HomeMy WebLinkAboutCemBK1901to1907pg100,101-0063101
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F UNEARZAL
D OF
ton.�Jc® -.
Date ....J. �
Nameof the Deceased--
��
Charge to
Order given by----'—
II'ow secured —
Date of Funeral 1 -
Funeral Services
Seruiccs
Time of Flirter
Clergyman
Certifying Physician_ _ r
Number of Burial Ce
Cause of Death_
Date of Death
Occupation of he. Deceased
Single or Married—(i;,LReligion -�
,A18 — -t— Years, —l�-Months, . -Days.
Body to be shipped to
Size and Style of Casket or Coffin
Manufactured by
Metallic Lining
Outside Boa:
Interment atA�y�
Cemetery.
Lotnr.GraveN�(ily�
&ion
eo -No•_ _
s.
g:.__...____._�.6.
price of Casket or Coffin
fin
Metallic Lining ,
outside Box .
Grave Vault
If Burial Robe .
if Burial Slippers and Hose
EmbalmingBody(with ......................................... Fluid)
Washing and Dressing .
Shaving
Keeping Body on Ice
Disinfecting Rooms
Use of Catafalque and Drapery .
if Folding Chairs . .
if Candelabrum •
Candles • • • • • •
Gloves .
Crape .
Number of Carriages ................................. G $---------._
Hearse
. _.._�
Wagon Deliveries .................... I,
Death Notices in ...................... NewsP P a ers . )—
_�.................................... _.....
_—
(Names of Newspapers)
Flowers
Outlay for Lot
Opening Grave '
Lining Grave
Shipping Charges, prepaid
IRemoval Charges
Cremation Charges
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 2, 4, etc )� and mark
space for this Funeral with across ({ ),
Use
Designate place for Monument with a small square (p).
_ spa• a to the nghtof Diagram for the names of those buriedin Lot.
Total Footing of Bill �.
Ili
By Amount Pald in Advance ;
Balance
or below,
En tered into Ledger, page....... i
B_v Cash...
I" _ I-- —
WI,C;ORD OF
FUNERAL.
Date-19L�f?
Gf-----
,Warne of the Deceased...... .
Charge--------
liven by. ------.__........_
Order y Price of Casket or Coffin
--
Flow secured __ — -- L
e\
�' Metallic Lining
Outside Box • •...........
Date of Funeral.
/� L
. •
Grave Vault
.__.. _ ......_
Funeral Services �j�q
Burial Robe
Time of Funeral Services ......d
"` "'"
" Burial Slippers and Hose •
___.... __...._ ..
Clergyman t
EmbalmingBody(with ... ..... ......................... _Fluid) ..___. _..
'
Cortif yinl physician _. _ _........._._ --- ....._ _
Washing and Diessing -----
Shaving
Number of Burial Certificate ------- --
Keeping Body oil Ice • - —
Cause of Death •
Q'�
Disinfecting Rooms • • .
Use of Cata falque and Drapery
Date of Death —
�� Folding Chairs . . . .
the Deceased
Occupation of t
Religion
i' Candelabrum . -
Candles {
Single or ,Married.�
•Aced ................... -...Y ars, ....._._......... .Months, _------ Days.
Gloves I ....
Crape . • . .
I
Body to be stripped to �—
Number of Carriages ..... .... .- -------- _....- @ $..................... . ..._.
Size and Style of Casket or Coffin.____..__— _
Hearse . , • .
Wagon Deliveries ... ....... ......... _.
Death Notices in.__-__.-_.._._ ewspapers
--.-.......... ---- I--
11 anufactured by
dletallic Lining —
Outside Box .�%%
Interment az4(
Lot or Grave No. I
I
Cemetery.
—�(,%,ames of Nerrapapen )
Flowers
Outlay for Lot
Opening Grave .
Lining Grave
Shipping Charges, prepaid
Removal Charges • •
1.............
Cremation Charges .
4. ...__.....�..-- _ - --.� ...
I---�Total Footing of Bill
a By Amount Pa;d in Advance
(Diagram of Lot.) - Balance '
Designate all Graves in Lot with numbers (i, 213, 4, etc.), and mark
space for this Funeral with a cross ($•)• or below.
Designate place for monument with a ema11 square (0)• Ledger, page----
Use space to the right of Diagram for the names of those buried inLot. Entered into
_-- -
`�.._— I Total, By Cash._--._. -----
J!. ...._.__ $
�, I q�•uneral�arges_,._.._..._
n / / /t - /�%' IL ._/�!/l i�i.�tl.�!•!k._.��f..... ....... .{mil
_
. ..... -V : Y
Af0•. UIn ,e YOar 1900.
Con,Piled by F. ✓• Fp.tNEhfAN.
SL Louts,
Compiled_ _.•.......
by F. �, FEINEMA N, St. Louts, AfO.. 1n the year 1000.