HomeMy WebLinkAboutCemBK1901to1907pg114,115-00704
®� FUNERAL
R500 RECORD OF FUNERAL.
Nano of the Deceased _--_
Charge to
order given by
How secured -
Date of Funeral
Funeral Services at---'�---
Time of Funeral Servieas'- -
Clergyman
Grlifying
Number of Burial Certifteate-_-- --- '
Cause of Death.__-----
Date of Death
. ._------------_"
Occupation of the Deceased
Religion _— ---
Single or •tlfarried._.__-----
Aged -Years, _. _ . Months,
Body to be slapped to
Size and Style of Casket or Coin
.._.___..._._.__. Date:. ��/� .._.1._..-....
-`of t7ze Deceased_
yarne
Price of Casket or Coffin
fin , Metallic Lining rder a 6by -----
FPrice • Oyi•ven of Casket or Coffin $ -••
Outside Box gow secured �= -= —� �` Metallic Lining - --
•' Grave Vault Outside Box . . . . _.__ _....
Date of Funeral(
Burial Robe • Grave Vault . . . . _._..__ _.......
Funeral Services at . / Burial Robe . • • • • I -- -
" Burial Slippers and Hose � � f{ _%'. ��
Tivie of
Funeral Services . � ,d-�. -i'-- - i.j.. --- '• Burial Slippers and Hose • • --- --
Embal»t[ngBody (with ....... ............................ _ F[ei11 ` -
_'� _ _........... Emba[m[ngBody(with.._......._....._.-.. ... Fluid), .._..... - -
Washing and Dressing Clergyman Washing and Dressing Shaving 6 Plzysician . _ .../J c, t ..... .._:.._.______ ..- ---
g
Certifyins Shaving _ .
Keeping Body on Ice Burial Certifzeate ......
Keep g B Rooms Nunzber of --_-"' Keeping Body on Ice - -
Disinfecting Wit_.__._...____..__...•• Disinfecting Rooms . .
Use of Catafalque and Drapery Ca.rzse of Deatli_ -
t Use of Catafalque and Drapery .
Folding Chairs . Date of Deatlz -" - " Fo[ding Chairs . . . . -._. --•---
Candelabrum • . occupation of the Deceased " Candelabrum . • • • • ...... --
•
Candles Single or ✓1Tarried.�,�res ,Religion Candles • : . . . -
(( I
Gloves i —
Gloves lylonths, ...Lt........._Days. _
Crape .Aged . .............:Y'ears, _..�..-. Crape --
Number of Carriages ........................... C. $....... Body to be•sTzipped to Number of Carriages ...... ___.___.._.( .........................
.... _ Hearse . • ...........__ --..
-..... .
Hearse . Si e and Style of Casket or Coffn_._....._._.... -- -- Wagon Deliveries .......... .._...__
Wagon Delivel•ies....................... _.......... -- - — - ---- --
--- - Death Notices in --- _---- _.___Nesuspapers -_-- --•--•
Death Notices in_. ............. ........ Newspapers • Iruaetured by
Manufactured by— ---- .
"-- (Namesof Newspapers )
Metallic Lining Flowers '
Outside Box
Outlay for Lot
Opening Grave '
Interment at--- ---Cemetery. Lining Grave
Lot or Grave No.._Z_&_._._..Section No._._ Shipping Charges, prepaid
1. Removal Charges
I., __._____._....• I Cremation Charges
8.
4.
8.
s.
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (•p).
h
Designate place for Monument with a small square (0). Use space to the right of Diagram for te names of those buried in Lot.
I Io Funeral Char9eS--_--- 1
—Total, $ i.._..._.......
Jltetallic Lining ----
Outside Box ------
Interment at _� �i 1 LI'�t ---Cemetery.
Lot or(Trave llro,___,9 ........-..Section No-
. ..............
4.
_. __.._..... _.
S
e'
r
Total Footing of Bill Migram or Iot')
By Amount Paid in Advance Designate all Graves in Lot with numbers (1, 2, 3, 4) etc.), and mark
space for this Funeral with a cross (•f•)•
• Designato place for Monument with a small square (0)•
BdldltCe Use space to the rightofDiagramforthe names of those buried in Lot.
or bZ[o . Charges—Entered
� - - ----- ..... ! . ..... _..._..
Cash
(y ames at Newpapers
Flowers
Outlay for Lot • • • • --' -
Opening Grave • • • •
Lining Grave
Shipping Charges, prepaid _
Removal Charges
_............ -
Cremation Charges .
Total Footing of Bill
By Amount Pa;d in Advance
Balance
Entered into Ledger, page-. --- ---
or below.
IBy Cash..-.----_._._-._._.._____-
, $
--
._..._ _
...............
............. _......_..._ g(, J. FEtN er, 1sDo. Louis, Ara, In Uiuye
EAI N.
Lorr3Plrud by F.
-_ ......
Compiled by g, J, FEINEMAN, SL Louis, Afo., In the year 1900-