a. 7 Pa Le ee Her Birth-place a‘ ‘ a femwer— Her Birth-place Y , / i Cause of Death— Primary TSS 83-2 ae em Mine EPO ONCE Cause of Death—- Primary Secondary | Certifying Physician Residence Certifying Physician ©- PB - Aderwra. Residence Hy Place of Burial — Cf ate (47-82 —0f Cemetery i Place of Burial eased Milf Cemetery } , | luneral Service at 4. 43: } 62 Ce Lend M, Clas Ce. S tot No. Put in the Diagram one mark |ik 6 «/); Funeral Service at Moai der. ee Lot No. | i the Diseram one mark like tl | for every Grave in it. And mark his 3 3o- j : A140 f / (es bet iS 2 Grave No. Ti Service : ' Vime of Service f na ee Burial with double dagger thu: Time of Service Grave No Date of Interment Uf 3 43 £ Section Designate site of monument thu ry Date of Interment 4// ¥/3 3 é : — . ’ 7 ca | | thd, D Df Brvndianrey, * aa Cc. £. fia y" | | = semennemn ee SUF RRR oe Casket or Coflin No. i ; Candles |. Casket or Coffin No Candles . I» 4 i| } | | | : j | Size i Made by A ? | , | Gloves ° | Size b Ik Made by J. C \& Gloves bk ] | | Lining and Pillow Set No. | | Bearers or Porters Lining and Pillow Set No Bearers or Porters | i ie Handles || Hearse to 1 | | Casitas Hearse to §- Plate Removal Plate cS Removal 1 i } | - P | é Outside Box -eg—yaait Automobiles ! Outside Racor Vault 4 Lhios — Automobiles | — i burial Suit | 7 Burial Suit Pe | @ lippers i} | Newspaper Notices Slippers Newspaper Noti te: ot are y ig hanbalming | Embalming —. teks eo \ | : a) cake t_ eh e SJ Washing and Dressing i } | Washing and Dressing ; j . hie ivi Shaving ervices | Services i e of Chairs Transportation Charges Use of Chairs ae ran ! ‘ i urch Charges | Officiating Clergyman oe Church Charges Ofheratin ergyman : i | - mT J ¢ } ee Cemetery Charges | | Amount of Bill Zi if 0 Cemetery Charges Amount of Bill | : | i! } / . \f | Goods Ordered by Music Goods Ordered by ie Mio } | Bill Charged to Flowers Bill ¢ hci a i) : ' a os ere CR i, DR. CR. DR. Niel i ‘ iiniesiltiaaia i ; i RS eam — — 7 ™ , Z fo- é Z, a 268 iS : | Tae ; | pe fa Fad : | | |__| F13.3E | + Laake | 4oO,0° Pell -, oe > les | | | a | | oe (feu. | | | | | AS i | | | ; | a | | I | | | | | | | | | g " | : & : “| | | i | | | a | | | 3 | | 7 | | | | Ss — etd | | SR IP 3 eS 19BUED BY DORNTER CASKET CO. BOSTON mawe tele | ' 1SSUED BY DORNTER CASKET CO., BOSTON, Mase., 1018 eee nah ae arteseneateen’ nen en eaten 288 RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Total to date... Wy Qheei evade Make. Beg Residence. 4 7 Dood Kk ALse nn Place of Death Kaded tute, — we. Wife or Widow of Date of Birth 1 S54 7/ 3 Svears 5 Feeusbe Sex Color or Race (Year) ee ) - (Day) ~ Date of Death 19 7 6 sade 4 £ Age Sittin Single a : ss (Day) LD , / (AF i Maiden Name Ub ne , 1O Days Married ‘ ae Birth-place i Fife Leaf “. Occupation Name of Father 7 theurn,” Birth-place a7 detha Ce ae Maiden Name of Mother Wheurn, Birth-place oe @- Ze Cause of Death—-Primary a. Secondary : ieee Certifying Physician ae Residence NoePaur LE J; AewTa. Place of Burial Cemetery l'uneral Service at sr Lot No. | Put in the Diagram one mark |) ic (hii | for every Grave in it. And mar} Burial with double dagger thus Time of Service Grave No. Date of Interment thee ~~ 3b Section Designate site of monument thus j ] oe; Pee Casket or Coffin No. Mica " ’ é wee} Candles i} H | Size Made by | Gloves ; 0 | Lining and Pillow Set No... Bearers or Porters ; 7 | . Handles H Hearse to ¢ t Toe VA | | Plate Removal | Qutside Box or Vault Automobiles e + . | Burial Suit | Slippers i | Newspaper Notices Kmbalming ' Washing and Dressing I I Shaving i| Joy Services r lise of Chairs a i| bees ; (church Charges aah | Officiating Clergyman metery’ Charges Bf {vere 4. a Amount of Bill JSIVO9 Transportation Charges Music | Goods Ordered by” ; - "“g “flex Flowers -oy- Ne ot J Y 7 Bill Charged to ¢ i DR. Cr. a = ia yl oy age a ’ 7 — | ||| fAeipe| My Che ele 57904 7 F441 =. J fis Bae } | || < | : | |__| |_| | | | | = 4 | | i mel ec ee as be Bae | | | | | ne | | = ; | ; | a | | i | ES a | ee os a a 2 rus a. ee dies | = a | RECORD AND BILL OF ITEMS Yearly No. ao FOR THE FUNERAL OF Tota/ to date Residence... 2D Place of Death Dawe ton; neyo Wife or Widow of 1 wales “er dade Date of Birth l ant Date of Deatk 103 C ( FS Years [Sex olor or Race ate o eath Y eo | | (Year) —. / ce Age 4 Pa Months Single Maiden Name 4 7 Be ta Birth-place Satiebl a2) ‘ ‘ - Occupation Name of Father ofiro = His Birthplace Va. --— Maiden Name ofMother Mtrroh. Cut Her Birth-place s/f Cause of Death— Primary Sannuder Certifying Physician Residonns Place of Burial Qot Camntars Funeral Service at ar ‘ VK es Lot No = iia Putin the Diagram one mark like this Time of Service - a Grave N I for every Grave in it. And mark this ¢ Burial with double dagger thus Date of Interment 13/4 ae aniins ; Designate e of monument thus os Casket or Coffin No. Prt! ro a a i Size Ve Made by Gore Behl, hae Lining and Pillow Set No Bearers or Porters Handles Plate OutsttesBer or Vault Burial Suit ae ee ki, oo oie Slippers ” uae eae % a sf fatices | Embalming o 7 O82 : Washing and Dressing Shaving ee Services ; Use of Chairs a { ration Charges | Church Charges ( : (lergyman sonics [re i ount of Bill be oS Cemetery Charges yx Music = Flowers : “ a? an / ‘ i / DR ; aa = : imate roy ’ pn oe ae ' | yf “hi vb hk, ALEK. “e aad é Ls SSOO i eKkeT CO,. BOSTON Mase tele isSUED BY DORNTEE CA tf Yearly No THE FUNERAL OF Total to date... 7 Yearly No. ig y om 7 FOR THE FUNERAL OF Tota/ to date . Hh 4 Mra , Malle 4 Ar. kha ® v ¥ et4L LAr i £4 He “ol 7 _ . 4 O tf - ‘ “s. i sn ta Residence ce .. «2 : . Residence / ; f o 5 Y (LLL “fe ei l€@e ie | Place of Death Wife or Widow of, GA- aH Bake (Lhoeecet ) Place of Death hed hele. Wife WA low of i: ke Date of Birth l ESY ye 2/ i ie 2Years Sex : Color or Race Date of Birth... 12 J). ULeeg § ‘Ss Sef y fs hale R ‘ie; (Year) (Monee) (Day) t 7 . (Seep) (Mong (Day ) j ¢ ears | Sex 7 ~ | Color or we i; | Date of Death 19.3 b tun Age Ze Months 4 Single Date of Death 199 lo Iy J! pis J ; ei (Year) (Month) (Day) 24 : (Year) (Deh ve Y Months ) Single 5 = ie Maiden Name : -Days Married Maiden Name Lalu ¢ © | Jf. Days | Married Fk frtile ! hi | Birth-place Quel = Le ’ VG s e ‘ Occupation . . . sesrtssersensansesncnsnangons vee . Birth-place ; V A) A C : Fin caine oot i? f 2 f [ f f J _ Vd fo 7 4 -~ “7 (¢ v curt ation Name of Father 144-4. .U/ ye fri], His Birth-place Draclet ca te oe lf} J ge ren . © Quftrdin 2 Birth-place 7 ELEM GB. 10 } ~ < + d ‘ : i, re - eS : , , : ; Z ee ie . Maiden Name of Mother — a. Ph PALCCOY— Her Birth-place See Maiden Name of Mother or h Ke 3 Her Birth-place / VCLELL ee AC i, | Cause of Death— Primary Secondary. Cause of Death— Primary Secondary | . | " <a pe a See A ! Certifying Physician Residence Certifying Physician ip fase. A a meeisoncs Ce L. 4 : Place of Burial Cahwawo0e€- Cemetery . : ’ Place of Burial Oak 00 og. Cemetery / ) 2 e) luneral Service at ft = at Bie. | Put in the Diagram one mark like t/:; Funeral Service at Lot No Put in the Diagram one mark like this | if lime of Service J O_LPAM __ Grave No. ahi ee . Time of Service Grave Ne bean ve Aiea aad At e ark this 3H Witcat tieement 6 Sf — on @ Section Designate site of monument thus: {7} Date of Interment Ss msi / ; | a ma the ig me! 1 | ea | - ieniieuemaniaiamialiia a — a = smmnenae a alii senile i : i | ai Casket or Coflin No yt s Se NE. ebro | Candles | Casket or Coffin No. | ; , } . | / i Siva Made by J | Gloves L- i j Size Made by { | | . Lining and Pillow Set No. i || Bearers or Porters Lining and Pillow Set No Hi } Handles Hearse to A | Handles ‘ Plate Removal | Plate e | a se 1| | } it Outside Box or Vault aes ey? hile | Automobiles .................... Es Outside eS x Vault se U | _ ie iburial Suit gle 2 cad | io Io | * Burial Suit . a | Hi a F i i ippers } | Newspaper Notices Slippers Ht sha. , 2 i H Embalming 1 | | i Washing and Dressing } |. Washing and Dressing ) | - | | 7 Shavin : wit . | + Shaving Al L | | i i ' S | ervices i i ew a eee - I Transportation Charges Use of Chairs iurch Charges | Officiating Clergyman as We ci aactin, Church Charges ssc Cemetery Charges | & | Amount of Bill | ae LE Cemetery Charges ip — yaa! Music } Goods Ordered by Music Flowers Bill Charged to Flowers EASE enciiantind canbe sah ties saa — DR. CR. DR. - . 2 ———— ihc ae : “a — a ca » oO pee ae 37 Od | | of Ly hack af | a 1 or (Pat 7 jews le oer / | — au , / Mean 5 a eg | | | ie ee Rt es te 3 | | | a | | | a \| ma i It | *” aery | | ae . 4 | | | 1 | | i | } I ; | . = | i cd Pras | | | 4 | | ia | i a | | —| | |——— | a | 7 ba | | | ce "| Eo ame Be = | | | j } —{| lj | cue ae etibtee | | 7 | - nt iil | | ‘ | | : | | od i ‘ _ oe | 4 | | a | | j - : \|- Neniereneeprperinne ona sr i | = ae & | | ae Ci | 2 17 . 'y empoeremornes sane tae mowes i i wae eS i ISSUES BY CORNTE « CASKET CO., BOSTON. MASS. '0'@ 292 293 RECORD AND BILL OF ITEMS RECOR Yearly No. FOR THE FUNERAL OF Total to date : 7 Yearly No. D Te aoe gal ITEMS cone yy THE FUNERA F ota/ to date Een 2402 iy Ore MM. KMeklbe TY ake % Maciel 4 i siteune a a a On atin Pornahan zn Residence O 4/1 Lied fh d we isdn at Ciauah qc Pa * — ‘ife or Widow of Nace of Death b Place of Deat! La - Wife or Wid Place of Deat! | AY Ls — a Date of Birth 16st e's Years Sex Color or Race Date of Birth a ilow of , | (Year) 2 - eet Yeas | Sex Color or Hace | . Date of Death 1936 — 30 o Months 9 Single a ree | ade | } | (Year) (Month) (Day) | ins (Month) Day) Nye Month Single ; } | Maiden Name . i Vays . Married Maiden Name | | Days Married Birth pli we 2 Le fe Yo LO game Occupation Birth- ple si Geil Poa . / ‘ AuUpalion Name of Father ML hom Se BEC ae sei, ; His Birth- -place DrewtcLe LO = p Name of Pathe [Car- ' ‘ " on aerate mse cneesrtstteinedn gener is Birth-place ‘ . ~- vf te nope m th | , Maiden Name of Mother. ¢ aan a “Airs Birth. place Maiden Name of Mother mi Tee ; Her Birth-pla + ™ 7 Cause of Death—Primary Secondary Cause of Death Primary ie Certifying Physician Residence Certifying Physician BS tise, . ~*~ Bind it Racial som. a Cemetery Place of Burial Doiatai " j : aneral Service at Com le C tuc Lat No, Putin the Diagram one mark like tis Funeral Service at Ps ¥ ; . A, a [for every Grave in it. And mark sh as et : , wram one m tke! lime of Service , Ae Grave No. J Burial with double dagger thus . lime of Service Grave N + a . aaa 7 ft | Date of Interment If > 3 “ Section | Designate site of monument thus Ct Date of Interment ” ' J iy ’ oo t & } eee: | meneame en some 1 51 Se AAEM APL 0 ee Casket or Coflin No ! Candles | ‘ Casket or Coffin No t : || | > uk Size Made b i Gloves 4+ Sise Mads ty fii LL KL Gva~—y i ae ii i Lining and Pillow Set No Bearers or Porters ! | Lining and Pillow Set No eee ata j | | a eet : H i VM aaracd le i Hearse to. Ao Handles Cee ‘ , t hate | Removal Plate / : \ hk | | : | vr oe 5 Outside Box or Vault | | Automobiles Outside Box or Vault | | | —— | | ' Hurial Suit j | | ; t per | | | Newspaper Notices | Slippers is | i| i 4 } {| i | j 1 mit 4 i| | lumbalming i | , | a hing and Dressing | | Vashing and Dressing v cia | ’ AA ' Vi i| having, lf | 4 | } i I ‘ {| | | ervices r a Cais i Transportation Charges (se of Chairs b fee Charge | } 1 Offi iating Clergyman 7 | oe Churgh Charges es a | | oJ. CoO » : POO O¢ i] if ( etery Charge Amount of Bill oan ey | Cemetery Bars v ORs. saceé , ~ pe eh ; me Musi | Goods Ordered by | i Music L "4a AOudd Ade EE | 1 | spa 7 Power | i Bill Che mee: to | | lowers O-Y 4 OOT ; i ssisiiceieneniincnneaaanieneielitisanitaa sci bi ia a DR CR — 1 - a . ei) F - ” a - te ete ip ie or | i | Se Al | | | | | I es | | | : | | + arma ' hy | + | | | | : q } i} | | j | | } | ; 3 | | | | Ai | oe | oo ed : ae ae | . “ ‘ore 1S8UED BY DORNTER CASKET CO... BOETON, MASS.. 10106 198UEO BY CONMTER CASKET CO wueTey: ne + 294 RECORD AND BILL OF ITEMS Yearly No. Residence / Place of Death f Ldifices @k- Date of Birth ] (Year) (Month) Date of Death 19 (Year) (Month) Maiden Name Birth-place Name of Father Maiden Name of Mother Causé of Death Primary Certifying Physdeten Place of Burial huneral Service at Dime of Service Date of Interment ly, , ¥ Casket or Coflin No l Size Made by Lining and Iillow Set No Handle Plate Outside Box or Vault V 1 ' bouiriad unl lippers nny ny and Dre iy DR. Sane memento a when ce avecemmaneanas parmcrers mane ~9 FOR THE FUNERAL OF byic. AF IEF, ) Lee glk Wik or Widow of Years | (Vay) Ape Months (Day) Days Occupation His Birth-place Her Birth-place Secondary Residence Cemetery Sex Total to date Single Married | for every Grave in it. Burial with double dagger thu: Lot No, | Grave No. Section | Candles (jloves | Bearers or Porters | Hearse to Removal | Automobiles | Newspaper Notices | | 750 | | | | | Officiating Clergyman Amountof Bill sil] Charged to ee be oR plooy®™, vy Transportation Charges Goods Ordered bynky “e . Leccele Va / tian Paw Bo | toy Moor //3! bh | | oi Color or Race Put in the Diagram one mark |ik: And mark ‘ Designate site of monument thus Cc) 1S8UEO BY OORNTEE CASKET CO., BOBTON, Mane., 1010 a Yearly No. Residence Place of Death Date of Hirth , 1 (Year) Date of Death i) (Year) Maiden Name ‘ Ve Birth-place Name of Father (| Maiden Name of Mother Cause of Death Primary Certifying Physician Place of Burial btuneral Service at ee ea Time of Service a ee Date of Interment iy OIE Casket or Coffin No FA Made Lining and Pillow Set No lundles Plate Outside bx or Vault Uurial Suit ppers obalming Vashing and Dressing @ waving vices e of Chairs “Church Charges Cemetery Charges 4 ; uUBic Winwinre ili case, DR. Law ‘ } FOR THE FUNERAL OF ( 1s8UEO BY CONNTEE / i i’ Wife or Widow of Year eX | i Aye Month Single Day Married Occupation His Birth Hi Birtt lia vn oem cen ALLL LALLA Caenet CO, @oeTON masse tele Se RECORD AND BILL OF ITEMS seer onan Tota/ to date (olor or Race 295 296 Yearly No. {tx — i i . Date of Birth if 4 6 = Bee vm ~ i Date of Death 193. @ - / (Mon Residence Place of Death (Year) len Na aT |e Maiden Name oMMothe ie : Cause of Death — Primary v } f Certifving Physician luneral Service at ae i} i lime of Service Coe. wart Wife or Widow of. 4 2 - ; Years Sex (Day) Ave Mont Singl 4.6 53 onths ingle pyr. Days Married Occupation His Birth-place With-place Secondary if. Residence Cemetery As Ee, RECORD AND BILL OF ITEMS ZL hl 2 Di My Carma chat Total to date... Vieille Color or Race Laz. Lot No. Grave No £ Section Put in the Diagram one mark like «|; | for every Grave in it. And mark // Burial with double dagger thus : | co OT Candles Designate site of monument thus: [ ' SY! | He ( /2 B i i Size... 4 Mad de by..Z 3 Gloves. ¢ : Mi nae Lining and Pillow Set No. Bearers or Porters is i e. i { a Handles I Hearse wo © | ive Phate Removal | eee t Guutgide Box or Vauli 7H Automobiles Cc 1 ree vurial Suit ‘ | iF j lippers Newspaper Notices } } a | | | | i lonbalming | 2 { | 7 q | Vashing and Dressing I i | | } | | Caer | 4 wing | | i } eae ae | / j 0 airs é | ransportation Charges | ie rch Charge | Officiating Clergyman ae f \| - 4 | Cemetery Charge ‘ | Amount of Bill Baqo0|° | } 1 | | | 4 M | | Goods Ordered by Th | : i | Bill Charged to | A DR. if scilliaiiiaaiiiasiieiaiiiis ‘ i ee . as i) : Hb | | } | | E | 1 S | Poo | ) . er ; f B | ' j | ee al ee , | | | | | | ‘i = od | IMBUES BY DOANTER CASKET CO., BOSTON, MASB., 1910 — © * o RECORD AND BILL OF ITEMS Yearly No. FOR THE FUNERAL OF Tota/ to date } Aare, aids ae am tA_x ea rc-d Me. 20s Hilo Af 4&. ae Etim? Mapa — or Widow of jet Aas - te er ‘aay * 7 aw, Residence. Place of Death Date of Birth 3 iy Sex Calne ine Mae Date of Death 19 3¢ 6 (Year) (Month) a¢ Ave x Months Single é (@ ‘ Maiden Name te ae . | ays arries Birth-place Je role tA... Occupation Name of 7 oF. tit 2 ‘ His Birth-place be oft Se er Far : x _t Maiden Name olMothe LIA as > -. ie Divehs ition i> te ; ; re Cause of Death— Primary SaApeuian . Certifying Physic ian 74 - <x. Vat. ana. a Place of Burial AMCaw luli Fa ons luneral Service at Tit. z. i: kK ¥ 2 eflerte Lot > ie 3 Aa ast 2 = i ‘ vit. At ark ¢/ B | dagger Ke efter. X& , CC a fee 423-4 ye” a e mark hketh Time of Service Date of Interment fr ° J8 L SE Casket or Coffin No. a: ach ize Cot... Madeby J bts ; : Lining and Pillow Set No soins ilandles Vlate Outside Box or Vault oh rf nobiles Burial St Pourarn 7 32 Slippers Notices lmbalming as Washing and Dressing Shaving Services L e of Chairs Church Charges Cometery Charges 2 CR. ok Michal V7 Moe a re, er 2-0$ 3¢ {/0O,¢0 cee nN SA is SosTon MASS 1e'8 5 mentee Cagner CO " 1S8UED BY OO ‘i er anne is ON SORIA Lem ee PRR ERS an ns TAN - SE Air nar a the sienna etic mene : ‘ | j i Me H } / | / | |; Hee | : | 7! i | + } } | # | 7 1 i i) i a ti Fy + .. il i 298 RECORD AND BILL OF ITEMS Yearly No. , FOR THE FUNERAL OF Total to date i / * Residence } } Place of Death Wife or Widow of. i Date of Birth .....1 Years Sex Color or Race (Year) (Month) (Day) Date of Death 19...*). ; LW Age Months 4 Single “ (Year) (Month) (Day) Maiden Name Days Married Birth-place I ina eetterstee test osectanetctes Name of Father His Birth-p'ace Maiden Name of Mother. Her Birth-place Cause of Death— Primary NE cans snysrs tcc ccser tba penne eetee alan spon so stapes Certifying Physician Residence Place of Burial Cemetery Funeral Service at j Lot No. . | Put in the Diagram one mark like this : pei SA: ' | for every Grave in it. And mark this line of Service Grave No. | Burial with double dagger thus : + Date of Interment Section } Designate site of monument thus: C) ee Casket or Coffin No i Candles , | ; | Size Made by Gloves |! Lin ng and Pillow Set No.. | Bearers or Porters Handles | Hearse to i | | } Plate Removal | | | Outside Box or Vault | Automobiles .................... ! surial Suit t slippers i| | Newspaper Notices i } | lrabalming || | | i| | Washing and Dressing ! | 1} | . Saving | | i ¥ services | | } l'se of Chairs Transportation Charges i iurch Charges | Officiating Clergyman | : >| il . . Cemetery Charges || Amount of Bill Music Goods Ordered by lowers Bill Charged to | DR. CR. i \| | | i eleineniage | | | | | | ; I} n {- . fe a | ' | | i} HI | ] I i| | | \| | | ! | | | i| ; : | 4 | agi \| | . | | | oe | | | | l | | o ee | | | i i! | | } | } | Ea a —_—- | } _ ———— —- — — j fae es neni ical cleanin pnsiniirecetli etal hosted ba ad | 7 é a 18SUTD BY DORNTER CASKET CO., BOSTON, MASS. 10186 Yearly No. Residence Place of Death Date of Birth l (Year) 19 7 © (Year) (Month (Day Date of Death (Month) (Day) Maiden Na.>e Birth-place Name of Father . Sf Cé442. Maiden Name of Mother... Cause of Death— Primary Certifying Physician Place of Burial | Ge Funeral Service at Time of Service Date of Interment Casket or Coffin No. Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services ...... Use of Chairs Church Charges Cemetery Charges Music Flowers DR. RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Wife or Widow of ‘ Years Sex Age § Months 9 Single = l Days l Married Occupation His Birth-place Her Birth-place Secondary Residence Cemetery Lot No | Grave No Section Candles Gloves Bearers or Porters Hearse to ~~ Removal Automobiles Newspaper Notices Tr insportation Charges Officiating Clergyman Amount of Bill Goods Orde red by Bill oer TR OS ( harge d to 299 Tota/ to date Color er Race a ae ISSUED BY DORNTEE CASKET CO.. BOSTON MASS ‘ere ) | | Putint Diagram one mark like this Grave in it And mark this h t agger thu sso onsen the: an vans come t q ans San cena ms . So re pee RE aegis nea 8 2 i nsdn? RECORD AND BILL OF ITEMS Yearly No. SF tO Residence Place of Death Date of Birth .......1 (Year) (Month) Date of Death 19. (Year) (Month) Maiden Name Birth-place Name of Father Maiden Name of Mother Cause of Death — Primary Certifying Physician Place of Burial Funeral Service at lime of Service Date of Interment Casket or Coffin No. Size Made by Lining and Pillow Set No.. Handles Plate Outside Box or Vault Burial Suit Slippers embalming Washing and Dressing Shaving Services Use of Chairs hurch Ch irges Cemetery Charges Music i i i FOR THE FUNERAL OF Total to date... Wife or Widow of. Years Sex Golor or Race Months ¢ Single Days | Married Occupation . His Birth-place Her Birth-place Secondary Residence Cemetery . T Lot No. [ Put in the Diagram one mark like this 1 for every Grave in it. And mark this Form 11 H.D.C. J Health Department of the District of . Poss penguin keuuka lpaaa eqn kaha es Place @degth ss Place of residence ‘i hana PEC Ld a : Duration Cause of death Immediate .._.__. Duration eee . Attending ier ae ZA JON CONTAGIO! ae Permission is he ~ given for Pe ece the remains of the : Ek, cen above- nespeApetin, by nde »M. D Health Officer. IMPORTANT This is a duplicate of the permit issued in this case. This duplicate is not to be returned to the Health Officer of the District of Columbia, but mbia, bu oe accompany the remains to their destination, | | [ 1SSUED BY OCORNTER CASKET CO... BOBTON, MASB., 1018 Yearly No. Residence Place of Death Date of Birth l (Year) Date of Death 9 3 ¢ (Year) Maiden Name Birth-place Name of Father 4 ibAt Maiden Name of Mother Cause of Death— Primary Certifying Physician Place of Burial @ mA Funeral Service at . Time of Service Date of Interment Casket or Coffin No Size Made by Lining and Pillow Set No Handles Plate Outside Box or Vault Burial Suit Slippers Embalming Washing and Dressing Shaving Services... Le Use of Chairs Church Charges Cemetery Charges Music Flowers RECORD AND BILL OF ITEMS FOR THE FUNERAL OF Tota/ to date Wife or Widow of (Mouth i | ! Years Sex Color or Race (Mohth) ‘tae 4 Months Single Days . Married Occupation t f His Birth-place Her Birth-place Secondary Residence Cemetery Lot No Cretan Na { ever a nit And mark this Section i oaRasaE as = Candles Gloves Bearers or Porters Hearse to Re moval Automobiles Newspaj} er Transportatic n Charges Officiating Clergyman Amount of Baill Goods Ordered by Bill Charged to seer ISSUED BY DORNTEE CASKET CO. BOSTON MAGS 1018 one mark like this State of North Carolina Department of Archives and History Raleigh were target sheet(s). rrder t filmed, they were and film approved