HomeMy WebLinkAboutCemBK1901to1907pg180,181-0103;A
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or f:UNERAL.
IZECOIZD ---_
Date.......... _............. ...
/ r')
RECORD OF FUNF,RAL.
Date......... -..__------._.-._----_ 18--._
--- ................--- __-----
- ' the Deceased. - - -
the Deceased------- _.•--------'_�__ -- -�- -- — _---�- NapLe °f ._.---
,YarA6 Of
--
---
Charge to Jf ........_.. Casket or Coffin
Charge °--- ...._.__. .
I Price of I
------ -____ S Given by _.-.-_•-.........__.-.___--_............._.. _. _
give, by -- -- 1etallic Lining Order 5 -__ I Price of Casket or Coffin $II
Order g ----- --"- " Metallic Lining , • i
-- --- Ijow secured ____
Outside Box
Sow secured--�'- Outside Box
Grave Vault Date of Funeral- --------- •- ._-_._.-_._ -
Date of Funeral- Grave Vault
- - Burial Robe
_. ..__.-- ,� Funeral Services at _..._._....____..---•---_-..........___._ ., Burial Robe
at ----- Burial Slippers anel Hose
Funeral Services •"' � "' �" '• Burial Slippers and Hose
-------- " Funeral Services ._..__._-__
Timer°man_-------- - - --- _..__.____- EmbalmingBody(with_....._--.-_----------- _Fluid)
Time of Funeral Bernier -- _` Fluid)
_ .-._. __.__....._.__ EmbaltnittgBod�('cvtth_...................................._.
--- ClergJ
C�r$yman_�-- Washing and Dressing Washing and Dressing ;
Shaving C<rtifViny physician ...___....__.... _ --- --- ..-......._ . .
_Shaving
Cyrtifying Physician ---__...._. Body on Ice t ce .
Keeping y Number of Burial Certificate........_.._.__ __-_.
Ke ing Body or I
Number of Burial Certifleate_._-- - DeatlL._..___..._.._......__...........__..._.. _..... D
..__........... Disinfecting Rooms Disinfecting Roonts .
Cause of Use of Catafalque and Drapery
Cause of Death_` Use of Catafalque and Drapery Death -
Dais of -- Folding Chairs
-----'------� Folding Chairs _
Date of Death " Candelabrum .
ation of the Deceased----
" Candelabrum occupation •
Occupation of tlae Deceased_ Candles ' ' ' Single or Harried_ .Relision _- Candles
Religion --- -- Gloves
Days. Glo
Single or Married_._- Gloves,gsed.____._._._._Y'ears..................... Xonths................._ Crape . . . . . . .
s
Aged_ -Years, _ Months, ..... -Day ' Crape
Body to be sTr.ipped to-_.__._.._.------- ---_----- Number of Carriages...__._. -_ C�$....... ....._...
--- Number of Carriages ........- .................. O $...-__ .. .
Body to be shipped to_---- - ..._ - Hearse • ... .
Hearse . Size and Style o Casket or CofjirL..__.. Wagon Deliveries
Size and Style of Casket or Cof it-__-.--_ ..•...••.._.___ J f - - --` Death Notices in_...._...... _ ...Newspapers
.
Wagon Dehvet•ees...._._ _ _ `._-____-
UanufacEured bt1 --
- ----._......_._—_._.._._._--..._.___---_...— lNamee of NerrapaP�ra I
Death Notices m......................_ erwspaper
.......... ---- Flowers . . . . . .
1lfanufactured by__-------- (Names of Newspaper') letallie Lininf'_--- -- Outlay for Lot • • • • '
Metallic Lining - Flowers Outside Box ___-_---- . .
Outlay for Lot Opening Grave
Outside Boa _._Cemetery Lining Grave
�_____----------- Interment at....___.____—...._._.__
Opening Grave •
Interment at_- __- ---- --Cemetery. Lot or Grave No................._..............Section No•- •- Shipping Charges, prepaid
Lining Grave Removal Charges . • • • ' '
Lot or Grave No, ___Section No•- -_--- Shipping Charges, prepaid i.
Cremation Charges .
><. Removal Charges •..................................
Cremation Charges .
2. .....
_ 4
S.
4. . -_ _____._._.._�._._ Total Footing of Bill
._.-.._.__ -_ _ -.-...__.._.___.......__......_.._..._.....__._
8. �.._._____--.-.__._- ... ..... By Amountpaid in Advance
e, Total Footing of Bill -
(Dlagraw of Lot.) Balance .
- - .�.-----------_. g b s (1 � :; .1, etc.), and murk
By Amount Paid in Advanc
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark Balance '
space for this Funeral with a cross (.1•).
Designate place for Monument with a small square (13). or 6Z10 '
Use space to the right of Diagram a e..._,.........__- • "
IfrumforthenamosotthosoburiedinLot. E'rtter'edilltOLedger', p g
'` o Funeral Charges Total
• 3 ......._........ __...- B Cash......_.______.
1)eslgnato all Graves in Lot with num er , .•, .
`6-u o for this Funeral with a cross (d•)•
Dc,ignato place for Monument with a small square (0)-
Use space to the right of Diagram for the names of those buried in Lot.
I..... ...... .ITo Funeral Charges ......... —...... Total, $
Entered into Ledger, page
_!By Cash--
` ...-
- f ,
........_--------- St Louts, Dla. In tLe year 19a�.
Complied by
F. J• FE,NEMAN,
Compil'd by F d FEMEMAN, SL Louis, Ma, In file Year 1900'