HomeMy WebLinkAboutCemBK1901to1907pg20,21-0022RECORD OF JPUf\ ERAL.
Name of fire Deceased C
Charge to
Order given
Ifow secured_. Q /!
Date of Funeral-----�p
Funeral Services at -1
Time of Funeral Services
Clergyman
C<rlifying.Physician------
Number of Burial Certificate-..-.•-- --
Cause of Death_
Date of Death A —
Occupation of the Deceased , /
Single or Harried_ , Religion .CLd=
.Jlged-JYears, -if- Months, Days.
Body to be shipped to
Size and Style of Casket or Coffin
.Manufactured by..
Metallic Lining
Outside Box
Interment at _ • Cemetery,
Lot or Grave No. _Section No•-CE�2.
3,
- ---
6.
(Diagram of Lot.) __-_-._......
s Designate all Craros in Lot with numbers 1
pace for this Funeral with across h n
Desigusto place for , 2, 3, 4, etc.), and mark
Use spa" to the light Onumont With a small square
Gram for the names of those buried
inLot.
_ 4o Funeral Cha gem^ T
_ o1a1, 3
Price of Casket or Coffin
if Mdtallic Lining
if Outside Box ,
if Grave Vault , ,
if Burial Robe .
if Burial Slippers and Hose
EmbalmingBody (with ..__................................. _.. F
Washafg and Dressing .
Shaving
Keeping Body on Ice ,
Disinfecting Rooms
Use of CatafalqueondDrape)y ,
is Folding Cbairs ,
of Candelabrum ,
Candles • ! ,
Gloves
Crape .
Number of Carriages ....... .............. ......... O $............
Hearse . . .
Wagon Deliveries ...................... _............ .........
Death Notices in_ ...................... _Newspapers .
...............................................
(Names of Newspapers )
Flowers ,
Outlay for Lot . . .
Opening Grave ,
Lining Grave ,
SURPing Charges, prepaid .
Removal Cbarges . . , .
Cremation Charges . . . .
Total Footing of Bill . 45
By Amount .Fk d in Advance •..
Balance
Entered into Ledger, page.... _ .....................or
Gash_......... --_ __•_••_................ $
CornDliod by F EINBM
L Lotus,
OWs, MO., 1n the Year 1600,
RECORD OF FUNERALS
\No• ,)nDate_
' Name`o of the Deceased-
,11arge to-"
liven by -. - _- ___ _._-•---_....._.._ I
Orders I
Row secured __-•
o Funeral-6 -
Date f
Funeral Services at -u�
Time of Funeral Services �L}� ................... _..
_ Clergyman
Cortafyang Physician
!J-
'--
_ �.�'.......
jyu7itber of Burial Certifaeatte- .
L,ause of�I�lht�lt-
�_ Date of Death
t
Occupation of the Deceased at t
- Single or Married.�"'�" Religion..�%/r�-x�
aged-_.f_' ._.___ wears, _.J! .._.._ Jllonths, 3-LI Days.
Body to be sltipped to -- --
Size and Style of Casket or
Afanufactured---
Metallic Lining -
- Outside Box
Interment at -Ad ' 4----•Cemetery^
Lot or Grave .No. ..........._Section No•-Cfi--"'•1
3.
...._.............._.__
_ 4
l/ 1 5. __ ..
M
(Diagram of Lot.)
Designate all Graves in Lot with numbere (1, 2, Ss 4, etc.), and mat
Io for this Funeral with a cross (Q.
Designate place for Monument with a small square (G)•
Use space to the right of Diagram for the names of those buried in Lr
F '
—_._......... .....
_.-. rlo Funeral Charges —••••—•.••.•Total, $
rice of Casket or Coffin • , . • $ _... .. _...
is Metallic Lining , •
" Outside Box . . . • • ..-- -----
Is Grave Vault . . . . ... .__...._..
is Burial Robe --- -- .-._
Burial Slippers and Hose
;mbalmingBody(with..._............ ..... ........._......_.Fluid), __......._. __-.-
Vashing and Dressing I ..--••.
>having . . . . . . . --
Keeping Body on Ice , , , •
Disinfecting Rooms . , . , .
Use of Catafalque and Drapery --
Folding Cbairs . . . . .
Candelabrum . • , • • -•- ---
Candles • • • • • • • • —
Gloves .
Crape . . . . . . . . �._
Number of Carriages ... ...... ...... _.... .._ . C $.....................
Hearse . . . . . . . . —
Wagon Deliveries ....... .............--.-
Death Notices in -.-...-__.._._Newspapers -
(Names of Newspapers I
Flowers --
Outlay for Lot -
Opening Grave . . . . .
Lining Grave --
Shipping Charges, prepaid
Removal Charges . . . . _...__
Cremation Charges •
-_.-___ ----- - - -.................................... _.._
Total Footing of Bill . • • " . .
By Amount Fa:d in Advance
Balance-
k
or below•
t. Entered into Ledger, page. _ ...-._.
Cash---------'_._ _- - II--...
.. ........_. f
.••-_...—• F J. FEI)YEMAN, SL Louis, Ma. In tho year IQCO.
Compiled by
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