HomeMy WebLinkAboutCemBK1901to1907pg152,153-0089s
EcORD or FUNERAL.
RE
Dale,_
Name of the 11eee11ed —
Charge to- __ _ — - -
__ --- Price of Casket or Coffin ,
Order given by -' •• Metallic Lifting y
How secured ,� " Outside Box
Funeral_ / 1 d Grave Vault
Date of //// , f r-
" Burial Robe
Funeral Services at ---v-
.. Burial Slippers and Hose
Funeral Servi •es 41
Time of EmbalmingBody(•with.............................................Fluid)
�' / Washing and Dressing .
Clergyman �` � It 10 -'--
Certifying Physician- Shaving
te__ _.__- Keeping Body on Ice
Number of Burial Certaftc
I t,��r/(,�,_.•f�f•�+ Disinfecting Rooms
Cause of Death- J.� 1 ' t Use of Catafalque and Drapeiy .
Date of Death, _ Folding Chairs .
Occupation of t ae Deceased 'x r Candelabrum
l � I Relis6iom Candles .
Single or elfarried� ' Gloves .
Aged Years, _11 Months,__`I -- Days. Crape .
Body to be shipped to Number of Carriages - _ - -- ----- - -
Size and Style of Casket or Coffin Hearse . • '
Wagon Deliveries .............. ...._... _.................. _......_._--
Death Notices in..__...------._----- -Newspapers .
Manufactured by_-------
Metallic Lining
Outside Box -
Interment at -cemetery.
Lot or Gran' Vo. '�_ .__Section NO _
2.
6.
..........................
(Names of Nowspapers )
Flowers
Outlay for Lot
Opening Grave
Lining Grave
Shipping Charges, prepaid
IRemoval Charges . - ;
Cremation Charges
Total Footing of Bill
(nhgnm of Lot.) By Amount Paid in Advance
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
'pace for this Funeral with a cross W. Balance
Designate place for Monument with a small square (p). Use space to the rightof Diagram for the names of those buried in Lot, or below,
--__= Entered into Ledger, page...._- .................. __—
`Io Funeral Charges Total 1
f
Cash
RZECORD OF FUNERAL.
------ - Date , ..,------- —--. --
ana, of the Deceased._
Charge to- -- - - --
sivenby--��.._._ -_-------__.._......_......._._. I
OrdeT I Price of Casket or Coffin • $
now secured-_. ------ - - Metallic Lining
r Outside Box
Funeral � `` •-------
-- .........
Date of • Grave Vault
7 i'1i
Funeral Services at _. , Burial Robe . . . . . ._.....
Funer� Services .... !�' -I'-'s j' 7-- •• Burial Slippers and Hose
Time of Clergyman
f� =_ . _u t . EmbalmingBody(with ._._-._._................_............F7uid)
man
Washing ---
in c___--.l.�i !t ''--_._...:..__ g and Dressing
C,rtafy � Physician Shaving ._.__.... ......_......
,N'umber of
Burial Certi create....- _____.______ ........ Keeping Body on Ice I
% Disinfecting Rooms
Cause of Use of Cata falque and Drapery
_.
Date of Death, - - 1 i-L�...__._—_.----
�- , Folding Chairs . - - -- -
Occupation of tlae Deceased
' •' Candelabrum -- - — -
Single or ✓11arried.__ALzL-_(Reuoion _0--J61_..____ Candles •
Gloves . . . . .
Ased__�:f .'i Y'ears, ....... Xonths, ....j-...x......_.Days. - -
} Crape _
Body to be shipped to--...------..__.._ ----- Number of Carriages_........___-----....0$...................
Size and Style of Casket or Coffin Hearse . • •
_- -
Wagon Deliveries ......... ... . . . ...... . - _.......
---- Death Notices in.._._..._...___. ewspapers
di mrzfactured by ---'- `------------
- (Names of Nnwspapen
Flowers __..._._
-
_ Outlay for Lot
Oittside Box ......--- __._--- _..._...._.
Opening Grave
G <. �1t> C! _.__Cemetery. ----- -.__..
Interment at_...__�...-L.-�`=�i-=- •� Lining Grave
prepaid
Lot or Grave No._-ii.._...Section No•_ _--._....... I Shippingbarges, —
Removal Charges
Mlagram of Lot.) -
Designate all Graves in Lot with numbers (1, 2, 3. •1) etc.), and mark I a
space for this Funeral with a cross (+)•
Designate place for Monument with a small square (f7)• page __.......... or below-
Usespace to the rightof Diagram forthe namesof those buried in Lot. Entered fnt0' • p =
_._ ......__ .............
_. ..... l .
...._..._.____.-.__._._' is !lw year l90D
......-__..........._.....- 5= Louts. hfa.
"_ •~.•�• COUIpf!c', by F• J. t.EINEMAN,
COZPilod by FEiNEMAN,
SL Louis, Ma, In the year 1000.