HomeMy WebLinkAboutCemBK1901to1907pg12,13-001819. R50RD OF FUNERAL
t RECORD OF FUNERAL. y
Date.........���:�/..�.....�::�...
/1 r � l v
the DeoeasedA No. _-
,} anze of _—_ - - - -- ---- -- - tine, Deceased-1/_.x~
Name of
Charge I to _ _ _._.........._ � �
bPrice of Casket or Coffin $ Charge
Order given J Metallic Lining iOrder given by --_------ .-- ------------ __....._-
- I I
Sow secured - if Outside Box Fjozu Secured - —
Date of Funeral
" Grave Vault !��
• o Funeral �� ° 1�
/L /rN y _- Date f
Funeral Services at-f1/' " Burial Robe
6C -- - �• neral Services at
Burial Slippers and Hose I'- Fit
_.-..__
Time of Fune� Servic s �—
i l o Funeral Services ......_____- __.__....__.._
_-.._...._ E'mbalrrringBody (with..._ ....................................... F7uid)' _ Time f
Clergyman - Washing and Dressing
��
C^rlifyiny Plzysician f'. Shaving 6 ph sician _..L'f..._..1' mil•-( -- •.....
Number of Burial Certiftcata_ -----
Keeping Body on Ice . . CeHifyiny y
�� Disinfecting Rooms Number of Burial
Cause o DeatlaCf_.__._.........._............_
f �4i Use of Catafalque and Drapery _ Cause of DeatTc.�� -- .._ ..
Date of Death -
Folding Chairs Deatlal� —�- -
Occupation of the Deceased 1 Date of
Candelabrum
t Occupation of the Deceased___-__.
Single or ffarried jL- l Religion s-- Candles
✓Iged.40-Years, -- •Months, -l-Days.
Gloves Single or .Married.- _Religion
Crape Aged-_..__-_.__....Y'earr _ Jllonths. .................__Days.
Body to be shipped to r _
Number of Carriages....... _..................... a $ Body to be shipped to -
Size and Style of Casket or Coyla Hearse .
Wagon•Deliveries............... . . . ! -- Size and Style of Casket or Cofj"in_._......._..._..____.....-_._..__.._
................................................
Death Notices in .......................Nmspapers .
Manufactured by -
........ _............................
uetallic Lining (.`tames of Newspapers)
Flowers . . . . . .
Outside Box _ _ Outlay for Lot .
71,
Interment at-i�f ' ___Cemetery. Opening Grave
Lot or Gnaae No. Lining Grave
- .....-....SectionNo.It____
Shipping Charges, prepaid .
i. Removal Charges
2. Cremation Charges . . . .
3 - -- -_ _........ .................
4. -- - _ _
(Diagram of Lot.) ., -,
na -
Deu1 By Amount Paid in Advance
B to all Graces in Lot with numbers o 2, 3, 4, etc ). and mark
apace for this Funeral with a cross (g), UseDessp ale place for alonument with a small s
UseaPaw to the NghtotDia square Balance '
gram for the names of those buried inLot.
I Entered into Ledger, page..................... _....... or bel
oQFu//{�[raI Cl/farges-_--_-petal
Cash
c-
..-._.........
compllotl b
Y J. FEINEMAN, SSt.F. ' ""`
Louis, Mo., 1n ehe year 1900.
juanufac ure V -
-- ,Metallic Lining'
- Outside Box
Interment (it- .... ----Cemetery.
.*Lot or Pmue NO._.. ..-_.. . No. -
1. .... .........
i
z.-.-ram!-----•---
8.
a.
Hce of Casket or Coffin ; ........... .._.........
" Metallic Lining . . . . ............
Outside Box . - -
Grave Vault . .
Burial Robe !
Burial Slippers and Hose
4mbalmingBody (apith..__.._............_..................._ Fluid) .___........
Washing and Dressing ---- ..........
Shaving . . . . . . . . _--.- --- ---- -
Keeping Body on Ice . . . . . ........
Disinfecting Rooms _._..__
Use of Cata falque and Drapery -- -- -
Folding Chairs . . . . .
if Candelabrum . . • • •--
Candles . . . . . . —.
Gloves . . . . . . . - -
Crape . . . . . . . . . ... .
Number of Carriages _._.___...------- ._ O$........................_...._...... _—
Hearse . . . . . . . . . -_....._.___..—
WagonDeliveries ........ -......... _._._..._.._..._._.__._..._._._.._ .......... _....
Death Notices in..........................Newspapers
10 (Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (1)
Designato place for Monument with a small square (G)•
Usespace to the rightof Diagram for the names of those buriedinLot.
To F�t sera! Cl�rrges-._-___..._.Tofdl. $
/I 1 n O
A
—' (Namee of Newspaper)
,Rowers
Outlay for Lot • •
Opening Grave . . . . .
Lining Grave . • • • '
ShippingsCharges, prepaid
Removal Charges
Cremation Charges .
Total Footing of Bill
By Amount Paid in Advance
Balance • • • . '
Entered into Ledger, page .......................... or below-
. --
!By cash _ - -- - - $
...... ........ .. ._-
_..... —...... ._..... ....... _..........
_
_........ ............. i