HomeMy WebLinkAboutCemBK1901to1907pg178,179-0102a
OF FUNERAL.
�,�:, IZECORD _1-=-�= RECORDop FUNERAL.
IT)
- Date ... ............ _.__._.__._.._.-_,_
Date.._..._.._............_.._ ............._ ._.
Deceased_------�'-
-- -
---------------�-�-
,,ante of the
--•-_---
Charge to ---- - ........._.___._-.._
'I price of Casket or Coffin
S
Order given by '� �f -
i` Netallic Lining ,
secured--- -� _ ..---
of Outside Box
-
Vault
gow
Gravc
Date of Funeral _..___._-
- - ,. Burial Robe
Funeral Services at -- - -
Burial Slippers and Hose
of Funeral Service - - �'--
�'_ ErnbalmingBody(with ...... .................................... ..Fluid)
Time _ --
---�
Washing and Dressing .
Clergyrnan_-----i
,
Shaving .
Certifying Physician---`_
--�
._ . Keeping Body on Ice
y oil
Number of Burial Certificate..__.._.- —
...._. Disinfecting Rooms •
of Death--------
Use of Catafalque and Drapety
Cause
----------
" Folding Chairs
Date of Death••
Candelabrum •
Occupation of the Deceased
Candles '
Single or --geli�ion .----------�
Gloves .
--Days.
Aged_-- --- Years, _--_ months, --------
Crape .
e$_.... . _.
Number of Carriages............-..._....
Body to be shipped to
Hearse . •
Size and Style of Casket or Co►t
Wagon Deliveries ....................... _.__...._......... _.
Death Notices in.._ .................. Newspapers
manufactured by---=-•-------
........_.._.
' (Names utNewepapersl
Metallic Lining
Flowers
Outlay for Lot
Outside Box
Openirng Grave
Interment at _.__._.._ __ __-Cemetery.
Lining Grave
_
Lot or Grave No,_ _-__ -Section No-----
Shipping Charges, prepaid
Removal Charges
1
---'-
-� I Cremation Charges
_....
-. s. _..
.-._ _.....
4. ....... ... _........ .........
_...__.•••.---
e, _ Total Footing of Bill ,
_— —
��� By Amount Paid in Advance
(Diagram of Let.)
Designate all Graces in Lot with numbers (1, 2, 3, d, etc.), and mark Balance '
space for this Funeral with a cross (•1•). or yel0'
Designate place for Monument with a small square (13).
Use space to the right of Diagram for the names of those buried in Lot. Entered into Ledger, page ......... ••......
Funeral Charges—._.-_. Total, $
_.._._. _ _..........._
complteJ by P.J. FEINEMAN, SL Louts, Mo., In the year 10001
Nartte of the Deceased.
Charge to__.----
Order liven y ------
Price of Casket or Coffin
____. -,-- - -
---- " Metallic Lining
Row secured
of Fecneral._...__.-------� ------
...... _._._ outside Box . .
Date
Grave Vault •
Funeral Services at __ ..._.....-------------..._.__.
_ Burial Robe . . . . .
Time of Funeral Services ------
- - Burial Slippers and Hose .
____-__......._..__._.._
_..........._ EmbalmingBody(,with-..-._....__._._.........___....._.Fluff
Washing and Dressing .
Certifyins p7tysician
Shaving . • •• •
,vil•mber of Burial Certifleate
Keeping Body on Ice . .
of DeatTa...____-------_.__...__..-....--_--.-.-•-
Disinfecting Rooms . . . . .
Crr.tese
Use ofCatafat ueandDrapery
Date of Death,_----- — ----
-
- ---- ,• Folding Chairs . . . . .
Occupation of the Deceased--.-----
Candelabrum
Single or 7larried........--_-....Relision .___.--------..._._
Candles
'
Aged- Years, ..................... Months, ............_.........
Days. Gloves
Crape . . . . .
Body to be shipped to-_------------.-_._..__..____
_. -_-__. Number of Carriages ..._ _ ... _. C $..............
Size and Style of Casket or Coffin. _.__..._�
____.._ '
Hearse . Wagon Deliveries_._ •--.---------
..._.._
- Death Notices in____.__.__...... Newspapers .
lfanufactured by_...._.__....._-.._-._ --------
- _--''—�— (Names of Newspapers)
,ltetallie Lining_-- ---------
-- Flowers
Outlay for Lot
Outside Bose _-- -- -- ---
Opening Grave
Interment at—_.__..-._-_-•-•�-•�- ....
Cemetery. Lining Grave
, atd .
Lot or Grave No. . ..........Section NO—- Shipping Chargesprep
Removal Charges '
1. - --
Cremation Charges .
__._......._.-.... .......................
_..................
s _.
4.
G. $I
.....__.__.__.._.._.__.___.__......._... Total Footing of Bill
By Amount Paid ill Advance
(Diagrain of Lot.) Balance . .
Designate all Graces in Lot with numbers (1, 2, 3, A, etc.), and mark I '
apace for this Funeral with a cross (+)• _.._.Or beloall.
Designate place for Monument with a small square (0)• page,
space to the right of Diagram for the names of those buried inLot. Entered ----- Ledger, p g
$
�By Cuit..._._.____. _