HomeMy WebLinkAboutCemBK1901to1907pg140,141-0083a
FMMMPI�--
(Dp j�UNERAL
00 L)ate
PECORD OF FUNERAL,
Date f* L2fv..L—
&rSir-L
Name Of the Deceased
of the Deceased
yar?16
............. to Cliarile to
price of Casket or Coffin (;ivert by
Cilarle to Mdaltic Lining order Price of Casket or Coffin $
Order given, by outside Box Row secured Metallic Lining
Ilow secared� Crave Vault Date of puneral Outside Box . . . . .
Grave Vault . . . . .
Funeral Burial Robe ce� t- I
Date Of t Slippers and Hose Funeral Service ......... Burial Robe . . . . .
Services a _41�"- Burial e of Funeral Services Burial Slippers and Hose
Funeralral Services B t"l
Fmbatrning 04 Clergyman EmbalmingBody (with ... . ... ........ u d)
virfle Of Funeral -Wrashing and Dressing yman Physician, Washing and Dressing . . . . .
clerjYMan' shaving C'5 Shaving . . . . . . . .
rtifyind physician
cffl.rtifyini physician Body on Ice Xurnber of Burial Certificate-..---— Keeping Body on. Ice . . . . .
Keeping 0 Y
Ce Disinfecting Rooms . . . . .
ber of —
Burial — ----- Disinfecting Rooms Cause of Death
Yarn —
Use f Catafalque andDrapeu jfij Use of Catafalque and'Drapery
0 $1
Cause Of Death Folding Cbairs Date of Death, Folding Chairs -
n, of the Deceased Candelabrum . . . . .
Date of Death 6 Deceas Candelabrum occupation of t ion Candles . . . . . . . .
--------
occupation -1 Candles Ma r r i e d R e 1 iff Gloves . . . . . . . .
eligion Yearso . . ........ lonths . ......... ...... -Days.
Single or garrie' Gloves gded ---- (-J� Crape . . . . . . . .
' W' _ jjonths, Crape shipped Number of Carriages ....... $ .......... . ........
Aged—W— rearsy Number of Carriages.........._......_.__ Body to be Hearse .
Body to be shippHearseDeliveries........_...___..._.._...._..____.__....___
. . . . . .. ....... .
ed to Size and Style of Casket or Coffin ------ Wagon Deliveries ------------- - ---
S,,, and Style of Casket Or 00fifin"' Wagon Deliveries .......... . ........ . . Death Notices in-.-.-...--New5P#Pers
Death Notices 11anufactured by--—�--.------- ............ ..
(Names of NeWsPaPen
ganufactured (Names Or NLW51)"Pers)
•
Rowers
AfetaUic Lining outlay for Lot
outside Box Opening Grave
Interment atlEll a�. Cemetery' Lining Grave
Shipping Chalgest ppep
Removal aid
Lot orGrave ivO. 44_Section No. [ Charges
- -
11
Cremation Charges - -
....................
....................................
5.
6. Total Footing of Bill
By Amount Pad in Adv"rlce
4retallic Lining------
Rowers
outlay for Lot . . . . . .
?utside Box
Opening Grave -
rnterinent a2--Cemetery.
Lining Grave . . . . . . .
Charges,
607r*0
Shipping prepaid
Removal Charges -
Cremation irges . . . . . .
. ......... ........... . ... ...............
3.
..........
. . .. . .............
4.
. . . .....
Total Footing of Bill
By Amount pa;d in Advance
M124raill of Lat.)
Designate all Graves in Lot with numbers (it 2, 31 4, etc.), and mark
Balance
PUCc for this Funeral with a cross (-I,)•
Designate place for Monument with a small square W. t
;7,;tered into Ledger, page, or below,
(Magram of Lot.) I Use space to the right of Diagram for the names of those burled M 0 , I
Designate all Graves in Lot with numbers Balance
space for this Funeral with a cross (+), (1, 2,3, 4, etc.), and mark
Designate place for Monument with a small square (0). of
Use space to the rigbtof Diagram for the names of those buried inLot. Entered into Ledger, page .....'--�
I. . .........
COmPlIed by p. j
- FEINEMAN,
1900.
Mo., in thu Year
Total, $
To.Fix-neral I - / ...... . . isy
I
..... ..... .
...................
EMAM St- in U,, y,,r
,3 Co,pjIod by F. J. FEIN
MAI
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