HomeMy WebLinkAboutCemBK1901to1907pg106,107-0066■
,
.r�
106
IZECORD OF FUNERAL,
-
V /A 75r--
lane of the Deceased
Charge to-__
Order given by
Iiow secured --
Date of Fzeneral 1,
Funeral Services at _
Tune of Funeral Sery
---`"- - I price of Casket or Coffin
Metlitic Lining
Outside Box
Grave Vault .
S Burial Robe
Burial Slippers and Hose
E'mballningBod:) (with ....... ........ ................
__.........17uid )
Washing and Dressing .
Cortifyins Plcysieian_ f Bod on Ice
Burial Certifteate_..._..__.—.----
_____..._._ Keeping y
Number of Disinfecting Rooms
ry .
Death _ Use ofCafafalquaandDrapct�y .
Cause of _
r �l 1 is Folding Chairs .
Data of Death,
the Deceased n is Candelabrum .
Occupation of r,„,llvs
Single or Jlfccrri€d ,
Religion
/• A' .Months, ... Days.
Aged 1 i( years, -
Body to be shipped to
Size and Style of Casket or Cof fin
,Manufactured by____. --------------
,Metallic Lining
Outside Box _
Interment at 1 -.-Cemetery.
Lot _Section No•y.�
3.
RECORD OF FUNERAL.
,Name of the Deceasrd _..
order given by
Row secured__-r � -t --
Data of Funeral_._:1� . _+_.?• � Funeral Se �-��-f.----
rvices at
�
��
Time of Tuner al Service $
:L'° �.:- --
Ctergyman '
Cori
ifyins Physician <.!....J/L�t.;�1..2e.>._ ..._....
Burial Certificate........_.__�-_-.___.-_ _..-.
Nrcmber of � .
Cause of Death_ a :c yr. ........... .... --
Data of Death-
Occupation of Vie D�eI/c/eased ) _
c Ls o�-Jl2arried.._l.cl l.��> eli.sien
Gloves • .Alontlzs, .... ............. .Da ys.
Crape Body to be shipped to -
Number of Carriages .............. _............. . C $.............
Hearse . Sipe and Style of Casket or —.--
WagonDeliveries ....... _._........_._.__............._._. .......---_ _.
Death Notices in .... ................ Newspapers
+;Irzuufactured by_......._.._.._�.._----------
- -- - __Jame.................g
(Names of Pewsp-p..ers )-r.s.........._. - -- Metallic Linins ---•-- _
Flowers Outside Box
i
Outlay for Lot (� �� ..._,._,,.Cemetery.
• Interment as.%�.�-�= `
Opening Grave
Lining Grave Lot or -Grace No. � ..... --.... section No•_ ----
Shipping Charges, prepaid 1
IRemoval Charges.
Cremation Charges s.-.Fc.
4.
b.
-....... ..... ................... _._.._..-....._._._.._.__ - a
8---
Price of Casket or Coffin $�Y
Metallic Lining
Outside Box • • • •
Grave Vault . • •
Burial Robe
Burial Slippers and Hose
EmbalmingBody (with ....... ...................... ......... _Fluid)
Washing and Dressing .
Shaving . • • • • • • ' I
Keeping Body on Ice
Disinfecting Rooms
Use of Catafalque and Drapery .
Folding CI airs . .
Candelabrum .
Candles • • • • • , • '
Gloves • • • • • '
Crape . . • • • • • •
Number of Carriages. ..... ............ _._. @ $...._................
Hearse . • • • • • • ' '
Wagon Deliveries.__..._ -.._
Death Notices in --__._._.._---Newspapers .
e. Total Footing of Bill • (Diagram of Lott
---•---.....—...____.—..._,__......—._ � 2 3 1 etc.), and mark
1 By Amount Paid in Advance Designate all Grates in Lot with numbers (1, , , • ,
(Diagram of Lot.1 space for this Funeral with a cross (•f•)•
Designate all 0rarea in Lot with numbers (1, 2,3, 4, etc.), and mark Designate place tog Monument with 06,
mall square those
space for this Funeral with a cross Balance Use space to the right of Diagram for the names of those buried in Lot.
Designate place for Monument with a small square (p).
I
Use space to the righEntered into Ledger, pig=
tof Diagram for the names of those buriedinLot. Or below,To Funeral Charges------
$ -,/ �
— --
------ lirlo Funeral Cha•gat, t _
... ..__....... __.._- Sy cash __...__......__-...__ _........ . ...
_....--------------- -
- ...........
... _..........
(\amea of Seeepapers 1
Flowers -
Outlay for Lot
Opening Grave
Lining Grave
Shipping Charges, prepaid
Removal Cbarges -
Cremation Charges
.............................
Total Footing of Bill
By Amount Pa;d in Advance
Balance
._
Entered into Ledger, page ..._... or be
L_._._.'ByCash_- _.. ____ _ __._ $
............... _.._ - ...
_ ..._ (�
_.
........... __...._. In the Ycur 7909.
J, FEINEAIAN, SL 4o++ls•
compiled LY F.
.. k
107
19.16 ... OL
Compiled by F. J. FElNEMAN, St. Louis, M�.._..
.................. _.
o., in the year 1000.