HomeMy WebLinkAboutCemBK1901to1907pg16,17-00201f�
1 RECORD
-- _ Date... RECORD OF FUNERAL,
1/�.Q/� .
\,1. Date.. 1�'tn ... ..... ._ .
,h'ante of the Deceased
- o
Clifule to—
---- -- `"--•,.�\ Nam,e of tits Deeeased_.�-—�-•------
order given by ------•--- '� ~ Price o � Casket or Coffin in $ Charge to
« f � I liven by _-------_..._.___._..._
How secured.—. IWc Lining Orders Price of Casket or Coffin
Outside Box41
Date of Funeral Ilnur secure __-- IIMetallic Lining
Grave Vault n �� '
jr uneral Outside Box
Funeral Services at El Burial Robe Date Of / l "
Funeral Services at _�-l'?'� �^1_-Cr tz� l�_7= Grave Vault
Time of Funeral Services ` Burial Slippers and Hose Burial Robe
/ ---•- EnlbalmingBody (with ................... - Funeral Services ..f��21�---------- - '• Burial Slippers and Hose
Clergyman ...............Ruid)' Ttme of c
Washing and Dressing / ' ���� EmbalmingBody (with
Certifying Physician �- Clergyman �c{ /
Shaving 6 Physician r11.. L/h>_.......... .....__ n Dressing . . .
Washing and D ing
Number of Burial Certiflea a__-_ Keeping Body on Ice C^rlifyin> Shaving . .
Cause of Death -- Disinfecting Rooms Number of Burial Certifteate____ - - Keeping Body on Ice . .
/ / __......
qq Death ---/��-L!!'�----- Disinfecting Rooms
Date ofDeatlt h r(/� Q y Use of Cause °f Y Use ofCatafalqueandDrapery . .
- Foldin Chairs -- .�—rr-�o- �_..._�-_-_- �� •
Occupation of the Deceased - g Date o Death-
Candelabrum f Folding Chairs
A / Oocupatiorb of the Deceased_
Single or Married�ll41ion �� Candles r Candelabrum . .
i�/! r��x+ t s . i rj , _
Gloves - Single or
Months, 2�elr.aaon .._.__!:_:._f.--_._� Candles
IgedJ ' Years,_ ✓lionths, _1___.....__Days. Gloves • • • • • •
• �... Jl'Iontlas, ................_.Days.
Body to be shipped to Crape -- • . •
• Aged (r_..__Y'ears. ............ Crape
T - ----- Number of Carriages ------- @ $...
Size and Style of Casket or Coin___Number of Carriages ......................_ „ ,$ Body to be shipped to ---- ••--••.
Hearse . .
_ __- _ Size and Style of Casket or Coffin.._.___..._...__.._---. earls .
Wagon Deliveries ..................... _..... I Wagon Deliveries .......__
....._...._......__ . — Nevis a ers
-------- D th Notices in __-_ p P
manufactured by________ _ Death Notices in-__ .........._.....Newspapers
pf tall �-
etc Lining _.__.__._._-------_^ .....................
.................
(Names of Newspapers)
Outside Boa _ Flowers
��+��--- —_ __ Outlay for Lot
Interment at ( V
Cemetery. Opening Grave
Lot or- live-No.A.,___Seetion,7y°, Lining Grave . •
I Shipping Charges, prepaid .
.__._ RemotVt Charges
z. Cremation Charges .
4.
mugramof �'•-- • v`aL rOottng of Bill $I
Deai Lot)
4ace for g hiseFaaGraves la Lot with numbs By Amount Paid in Advance
Designate Place for withral a cross W. 1 (1, z, 3, 4, etc.), and mark . vlesPace to the . Aioaumeot with a small square
nehtofDis men as co). Balance
— f names of those pan
o F a ed in Lot. Fnte1 Zd '
oral �,a ,_ info Ledger, page ........... __».........._orbelovr•I
- ?_n l 'Ses--_ —
I L[
_ _I!..
I 1
i
------ I B.v Cash__._...._.._ _ _ ___._ $
�'. rllanufactured by_..-----•----_.__
✓tletallic Lining —
Outside Box.__-------- ----/ /---- —
__i_�1/A(�
- Interment at_.._
Cemetery.
--' Lot or Grave No...�..... __Section No. t time' �f
lL_ '
><.
- ................ _.._....
4.
........... .... .__._.__._
ea -�---
(Names of NewlPaper"
Flowers -
Outlay for Lot • • • • • .
Opening Grave
Lining Grave �-
Shipping Charges, prepaid
Removal Charges .
Cremation Charges . • - —
.... .................................
Total Footing of Bill
a' By Amount Pad in Advance
(Diagram of Lot.) tSatance
Des
ignato all Grates in Lot with numbers (1, 2, 3, •1, etc.),and mark
:e for this Funeral with a cross W. Or below-1
Designate place for Monument with a small square W. Page -- - -- ii I
Use space to the righted Diagram for the names of those buried in Lot. Entered mtoLedger, pg --
I1B...._.___---- II ................ _. __-_
v Cash.--�-�--------
To Funeral Charges ---•--•Tow, $
......... i
Pttp byg J ____.� Compiled by F. J. FEINEAfAN, St_ Louts. a!o.. to ea
FFtN ._..._.
' - £MAN, SL Louts, _
Ma, in the Year 1000.