HomeMy WebLinkAboutCemBK1901to1907pg158,159-0092Deceased it
�ZFcORD FU
NERAL ,WN
Date .....
..... _..- _
� RECORD OF FUNERAL.
No.
ame of the Deceas,
NanLe of the - — -- --- N .
— Char
Charge to- ---- - - ' _ _
price of Casket or Coffin ge to ,
Order given by -- if mdallie Lining - Order given
How secured, ` � /�n� " Outside Box • �` gow secured. - --
f' �' , „ Grave Vault Date of Funeral
Date of Funerall�1 '
_._
�eLc_�•--•------ .. Burial Robe ---------...._
rvices at � Funeral Services at
Funeral Se _. _ .- _ _
1 _,,�2--- -- " Burial Slippers and Hose Time of Funeral Services __�/
Time of Funeral Services '
EmbalmingBod� (with .....
r1 t — -.. __....... Clergyman
ui /J
Clergy�n � � � Washing and Dressin ^`_ y^----__-•
emuA-- Shaving . . . Certifying physician
=
C,.rtif ying physician Shaving
on Ice -
Number of Burial Certificate —: -
Number of Burial CertLfleata_ ---"" ` Keeping
Rooms Death
f f 4 Cause of
Death*
Cause of Use o Cata al ue and Drapery �� ,�� ,,� i (, / --
Date of Death ! ` �- -- ------ Folding Chairs I _ Date of Death
1
i the Deceased
Occupation of the Deceased r / Candelabrum Occupation of
t `tReligion h-Nk` � ' Candles Single or-Married-
-1
Single or MarredAl =L` Gloves
Days. •gscd_ Y2-.--Years,___...J{lonths,..��._...._._Days.
Aged�y'earsp _j__. Months, Crape
Body to be shipped --
Body to be shipped to Number of Carriages ......................... C $.............. _
Hearse _ Size and Style of Casket or CofJi�L___ -
Size and Style of Casket or Coffin . ' - -
Manufactured by
Metallic Lining_
Outside Box. —
Interment atSSt-
Lot or Grave No,1
WagonDeliveries......................._....._._..__..__.._............... - _.......
Death Notices in_. ........... ........ Newspapers .
Manufactured by—�-----
_ ._
tNamns u[Newspapero) ,rife{attic Lining
Rowers '
Outside Box
Outlay for Lot _-Cemetery.
at -Cemetery.
Opening Grave �(/ /
—Cemetery o�.i t �.L�
Lining Grave Lot or Grave No. __Section-N
_Section No. C G Shipping Charges, prepaid
1. Removal Charges
z• Cremation Charges .
8.
_ ...................
._.
i
4.
85. $
1 ij
s. Total Footing of Bill .
(uIagram of Lot.) ......... By Amount Pa;d in Advance
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross W. Balance '
Designate place for Monument with a small square (p).
Use space to the right Of Diagram for the names of those buried in Lot. I or below.
Entered into Ledger, page..
;'9�N F at Charges-
- Total, $ __ _
wIn I ,---a—_ �B,� gash
I
Price of Casket or Coffin
Metallic Lining
Outside Box .
Grave Vault .
Burial Robe
Burial Slippers and Hose
EmbalmingBody (with.........-._ -- ------- .......... __.Flu
Washing and Dressing . . . .
Shaving . •
Keeping Body oil Ice
Disinfecting Rooms
Use of Catafalque and Drapery
Folding Chairs . . . .
Candelabrum .
Candles . • • • • • • •
Gloves . • • • • • • ,
Crape . . . . . . . .
Number of Carriages ... ...... _...__._.._.... C` $............
Hearse . . • • • • • ' '
Wagon Deliveries ....... .............—____ -
Death Notices in. ------- ....--------- -Newspapers
(Magram of Lot.)
Designate all Graves in Lot with numbers (11 2, 3, 4, etc.), and mark
:e for this Funeral with a cross (•I•)•
Designato place for Monument with a small square (G)-
Use space to the rightof Diagram for the names of those buried in Lot.
TO
0
--' (games of Nowspapars)
Flowers • . *V+ . . .
Outlay for Lot
Opening Grave • -
Lining Grave . •
Shipping Charges, prepaid
Removal Charges
Cremation Charges
Total Footing of Bill
By Amount Patd in Advance
Balance -
Entered into Ledger, page ....... .......--_._ or
ByCash____.._...._.__.._....__
...........
n
4
VL _._........ _ _-
Complied LY F. J• FE7NEhfAN.
SL Louts• 1610., In tho Year 1900.
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__1----�-__ ....... �
t_ _. _.................
Compiled 6Y A J. FEINEMAN, SL Louts, Mo., 1n the Year J900.