Date of Entry Year 1949
Name of Deceased Addie C. Jaqua
Marital Status
Residence East Main
Husband/Wife/Widow J. A. Jaqua
Charge To Paul Jaqua
Address
Order Given By
How Secured
If Veteran, State War
Occupation
Employer & Address
Date of Death May 12, 1949; 1 p.m.
Date of Birth October 1, 1860
Age 88 years
Date of Funeral May 14, 1949; 10 a.m.
Services At Residence
Clergyman Noll & McCance
Religion of Deceased
Birthplace Hartford City
Resided in State
Place of Death Residence
Cause of Death
Contributory Causes
Certifying Physician Hammond
His Address
Name of Father Chas. R. Cooley
His Birthplace
Maiden Name of Mother Katharine B??gh
Her Birthplace
(Motor/Ship) Remains To
Size of Casket Metal 1/2; green velvet
Manufactured By Springfield Metallic
Cemetery/Crematory Green Park
Lot No. No. 1
Grave No.
Section No.
Block No.
Owner
Diagram of Lot or Vault
Note
Date of Entry Year 1949
Name of Deceased Addie C. Jaqua
Marital Status
Residence East Main
Husband/Wife/Widow J. A. Jaqua
Charge To Paul Jaqua
Address
Order Given By
How Secured
If Veteran, State War
Occupation
Employer & Address
Date of Death May 12, 1949; 1 p.m.
Date of Birth October 1, 1860
Age 88 years
Date of Funeral May 14, 1949; 10 a.m.
Services At Residence
Clergyman Noll & McCance
Religion of Deceased
Birthplace Hartford City
Resided in State
Place of Death Residence
Cause of Death
Contributory Causes
Certifying Physician Hammond
His Address
Name of Father Chas. R. Cooley
His Birthplace
Maiden Name of Mother Katharine B??gh
Her Birthplace
(Motor/Ship) Remains To
Size of Casket Metal 1/2; green velvet
Manufactured By Springfield Metallic
Cemetery/Crematory Green Park
Lot No. No. 1
Grave No.
Section No.
Block No.
Owner
Diagram of Lot or Vault
Note
Family Members
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