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Home My WebLink AboutCemBK1901to1907pg122,123-0074A I j 1 . ' i 1 t � YJ .{1 •I REG®RD FUNERAL 12 -- Date ... Name of the Deceased — Charge to Order given by -- — `— -- How secured _ Date of Funeral Funeral Services at _J Time of Funeral Services—� Clergyman Certifying plcysician Number of Burial Certificate Cause of Death - -o ,/' Date of Deatla .( -F, I, G Single erfurraed Religion = Rged— —Year$, Months, _..i�_D.ays. Body to be shipped to Size and Style of Casket or Coffin Manufactured by ---- Metallic Lining Outside Box Interment at --_._Cemetery. Lot or Grace JV o,�t�i� ._.Seeo• y� RECORD OIL FUNERAL. - — — -- / l / Date.�!�CL7119Qta Name of the e \\ a to..._..., --------- - ----- puce of Casket or Coffin Chaig r-------- Metallic Lining a Order given by �------- � -- , I Price of Casket or Coffin $ Outside Box I How secured____—•----- ---- Metallic Lining " Grave Vault Funeral -- �- ��— Outside Box Da E , of �` Burial Robe Grave Vault Funeral Services a - 4' Burial Slippers and Hose - / " Burial Robe • Funeral Services .�}yi,C � r�.4M �.._._.....— ., Burial Slippers and Hose EmbalmingBodY(with.........................._................Tluid�. 7'iJe of Washing and Dressing Clergyman EmbalmtingBody(with .... ........ _.__.__....__..__F7uid Shaving a Ph sician _.� ___._. _...._....._.. __ n s . Washing and Dressing ' Certifyan,. U Shaving Keeping Body on Ice Burial Certificate_...._..._ __� _.._..--.-. -- Beeping Body on Ice Disinfecting Rooms Nfanaber of /n .L/1r r1tr� _ Disinfecting Rooms Use of Catafalque andDrape,y Cause of Death,_s� � seofCatafalque and Drapery . 00 Folding Chairs .✓ � Date of Death 4"*L9� ,• Folding Chairs Candelabrum Occupation of the San leg Deeeeased Candelabrum . Candles cl.cQn�eligion4,-zi Candles ' Gloves ' Gloves r>� Ag dam.._.__ / Years, ..__............. ...Alonths, ........... --Days. Crape . . . . Crape . . Number of Carriages ...................... _......... •` $.......... ..... Body to be slaappe o Number of Carriages .............................. ....... Hearse . Size and Style of Casket or Coffin ..... ..._.... _-_—_- Hearse . • • • • Wagon Deliveries ...................... __....... Wagon Deliveries- .—------- __ _._.__—..._...... _ . __.--___ ---- Death Notices in— ------ ---- Newspapers . Death Notices in. ... .................... Newspapers . dlanufactured ewepa. (Names of Npen) (Names of Newspapers) ,41etallic Lining --•-•------ Flowers Flowers _ _ Outlay for Lot Outlay for Lot Outside Box - ------ _ Opening Grave Opening Grave Interment at _ Cemetery Lining Lining Grave LiningGrave p Charges, prepaid . Lot or Grave No. No•---- Shipping Cha es, p eP • Shipping Charges, prepaid 1 Removal Charges • -._.__ Cremation Charges . Removal Charges . ............... Cremation Charges • •--..... _............. .... ..... 2. ts. s. (Diagram oI Lot.) Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark space for this Funeral with a cross (d.)• Designate place Usepace for dfonument with a small square (0)• Use space to the rightof Diagram teethe names of those buried is Lot. ITo Funeral Charges. 4. .....__. __..__--._......._______-_-_-...._ i b. Total Footing of Bill cs.-__-- ........ ........_._. �q ant Pa:d in Advance . Total Footing of Bill By Amount Paid in Advance Balance Entered into Ledger, page ....... _...__...... . orvao �, . By mo (Diagram of Leta Balance ' Designate all Graces in Lot with numbers (1, 2, 3, 4, etc.), and mark ;:pace for this Funeral with a cross (&)• Designate place for Monument with a small square a ...._.. ___.._...._.or Use space to the right of Diagram for the names of those buried inLot. Entered into Ledger. Page. below. g r .s n .ter t 01, ........ !_ t.....rL:...�-�L�[r rc•.•!�!r� -- ` - — - j��> r. _ . - .. . f� ...... V. - L-L4 J. •��•�G44� t t ._. _..r__..-...__.__. .r. .� ♦ ... �i�r-�I•wt __._...... • _._ 0)led Ay F. J. '_E11VEMA1, Sc Louis, Afo., In the year 1900.