HomeMy WebLinkAboutCemBK1901to1907pg150,151-0088i AI
RECORD OF FUNERAL.
i.
No• --
Nance of the Deceased r
_ _-----_
Charge to ---- - _ _ I
Order given by ---�-
Ilow
Date of Funeral ,
Funeral Services at
�%
Time of
Fune�)r,
l Services
Clergyman Ll
T a4
Certifying Physician).
Number of
Burial Certi e-------"'--
Cause of Death
Date of Death b -
Occupation of the Deceased �t
Single or Married
Years, Months, "Days.
Rged I -
Body to be skipped to
Size and Style of Casket or Cof►c
price of Casket or Coffin
fin
" Metallic Leung `
`• Outside Box
" Grave Vault ,
" Burial Robe ,
" Burial Slippers and Hose ,
EmbalmingBody (with ............................................ Ruid) .
Washing and Dressing .
Shaving
Keeping Body on Ice
Disinfecting Rooms
Use of Catafalque and Drapery .
" Folding Chairs - . ,
" Candelabrum ,
Candles . • • • •
Gloves
Crape , • . •
Number of Carriages .. ...................... C
Hearse .
WagonDeliveries ..... ..... _........._......................_........ ......
Death Notices in ... .............. .......Newspapers ,
Manufactured by - I
.......................................
(Names ut Newspapers)
Metallic Lining Flowers • '
Outside Box Outlay for Lot
Interment at_ I V�—Cemetery. Opening Grave
el Lining Grave
Lot or &W&No.-o _-_Section No•4-.---��� Shipping Charges, prepaid
' _ f9"I Removal Charges ;
z• Cremation Charges
-- ...._..._..----................... ... --._..............
3.
4.
s.
a.
Total Footing of Bill •
By Amount Paid in Advance
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (d.), Balance
Designate place for Monument with a small square (13). Use space to the right of Diagram for the names of those buried in Lot. or below•
g Entered into Ledger, page..
f
To Funeral Cha ges__Total, $I —
I_.... _.......
Cash
f
RECORD OF FUNERAL.
Name of the Deceased. - -Ci----
Charge
19-._._.-
order given, given. by _•---'__--"._� _____-_.
Price of Casket or Coffin
secured _-- -- - - --
`• Mel "ic Lining
gocv
Date of Funera _.__.-------_._..___..__._._.
•• Outside Box
Grave Vault
Funeral Services a - .--------- _ - -
Burial Robe
"'" " "- '
Time of Fccneral Services ._.. "
do Burial Slippers and Hose
—._—_______.__._.__
EmbalmingBody(With .. __............ ......._._.........Raid
Clergyman-------_—" -
•
Washing and Dressing
Certifying PTaysici,an._r_..__-______ __.-_
Shaving .
Number of Burial Certifteate_..._._..-------- —
Keeping Body on Ice
r Dealk"_-__---------__.._..____�.._....... .._..._..._.......
Cause of
Disinfecting Rooms .
Use ofCatafalflueand Drapery
Date of DeatT+, - -- ------ -"" -- -
•� Folding Chairs
Occupation of the Deceased.
" Candelabrum
Single orMarried ._....-_------ -._..-Religion _._...._-...__._..__
Candles . •
' '
llged.._._.___.......Y'ears,.................._.. Jllonths, ..................._ Days.
Gloves • ' ,
Crape . . . .
Body to be shipped to—._----------
Number of Carriages ... .... _... .... ......... .... 0$............... .
Size and Style of Casket or Coffin.____.._.__..------ --
Hearse . • • • • • ' ' '
Wagon Deliveries .._.... ..._.........-------...._.__..._-_-.__.
__ _.-_.------.-- - ---- —
Death Notices in --- ------- _.......... .Newspapers .
-----.._._
,rlianufactured by_.._—
- (.amesofNcW�cav�ra)
4felallie Lining ---- -
Flowers
Outlay for Lot
Outside Box .___ --
Opening Grave • ' '
Interment at _.._._Cemetery.
Section No - —
Lining Grave
I Shipping Charges, prepaid
Lot or Grave No,
Removal Charges
i. .._........_.
---"" "" "
Cremation Charges .
s.
......... --
4.
........ .____._..
_._--•-_._____....._.__...
Total Footing of Bill
a' .._..
By Amount Pa:d in Advance
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (+)•
De,ignato place for Monument with a small square (G)-
Usespace to the right of Diagram for the names of those buried in Lot.
Charges -------- T..Tata , $ i. _..._.......
L��, T..-
1
Balance
or below.
Entered into Ledger, Page .._._..-_.._......
_ By Cash --- $
comp❑ed y.v F J, FE+NEMAN, St. Louis, Ma, to the year +000.