HomeMy WebLinkAboutCemBK1901to1907pg138,139-0082i
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_ RECORD or rUNERAL,
37 �- ---- RECORD OF FUNERAL.
Date ... _:_....... __ ....
-
...... 19c�....__
of ...-. the Deceased__1_!
Name of the Deceased 11rame
--
- Charge
Charge to price of Casket or Coffin
liven J- -` Metallic Lining � Order yiUen by �"-`-`-' -- - , ,
br Price of Casket or Coffin $i---- - --
Order , _--
-� __ If Outside Box IIow secured --• " Metallic Lining • • • -
Ilow secured r Outside Box ; - -
�.) Grave Vault Tuneral_ -1 h-L1 ---- -
Funeral Date of Grave au t .
Date of .� `
1 '�^ ' - - Burial Robe � � rL.�.�._ �
Funeral Services at �t�'' Funeral Services at _ .. t -.. { if BurialRoe iI
* -- " Burial Slippers and Hose
.: r� - .. an Ho
o Funeral Servuscs -- EmbalmingBody (with. Tinge of Funeral Servzees-'-..l.-�'1� Slippers d H
Burial
Ft)),a� n
Tzme f _,,! _:_._•-:�- - / EmbalmingBody with....:_.......__._.._..__..__.Flai ), ._ «
Washing and Dressing Clergyma
Clergy- �� _ n Dressing
.�..._.__ , my PTzysician _ ----
Shaving C,rtify tom.......... c .. —
Washing and D ing
Corlifying Physician--_-.-•1-.` Shaving Ice
---
- --- - Ke in Body on Ice Burial G'ertif cafe....._...__------- -- Keeping Body on
Number of Burial Certzffcate__--•- g Number of I -�
Disinfecting Rooms Disin ectin Rooms
f g Deatlz ( ._._........._... - f g -
DeatTt__---- = UseofCatafalqueandDrapery Cause of UseofCatafalqueandDrapery -----
Cause of Death, l � 41 f -�� e Folding Chairs _
_...._.....__ I .. Date Of -
�; • ___---- `I Folding Chairs o mg
Date of Death . . . . .
the Deceased-_------ Candelabrum Occupation of the Deceased.1 r' r" Candelabrum
Occupation of \ e r Candles ..-Religion ---- — es • • . . ...-.__.
Single or lfarried_ . - ='Religion ---- - --' ,. Single or Married....:....- � Cves • • . .
Gloves Years, .....- _... , IontT , _.D y .
�(�.. of s Gloves
Days. ,Rged- �- .. JI zs Crape
i Years, �. •Months, J-4 U...._
Crape . • • • • '
Aged.._. � Body to be slazpped to ----- -- --'� Number of Carriages......_....._.._.__.O$........... ...... _.I -
.--..-
Body to be shipped to Number of Carriages ._..........__.... C $........ y Hearse
.__...._ -
Hearse Size and Style of Casket or Coflzn------- ___-- Wagon Deliveries.____......_..-_____ •---_, L.. .__._
Size and Style of Casket or Coffin__ - Wagon Deliveries ....................__..........._. __.--- - - -_-_ —
Death Notices in...._.__.._._.__Newspapers -- -- --
- Death Notices in .... «.............. «_. ......................
Manufactured by_-._--_-•--.�._.___-_---_____----�-��--..._.
tames o[ ye.a5Payera I
dlanufactured by------- -- -- ............. .- - Flowers ,
-�(Names urNewspapers) ,illetallic Lining ----" —
ll' L' Flowers . ' Outlay for Lot -- --
,Meta zc znzng ----
Outlay for Lot Outside Box. Opening Grave _ -
Outside Box_ --.. / Cemetery. •
Opening Grave Interment at .__c • � �+ !-a.�ll��-`---" ��,/ Lining Grave -• y -
Interment at_ t Cemetery Lining Grave Lot or Grave No._........._Section No•__ -r) Shipping Charges, prepaid -
T _. _.- Removal Charges • -
Lot or Grave No. 4Ls _ _..tSesSt�iit Na(` Shipping Charges, prepaid .._....____-_._.........._.... Cremation Charges •
Removal Charges.............
z, Cremation Charges • 3.
- —
4
- ---3. ............. -.. I
— ..... _ _-- _ _..._ _....._._ $I
4. —
__..
...._._•-•-•-- � 1"otal Footing of Bill
a•----�•---•-�'��� $Amount Paid in Advance
S. a ............ _..._....- -
a.Total Footing of Bill (D)agrm„°t Lot.)
. 3 and mark
lDlagram of Lot.) By Amount Paid in Advance Designate all Graves in Lot with numbers (1, 2, , •t, etc.),
apace for this Funeral with a cross (•I')•
Designate all Graves in Lot with Dumb (1, 2,3, 4, etc.), and mark Designate place for Monument with a small square (0)-
space for this Funcml with a cross Use space to the rightof Diagram for the names of those buried in Lot.
(�,)• Balance _
Designate place for hfonument with a small square (0) —
Usespace to the ri b��d'u' I •—_-•_ --_.
I
ghtofDia or
= To Funeral Charges.___•—Tafa1, $ ..
llmatforthe namesofthose buriedinLot.
— Entered into Ledger, Page ............ ....
_ - f may/`
-- F I7P nrral ry :_------. _ - - By Cash - , I E / - �_ Cha ;
.
_. .
.-__ _.__ _...__._
__ • r .--_.......... I .—_ �...._._.._..._..__...._.._.._.__....
�•_'-_— _. ..i. I 1. li
•
_' -- _.............. ......«... ..........._._...
COn,P!!ed 6y R J•
FEINEMAN, St, Louis, Ma, In ura ye,+r 1p00'
y
Balance
Entered into Ledger, Page ._._......._._......_ or below.
__. Z
Cash
r-
,