Front:
Assessment No. 9 for 1883.
Present Membership, 9,002.
No.
Name.
147 Chas. A. Grapotte,
148 Christian Nestle,
149 Chas. W. Cochrane,
150 R. L. Sherman,
151 Jno, R. Willcox,
MUTUAL RELIEF SOCIETY,
AMOUNT:
$2,00.
BENEFIT $2,000.
You are here by notified that the Proofs of Death have been received and approved by the Executive Committee on the following members;
Residence.
Cape Vincent, N.Y. Aug.
Rome,
Mch.
White Plains,
Watertown,
Rochester,
66
Deaths Nos. 147 to 151 inclusive.
Liable on this Assessment. 8,804.
Received Payment. 837
Rochester, N. Y., Aug. 1st, 1883.
Admitted. At age
July
Dec,
Oct.
Died.
26, 1883 Acute Phthsis.
27, 1883 Bilious Fever.
22, 1882 29 yrs June
6, 1880 59 yrs
28, 1880 25 yrs July
31, 1879 43 yrs
29, 1877 45 yrs
You are required to pay the amount of your assessment within thirty days from date, or forfeit all claims
upon the Society. (See Article 4, Section 7 of By-Laws.) If members desire their card receipted (who remit to
Rochester) they must enclose a 3 cent stamp. If a member of a Local Board, pay your assessment to the Local
Secretary, who will receipt this card.
9, 1883| Pneumonia.
9, 1883 Accidently Shot.
29, 1883 Pleuro Pneumonia.
A. G. SLOCUM, Secretary,
Cause of Death.
Office, No. 28 Elwood Block. Rochester, N. Y.
$/31 16 June
TIME EXPIRES:
Aug. 31.
Local Secretary.
Back:
I POSTAL CARD
NOTHING BUT THE ADDRESS CAN BE PLACED ON THIS SIDE
Myron Kingsley
Stanlands
und Stone
Pa
