HomeMy WebLinkAboutCemBK1901to1907pg118,119-0072s
POW0
REGORD (OF FUNERAL
.....
,h^ame of the Deceased --
Charge --
Order given by
HOW secured_- ___
Date of Funeral
Funeral Service)at
-���,lP.....
Time of Funeral
Clergyman U
Csrtifying Pltysician��
Number of Burial C��iflcate�---
Death. _---__..........
Cause of �S.-• _._
Date of Death
t Deeeased_(46 -
Occupation of
Single or ifarriedReligion Cll
,Aged -years, _OY- Xonths, ._J�:__Days.
Body to be shipped to
Size and Style of Casket or Coffat
R,EC,ORD OF FUNERAL*
I)rcty-_-__.—___.I9rJf__
Hanle of the Deceased f
price of Casket or Coffin
Charge to_------
- - --- -
40 Metallic Lining It
riven by .____-_-----------•'-_.__...._
Orders
Price of Casket or Coffin - - - - -
•• Outside Box
-
Flofv secured__ -- —
•• 14letallicLining --- --
" Grave Vault
Funeral------ ' - --
of - l
Outside Box - --
" Burial Robe
Date
_
•' Grave Vault __.__..
Burial Slippers and Hose
Funeral Services at __....._.-
,I BurialRobe . • • i --- -- -
EmbalmingBody(with..._................................._. Ruid�
game of Funeral Services ...__.�- ............ .
.. Burial Slippers and Hose _......_
EmbalmingBody(with ....... ..... _.._-...._.._.:__Fluid)
washing and Dressing
Clergyman
Washing and Dressing
Shaving
C,rti r cn Physician._.
'
Shaving . . . .
Keeping Body on Ice
Nuntber of Burial CerEaflea e...........-._.... ___.._.._........._ _
Keeping Body on Ice --
Disinfecting RoomsBj.
rf__. _ _
of Death,
Disinfecting Rooms _....... _
Use of Catafalque andDrapeiy
Cause N
UseofCatafalqueand Drapery
Folding Chairs
Date of Death ---t�- "-
�• Folding Chairs '-- - -
" Candelabrum
Occupation of the Deceased _
•' Candelabrum • • • • • - - _....
Candles
o �,//y�.� IReligion �1
Single or Married._. fl1
Candles
_-'
Gloves
years, ...Alonths, ._�.1J-Days.
._ ....
(,(ones
Crape. . . . . . . .
Number of Carriages .......................... ....._ �• $....
Aged..--
Body to be shipped to
Crape
Number of Carriages ... ......... .._...___.
___._...
Hearse . . . . .
..
size and Style of Casket or Coffin ............. .... ...... _........ _._.._
..._....__.
Hearse . �� --
Wagon Deliveries ____..___.__ _.___..._...
Wagon Deliveries_ .....................--
_
Death Notices in_.__..._ -_Newspapers ----
Death Notices in. -..__._........_.._Newspapers .
_ _
__..._._.._-_._..._.
(Names of Newspapers )
dfanufactured by
_—................................ ...... ..
__-
Flowers
dfetallie Lining
(Namesuf Newspapers)
Flowers
metallic Lining
-"�----�-----�---"--
---
Outlay for Lot _
Outside Box
Outlay for Lot
Outside Box -
! opening Grave
Cem'etery.
r t
Interment at Cemetery.
Opening Grave
Interment at
_ Lining Grave
t�ozb .%a - Shipping Charges, Prepaid . _--
Lot or-Gr Xo, Section No•_@� _
---Section
Lining Grave
Shipping Charges, prep aid
Lot er _ave #o•- ..
.. ........._
Removal Charges - -'
i<.
_. Cremation Charges .
I I
Removal Charges .
/' ,' `/�
!
„._._......_._..
2. --
3.
4, _..
s.
(Diagram of Lot.)
Designate all Gravea in Lot with numbers (11 2, 3, 4, etc.), and mark
space for this Funeral with a cress (q.).
Designate place for Monument with a small square (p).
Usespaec to the rightof Diagram for the names of those buried in Lot
2oFuneral charges____..Total, �I
Cremation Charges -� _ _ ----- -
4.
......... __.__
---"� `- Total Footing of Bill
a• ----......... 1q t Pa& bt Advance •
!—
Total Footing of Bill
By Amount Pa;d in Advance
Balance
By moue
(V(agram of Lot.) Balance
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (•1•)•
Designate place for Monument with a small square (G)• ---- -Or
Use space to the right of Diagram for the names of those buried inLot. Entered into Ledger. page____.
or bzlo�
Entered into Ledger, page ......... ........ ... _ ......
_._..... _..........
IBv Cash... -_____.- 9,t
3I._..._.......... _. I -..- - /.... L_.__
.............-
�� .. -
_ ......_.. -.
..._
.._......__..._.......
_._..._...._.__-____.._._....._-.......__-.. .
.............
- _......_.
- .....__.•- , In year ' y lied by F. J. FEINEAfAN, St Lot"" Come
1-1 l`a Dy F, ✓• FEINEMAN,
St Lows, Mo In the year 1900.
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