HomeMy WebLinkAboutCemBK1901to1907pg154,155-0090rUNERAL,R50RD
S
U
- Date-------------------
_...
Name of the Deceased !'
---` I price of Casket or Coffin
Order liven by � Metallic Lining
Sow secured— _ " out
Box
Date of gunerat " Grave Vault
Burial Robe • .
Funeral Services at=FJJ
3L _. pp
Time of Funeral Servie
Burial Slippers era an Hose
dDovect 1
Clergyman
�t_{ti�-------_._-- Wahing an 9
S
Certifyinff Physician avmg CortifYinl physician �----__ -
-
Burial Ce�iftcate_----�-- Keeping Body on Ice • II_ ,hrumber of Burial Certificate__._ -•--
Number of Disinfecting Rooms . . -
Death �'I-
is of Death I
Cause of r- UseofCatafalqueandDrapefy �� —
J -�- " Folding Chairs Date of Death
Date of Death '
t Deceased " Candelabrum Occupation of the Deceased -—
Occupation Of _
n ARelilion.'� Candles i.- Single or ,Married,7�Reliyion
yet lliarried
Days. Gloves Rged._--Years, _.- J6lonths, ._.. Days.
q¢� _Y•,ars, Months,.Crape
p Body to be shipped to
Body to be shipped to Number of Carriages ................................. •� ...........
Sine and Style of Casket or Co�'in Hearse . • • Size and Style of Casket or
Wagon Deliveries ... .... ._._. _ .. _....................------�
Death Notices in .....................Newspapers .
•Manufactured by -............
•... -
___ (Names of Newspapers) ..._._.:
Metallic Lining Ko•wers
Outlay for Lot
Outside Box
Opening Grave
Interment at —______Cemetery. i
Lining Grave
Lot or Grave Section No•--2-3— Shipping Charges, prepaid
Removal Charges • •
Cremation Charges I -
3.
4.
s.
a.
(Dlagme, of Lot.)
Designate all Graves in Lot with numbers (1, 21314, etc.), and mark
Own for this Funeral with a cross (•p).
Designate place for Monument with a small square (p).
Usespaco to the rightof Diagram for the names of those buriedinLot.
�To l
e
Total Footing of Bill 'F
By Amount Fad in Advance
Balance l
or
Entered ir:to Ledger, page_ .. �----•-•-- Belo-- f��
t 1 i
u
-- L._...._..._�_-._.............. .........
.............. —,
Compiled 6 �— ...........
.
y F J. FElNEMAN, St Louls, Ma, 1n Ufa year 1000.
15r
RECORD OF FUNERAL.
Date.. _ ZgLLI
No• `
the Deceased
Name of —
Claarg--_.�._
e to - -----
siven by..---• -_- __
Order Price of Casket or Coffin . , • $
flow secured _ ---------- - - " Metallic lining I ._-_••__. ._._ ... .
Outside Box
Funeral --
Date of , 1 I - -
Grave Vault . . . . .
......... ---.-- _ _
Funeral Serviced at
Burial Robe
gime of Funeral S�1�cesLo....__... _ Burial Slippers and Hose I - ._ ..._..._..
✓� Fluid l ..........-- ..
EmbalmingBody (with...._..___.__...-_....•-.._•
Washing and Dressing
Shaving-- - ---
Keeping Body on Ice
Disinfecting Rooms I ----
I
Use of Catafalque and Drapery
Folding Chairs . .
Candelabrum ._.._.__ -
Candles ° _-
i
Gloves . . . . . . . _-
Crape . I _.._..._... _ _
Number of Carriages ..._._..... C• $... .... ...............
Hearse . . . ...._...
Wagon Deliveries....... -..._....._._.._.....- ----- ...... __ ......... ----
Death Notices in ................. ........ Newspapers _.--
,+Manufactured by _----�
Melallic Lining' --
Outside Box ._
Interment at_ -Cemetery.
Lot or Grave No. _ _Section No•
I. ✓ ___—....._.._.
'L.
S.
4.
g•—_..__...___.__..._......
a. -•-- ............ .
---
�_.._..........
(Ramie at Sewapapen
Flowers _._....
Outlay for Lot • • • • • . —
Opening Grave
Lining Grave - -
Shipping Charges, prepaid 1
IRemoval Charges .
Cremation Charges •
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (•h).
Designate place for l fonument with a small square (0)-
Use space to the right of Diagram for the names of those buried inLat.
_. .........I.-.--.... I'Io Funeral Charges—.--._. Tofaf, $ I...-.. .
i
Total Footing of Bill $1
By Amount Fa,'d in Advance
Balance
Entered into Ledger, page .. - or below,
By Cash_ -- —_.____._—.— $