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FUNERAL
1� RECORD kEcow OF FUNERAL.
Date
No.� �%
Name of the Deceased
Charge to-
Order given by -
How secured _ IT!�
t
Date of Funeral / n/
Funeral Services at
Time of Funeral Services �---
r—
Clergyman
C9rtifying Physician._✓ 2 - ---
Number of Burial Certi-•-
Cause of Death ` - --.-•
Date of Death r, a ------
Occupation of the D
gqe
�ceased
Single or �lfarried�y�&Peligion
Rged U Pears, -Ie __ .Months, —,'Days.
Body to be shipped to
Size and Style of Casket or Coffin
Manufactured by._.
Metallic Lining
Outside Box
Interment at��c�_y Sp `t—
cemetery.
Lot or Grave No— .0& --Section No• H
a.
4.
6,
(Dla;ram of Lot.)--•.__.�_....
Designate all Graves in Lot with
Space for this Funeral with a cross (q,),
Designate place for Bloaumest numbers (1, 2, 3, 4, etc.), and mark
Usespaco to the right cross
with a small squaro
Of Diagram for the nn (
mcaotthose buried inLot.
_ .._ ...... To Funeral as ges� . To
tal, $'
_I
r
..,Jiro.
�Iranae of the Deceased.
Cliarge to
Price of Casket or Coffin liven by
40 Metallic Lining Order
F,
Outside Box - Uow secured —,-—
Grave Vault pate of--
" Burial Robe - ---
' : 1+•uneral Services at
Burial Slippers and Hose Time o f Funeral Services ._%_ .-�___ �_... ...............
EmbalmtngBod, wttlf ......................_...... Fltfid /�
Washing and Dressing `` Clergyman /�)'�,y' -- ' -- - `-'"-
Shaving Corti fyinff Physician ICI �'i'. _...........__._
Keeping Body on Ice Burial
Ntcmber of
Disinfecting Rooms
Use of Catafalque and Drapery Cause of
Death
Folding Chairs Date of Death ,e� - --
Candelabrum ' Occupation of the Deceased_ -Ail
Candles r • - t elig ion � ;
' ---__ _ Single or ,Married_. " �-�
Gloves . . . . . ,� ; Days.
Crape ---'- s16ed--DUI Years, Months, .._..._.......__
Number of Carriages ................................. .r $...................... _ Body to be shipped to
Hearse . . . . . . . - Size and Style of Casket or Coffin -.--.. —
Wagon Deliveries ......................._... _..... ..............................
— --
Death Notices in..........................Newspapers
,llrcnufactured by_.._..___..___-------.__—..._
__.................................._...._............---••--- — _
(Nam a,ufNuwspapers) ,1letallLC IiLILLnfg---- —'"
Flowers
Outlay for Lot -- -- Outside Box
Opening Grave . .� —__ - fit,terment at_-h� — _C''e99metery.
Lining Grave . --
�_,._..__Section No•5�%p
Lot or Grave No.
-Shippirig Charges, prepaid —�-
Removal Charges ........ _....
_-_.__._.
Cremation Chargesx• -
--_--____-_._..... _._...... _..........................................
s
4
6. — - .__...........
Total Footing of Bill
By Amount Para in Advance
Balance
Entered into Ledger, page..............................or below,
--- IBv Cash-__-___--- $
compnect E
oul; Dfo..
In the year 1900,
(Diagram of Lot.) and mai
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.),
ePnce for this Funeral with a cross (d•)•
Designate place for Monument with a small square (0)•
'Jae space to the right of Diagram for the names of those buried in Lc
_..__ I `fo Funeral Charges -------Total, $
Date__......__.._....---_..___..._........_....-----_--_..19..___.._
lee of Casket or Coffin • • $I---- -----
Metallic Lining .
Outside Box • �, ----- -
Grave Vault .
Burial Robe . . . . .
Burial Slippers and Hose ,
i mbalmin Bod with .......... ........ _-- Fluid)
--._.... _.._ .
9 Y�
Vashing and Dressing " --
'having . . . . . . . . ..__.. ._.._
beeping Body on Ice ,
Disinfecting Rooms _.._..._ ..__._._
Use of Catafalque and Drapery -- --
Folding Chairs . . . . .
Candelabrum . • • • ..... - . -
Candles . . . . . . . . _-
Gloves. . . . . . . .-
Crape . . . . . . . . . ---
Number of Carriages ................... -... C $ .................. ---
Hearse . . . . . . . . .... _.._.
Wagon Deliveries _._....-----._._`.---__...-_--_ ...._._...
Death Notices in-----_....._spapers .
(Names of Newspapers) _
Flowers .
Outlay for Lot • • • • • --
Opening Grave . . . . . . -
Linblg Grave . . . . .
Shipping Charges, prepaid
IRemoval Charges : :-_.....
Cremation Charges
Total Footing of Bill . • • • -PI
By Amount Pa;d in Advance
Balance
r ..........................orbetow]
t. Entered into Ledger, page I
.. 1 ,
Cornptled by F. J. FEINEMAN. St. Louls, Ala, In the year 000•
d