HomeMy WebLinkAboutCemBK1901to1907pg2,3-0012Mt
ooP FUNERAL.
RECORD
ECORD OF FUNERAL,
ro.
Name of the Deceased -- - Date_ _.� _ _..19L7L..--
Charge to---- lame of the Deeeased..___._�
Order given by------- Price of Casket or Coffin chargeHow secured—, .. Irderliven by._.__.._..._..._.........._—
P Metallic Lining
1. �f�..t%t .JL-Y.� Outside Box
( ( i - -
Date of Funeral Grave Vault tow secured __._
Funeral Services at [lf�_�%' )ate of Funeral—`:C��
di Burial Robe
lime of Funeral Se r ' zs1�-- Burial Slippers and Hose
+'�.tneral Services at
Clergyman__ -•-
Certifying Pitysician—
Number of Burial Certifteale -- -
Cause of Death ---- �"
r r
Date of Death � � "tot
--
Occupation of the Deceased
Single or Harried O elision ( ) -
✓Iged7L= Years, Months, -Lf) -Days.
Body to be shipped to
Size and Style of Casket or Coffin
Manufactured by
Metallic Lining -
Outside Box
Interment at._ -
Lot or Gkve No. 6
(Dla—�....._.......
gram at Lot.)
Designate all Graves in Lot with numbers
apace for this Funeral with a cross (I )• Designate place for lionument (1, 2,3, 4, etc,), and mark
Usespace to the rightof um With a small s
gram for the na qu ire (p),
Z mceofthoseburiedinLot.I
P ` r7o Funeral - I
77"' J.tL GIT„D a m i %tal, $ _
EmbalmingBody (with.... ime of Funeral Services ..__.—_ _:f>>......__
.............:..................... l
Washing and Dressing F7t,td . clergyman =t�� ` -�`�`=`-'-._._/./_(f........ _. _.._ __._....._
Shaving orttfytnya Physician..�,t—'
Keeping Body on Ice ,
Disinfecting Rooms Number. of Burial Certificate .......... ._
Use o Cata al ue and Drapery Death._...? L/...._......._....._._.:.... _...............
f f 9 pelt' Cause of
Folding Cbairs Date of Deatlt'-- U=� •-•----- -
Candelabrum �����
Candles Occupation of the Deceased " —
Gloves Single or Married.jl/�i!Relision tsL:.fL.11
Crape . 4. ed..._...)�...1�.__Y'ears Months, _........_... _..-Days.
Hearse
Number of Carriages ..... _................. $....... _........... Body to be shipped to
— - -
Hearse .
Wagon Deli ' ...... . Size and Style of Casket or Coffin .......
Death No tie to ... _._.— ----
.... ewspapers _
-- 4lanufactured by------ ----__.......
(Names of Newspapers) —
Flowers .
Outlay for Lot
Opening Grave
Lining Grave
Shipping Charges, prepaid
Removal Charges
Cremation Charges .
Total Footing of Bill $
By Amount Pa>d in Advance II
I
I,
Balance
Entered into Ledger, page ........... _..... .......... or belaw•
' Corn
plied by F, J.
i
1'0111" Ma. in the Year 1900.
✓Metallic Lining --•-----
Outside Box
Interment at_jL (:1.—�<.CCemetery
Lot or Grave .No. _.........Section No• —(.et!u
i.
...._..._._....._..___..__._..___.....__.•.._.
J.
4.
a. ...............
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and marl
space for this Funeral with a cross (Q.
Designate place for Monument with a small square (0)•
Usespace to the rightof Diagram for the names of those buried in Lot
Funeral Charges------•-• Total, $
Price of Casket or Coffin
Metallic Lining . . . .
Outside Box . . • •
Grave Vault . . . . .
Burial Robe . . . . .
Burial Slippers and Hose . .
EmbalmingBody (with ........... ... ._.......... .......... F&
Washing and Dressing .
Shaving . .
Keeping Body on Ice . . . . .
Disinfecting Roorns
Use of Catafalque and Drapery . .
Folding Cbairs . . . . .
Candelabrum . . • • •
Candles . . • •
Gloves . .
Crape . . . . . . . . .
Number of Carriages ........................... CZ$...........
Hearse . . • •
Wagon Deliveries ..................... _..__._..___..._._......
Death Notices in ........ .._..... ....._Newspapers
(Names of Newspaper)
Flowers •
Outlay for Lot • •
Opening Grave . • • •
Lining Grave .
Shipping Charges, prepaid
IRemoval Charges . . . . .
Cremation Charges .
Total Footing of Bill •
By Amount Paid in Advance .
Balance
r
Entered into Ledger, Page.._ _. _. _. o—
_ ......._. _.._.�_..._. 'By
.. -
-- _................._. , .._.._ ... ............
_...__.
..._.............
___.._......__.__._..__.
........._. . ...................
._.._._ •-
I
_..... .................. _
— ....._ .. _-..._....... _ _ ----- —. _ _._.
__..... - /
y " hfo. /n the Ycar 1900.
_ I/�I Con
pll,d by F. J. FEfNEMnrv. _r _'