HomeMy WebLinkAboutCemBK1901to1907pg112,113-0069® �UNERALe
,
RECORD OF
FUNERAL,
Date..lcC?
No,— _- �_ Yo.�--
the Deceased _ _-- -- the Deceased 1'I t ._• �Or'
Name °f °f ---
Charge to price ofCasket or Coffin Iearga t0-._- --- --
I
Order given by -- -^— M
tatic LiningIder given bl/ ---- Price of Casket or Coffin $
Rowsecured_-tside Box row secured __ ------ - - — : - - Metallic Lining `
�� " Grave Vault Outside Box
Date of Funeral 1 I�t Funeral.___ --• •
/ )ate of
at " Burial Robe __ _ -.._._
_ Grave Vault
Funeral Services a, ,� /� Burial Slippers and Hose ran Services at __--..--- Burial Robe
Time of Funeral
Serutces o Funeral Services __. - Burial Slippers and Hose
��swr�x=t,J-, EmbalmingBody(2.t�ith............................__ rlui�! !'ame
Washing and Dressing _-....._....._.-_..__._ _._...... E ni Body (with.........._ .............._............ Fluid
mbalr ng
Clergyman ;ter_jrlman_ _---- _` Dressing . . . . .
Pia sician --- — Shaving r 6 physician_-__....---...__...----...._.___....._._...._......._ aching and . . . . . . . W Ing
Grtijyln>. y Bod on Ice . � . '<rtifyiny Shaving ,
___----.. _ Keeping y
Burial Certifleate--- Burial Certiflsate._._..____-.______._- -- Keeping Body on Ice
Number of t Yu"fiber o
...... Disinfecting Rooms .- .
-,,.1�..._......_._....._- Deatla._.----.._..----------_..____..._..__...._..............._ _ Disinfecting Rooms .
Cause of Death Use of Catafalque and Drapery )uuse of Useof Catafalque andDrapery
_. Folding Chairs • )ate of Deatla_.-_—. -- -- - ._...__
Date of Death n r � (�� � Folding Chairs
�" �,,'r�ri Candelabrum ation of the Deceased._— " Candelabrum
Occupation of the Deeeased� )ccup
��� I,,�,eligion .- Candles , ' '
Single or Jlfarried-L!'.ln;ingleor,7lfarried_.._____._—_Reliyaon___---._...._-- Candles .
Gloves .Months, . ......................Dar s. love . . . . .
Gloves
flged "ears, _ Jllonths, .-.../_ --Days. Crape iced ................ ---Years, ...._...._........ Crape . .
Number of Carriages....._._..
- - - Number of Carriages _..............._ �.... 1od.y to be shipped to----------........_ --- --- _.-_..._._@$....._..._......
Body to be shipped to Hearse .
Hearse . lize and Style of Casket or Coffin-.._-_ '
Size and Style of Casket or Cof n,----------- Deliveries _..._.._............_ Wagon Deliveries - ......
-•---. --
Wagon ev....._ . ...... _._.__ .
• --- Death Notices in...__...____ .... Newspapers .
Death Notices in...........................Newspapers . It - .....-------.__--.
ranzafactured bJ--......___.___ t�ameeu[seAeoaven)
Aranufactured by -----------_ -----
(Namesutxewepapers) Metallic Lining--- --•--- Flowers
Metallic Lining-- Rowers Outlay for Lot
)utside Box _
Outside Box _ Outlay for Lot Opening Grave
Cemetery.
-�—.- Opening Grave nterment at_.--•------�-' Lining Grave
Interment at __.__Cemetery.
• Lining Grave � ;ot or Grave ,No, ... Section No•__._i_...---�- Shipping Charges, Prepaid
Lot or Grave No. 4- Section No•Shipping Charges, prepaid
Removal Charges
_ ..... ....... _.................. .. Cremation Charges
lZe Removal Charges
e
Cremation Charges •............ -._..._
3. _.._.._._...- - .._..._.._._.... .. _....... ...
...
4.
_ _ b.
__.._......._..._._..._....__.._._....._____-....._.-.- ......_.------. - Total Footing of Bill.
ls. $
By Amount Paid in Advance
a. _
8, Total Footing of Bill (Diagram of Lot.) Balance
o .1 etc.), and mark
By Amount Patd fir: Advance Designate all Graves in Lot with numbers (1, .., • , m k
lo)agram of Lot.) 5ace for this Funeral with It cross (•1•)
Designate all Graves in Lot with numbers (1, 2, 8, 4, etc.), and mark gnntc lace for monument with a small square (C)• Page. or bei
space for this Funeral with a cross Desi e -
Balance Use space to the rightof Diagram for the names of those buried in Lot. Entered into Ledger, p
Designate lace for Jionument with a small vats
ea' - u-e- a^• p °rbel "' --- -- --� _-- ___ �By Cash_._-.._..-----
p __ to the righto[ Dia � (�)' _ gram for the name- of those buried in Lot. I .. ...
_--_ Fnterad intoLedver. Cage 4 F, ..,r cr,.,.�ot..--_..__._Total, $�.-..__._._.. __..__
'.t
__..
---_...— ..._... ...... _...
yam.
---.
Con�Plied by F• J FEI NEMAN, SL
Louis, Ma, to OIL year LOGO.
..............
......._._....
.......
__.......
............. .......
FEI NENAN,
......... . --d
St_ LO:ds, ata,
In trm Year 79D0.
Co+nPlled by F. J.