HomeMy WebLinkAboutCemBK1901to1907pg142,143-0084OF FUNERAL.
jZECOIZD -
IV / / Date..:I ".' _Z�t!�ra
RECORD OF FUNERAL.
No•-�—� - �� No. _
the Deoeased--�---�� Name of tile, Deceased_ _
Nantc °f '--
Charge t0 Charlie
Price of Casket or Coffin
• 3 Given by ---•--.._.-____••-------..........._..._ ...............
Order given by --'i-- •• Metallic Lining Order y -- - - -- - - F
Ou -side Box IIour secured _ -
How secured_ ., Grave Vault /19 �CD.t.__..........__.__
Funeral Date of Funeral_L 1�-
Date of ` --~�' Burial Robe
-- � � Funeral Services at
Funeral Services at
- Burial Slippers and Hose
Ttme of
Funeral Services
Time of Funeral Services.- I EmbalmingBody (with -............_............... __..._.. F(,;1� yv
�/� __ Washing and Dressing Clergyman
.... ........
Clergyman Ku ^- Shaving 6 Physician ............ _
Ph sician� Cortifytns _.......
Certifying y — to Bod on Ice
--._..._ Keeping y Burial Cer rffeate_............. -.... ..._.._ _...
Burial Ce ifleate�-•---- Number of
Number of Disinfecting Rooms
f Catafalque and Drapery Cause of
Death _ Use o
Cause of Deatlb
--`-
Date of Death i' Folding Chairs • . Date of
Candelabrum Occupation of tTte Deceased..
the Deceased Candles , /
Occupation of � _ Reli.6ionV ... _._......._
Religion f� Sin.�le or 1{farrtednl-
Single or Married Gloves years, — jlionths, ._fi'........_.Days.
Years, -, --- months) 2-1—Days. rape Aged_�1e-._
Aled_jj-- _ _—
Bod to be shipped to -.---------
----- Number of Carriages ............................... � $....... y
Body to be shipped to
Hearse . Size and Style of Casket or G'of%in....._-_------•----
Size and Style of Casket or Co f jdn Wagon h Aeries... •........-.. ---_._----- .
Death Notices in ...................__Newspapers
_. lfanufactured bra_..__-.-
dfanufaetured by_.___------------'-' (Names elxewaDapera) ifetallic Lining -------"-
J{fetallic Lining Flowers
Outside Box
Outlay for Lot `Qs Cemetery.
Outside Box [ Opening Grave Interment at_fi�L _..- Z�-•--�--- //
Interment at .-.._Cemetery. __Section No•��'�(i
Lining Grave Lot or Grave .No.._.. QQQ
Lot or Grave No. -._-Section No•-C:C--- Shipping Charges, prepaid 1•
Removal Charges G S e
z. Cremation Charges s,
__.._
S i tf.
e. �_._.._._...__.__... Total Fooling of Bill (Uia raa of I ut.)
��� "` -•----•--•------ d ' Designate all Graves in Lot with numbers (1, .., , • ,
By Amount Pa,` to Advance s t ecc.), and mai
(Ulagtam of Lot.) space for this Funeral with a cross (•i•)•
Designate all Graves in Lot with numbers 1 2 3 4 etc, and mark Balance Designatepace place for :Monument with a small square those
gn Usespacc to the right of Diagram for the names of those buried inL(
space for this Funeral with a cross (� ' �'
Designate place for l+ionument with a small square (p). Total, Use space to the ri htof Diag
ram aye........._....._. _ ___ ......._ To Funeral Cha.ges—....__.. $ .._.............. _....
gram for names those buried in Entered tntoLedger, � -
�C —•__....... ...................
.... .............
I----L.._.._._.......... L.._.•---I--
rice of Casket or Coffin . it --- - ----
•` Metallic Lining • • -- .
Outside Box . . . • I _-•-----_..._..._..._
" Grave Vault . . . •
Burial Robe . •
Burial Slippers and Hose I - --
?'mbalmingBody (with ........................................... Fluid), ._.._........
Vashing and Dressing -- --
ihaving . . . • . . . ' - - ---
!(eeping Body on Ice ---
Disinfecting Rooms
Use ofCatafalqueand Drapery ------ ---
Folding Chairs . • • • • --- - --
Candelabrum -
Candles • • • • • • • ' ---
Gloves . . . . . . . __....... .
Crape • • • ' ' --
Number of Carriages ..... ..... ---•--....... ® $...................... I.._ ......... ..
Hearse . ..• • ' '
.-_-
Wagon Deliveries ................ -
Death Notices in ... ... .............. ... Newspapers _ -
_-
(Names olNewspapers 1
Flowers . . . . . . . .
Outlay for Lot • • • • • ' - - -'-�
Opening Grave . . . • • ' -
Lining Grave - -
Shipping Charges, prepaid -- - -
Removal Charges . . . . . _._......-- --
Cremation Charges .
Total Footing of Bill
. PI
By Amount Pa;d in Advance
k Balance
or below.
t. Entered into Ledger, page..._----_._._...._.
1 I-- IBy Cash ..----_..____- - - --- $
...._
.......... __._......
.._---__.._...._. 5_ Lout-:. Na, !n the Yesr IDDO.
Compiled by F. J• FEl NEh1AN. L
IN Compiled by F. J. FE/NEMAN, St Lours, Ma• in the year VOL"