HomeMy WebLinkAboutCemBK1901to1907pg128,129-0077i
1 128
i.
alp FUNF34RAN
Date
-i
,1,a7lle of the Deceased
Charge
Order given
Ijow
F
Date of Funeral
Funeral Services at -------- ----
V..
Time of Funeral ServicesM�
Cjeqyinan-&�j
Cortifyin.f Physician
Na7nber'ofBurial Certijtcate_..
Cause of Death�� - - ----
Date of Death 4!XI 9 oAk-7
occupation of the, Deceased*169,14
Single orVarried-Eelilion
Aged Years, � Xonths,--Days-
Body to be shipped to
Size and Style of Casket or Coffluz
Alanufactured by----
Aletallic Lining
Outside Box
Interment at Cemetery.
Lot or Grave No.- ...Section Xo..&-�
. . . . . .... .......
3*
4.
s.
RECORD OF FUNERAL.
L)ate. - 1, o 1 g
f
charge — F--- ---- - I
order d ven by
� i Price of Casket or Coffin
rJoul secured 11 Metallic Lining
of Funeral . ... . ... lf-4- 01 Outside Box - . . ....... ... . .... . ... ..
Date 11 Grave Vault . . . . .
-
Funeral Services at -- -----
Burial Robe . . . .... ... ..
Time of Funeral Services ... ... Burial Slippers and Hose
--- - - . ........ - ErnbatmingBod (with ... . .. . . ................ ........ ...... ..
Clergyman Washing and Dressing
Certifyinff Physicianc;) ...... . . having . . . . . .
Number of Burial Certificate.. <— Keeping Body on Ice . -
Cause Of Deatk .. .. .. .. ....... ...... Disinfecting Rooms - -
se of Catafalque andDrapery
Date of Deoi1h,. Folding Chairs . . . . .
0cCu,ratiov,,wf-iA,,,,, Deceased Candelabrum . . . . .
Candles . . . .
Single or ffarried��.,�-Reliiion
Gloves . . . . . . . .
K-Days.
Aded.... years . .... .... I ..... ill o i i t h sl-y_ ... ... ..
-31 ----- - -- Crape . . . . . .
Body to be Number of Carriages $ ........ ............ ....... ... .
Size and Style of Casket or Hearse . . . . . . .... .... . -
Wagon Deliveries ..... ........... ....
Death Notices in
II _.............. . . . .. ................
11(tnufactured by ------------- (�:Name;.of NewsP&Pe rg ... ... .
,,Iretallic Lining Flowers
Outlay for Lot .
Outside Box - opening Grave -
Interment at emetery. Lining Grave
Lot or Grave No I -it 4-- . ........... . Section No. Shipping Charges, prepaid
-3�Removal Charges . . . . . .
S. �j 77Cremation Irges e7
................ ......... . ..............
. . . . . ........ . ..... ....... .... ..........
41.� .................... - - -----
a.
Total Footing of Bill $
B ..a.
..... y Amount Paid in Advance
.. . .........
Magma, of Lot.) By Amount Paid In nwuanCG
Designate all Graves in Lot with numbers (1 2
%ace for this Nneral With a ores f '3, 4y etc.), and Mark
Designate place for a W. Balance
Usespac- to Monument with a small all square (0). below'
rilbtof Diagram for the names of those buried in Lot. ... 0
1 - - — - --- I Ento-ed into Ledger, page
I �10 Funeral Cha,aes
Total $
.......... . /
- — --- ---------- .... I
By Cash ;
a---�
te of the Dece asc
iYar,
"o
price of Casket or Coffin
Metallic Lining
Outside Box -
Grave Vault -
Burial Robe
Burial Slippers and Hose
EmbalmingBody (with ........................................ .
Washing and Dressing
Shaving
Keeping Body on Ice
Disinfecting Rooms
Useof Catafalque andDrapeny
Folding Chairs
Candelabrum
Candles . . . . . . . .
Gloves
Crape
Number of Carriages......_ ........ G
Hearse
Wagon Deliveries ........ .. . . .................... .
Death Notices in. . . .......... . ........... Newspap4
(Names of Newspapers
Flowers
Outlay for Lot
Opening Grave
Lining Grave
I Shipping Charges, prepaid
Removal Charges - -
Cremation Charges - -
I Total Footing of Bill
�1 1��
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.) , and Marl
space for this Funeral with a cross (+).
Designate place for Monument with a small square (13). dinLot
Use space to the rightof Diagram for the names Of those burie
Total, $ .. .. . ..........
.. . ...... 4 To Funeral Chaws
I... -- =.. ..........
Balance - - , *
Entered into Ledger, page. or below-
.. .... . ............. $
By cash
.... 6
J.— ................ .. .......
...... .. ............ . ...
. . ... . ..... . . ........... ...
. . ............ ........... .......... . ..... . ... ......
/ r117--
. .. . ........ . .. . ...
............. L Louis,j'f" In file
...Ye"
INEMAN. St.
. . . .......... . . ......... ... ........ . .......
Compiled Iy F. J. FE
..... .. .. .
....... . ..... �—A . . ..............
COMPIled by
PE"VEMAIV, SL Louis, Mo.. In the year 1000-
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