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HomeMy WebLinkAboutCemBK1901to1907pg22,23-00231 RD OF�tUNERAL Date� RECORD OF FUNERAL. 21, No. ............ Name of ilia Deceased ---- _ .."� ` ike Deceased_ O c!f!i 0 � i_ie� , cLA -_- Charga to � yanie of Ordergiuen by ------ -� Price of Casket or Coffin \Clcarge to ----- If Metallic Metallic Lining S'. 6iven by ----------._..... --._....__ _._..._....._.__. How secured_ T� ! Order • ,,,, , _ .- " Outside Box Price of Casket or Coffin $ Date of Funeral- `� ----- IZow secured _- - - \ •` Metallic Lining �U� Grave Vault L------ _..__. Funeral Services at o Funeral' --! Outside Burial Robe DaEe f t � — . . . - -i �— '-- " " Burial Sli ers and Hose Time of Funeral Serviva pp Funeral Services at ff-�il - _� `t Grave Vault Burial Robe , ' Funer, l Services ..._..-._ ...__. _ Clergyman • EmbalmrngBod>(with..........._....._....._ Flu Time of / r1: " Burial Slippers and Hose -__ ...._... r n Washing and Dressing ) ( _____...�--•-_ _ EmbalmingBod (<with..._...._._._.._...._.._.........._Fluid ); .___....._-.._.... Cirlifyin,c Physician - Clergyman y Shaving�/it Washing and Dressing Number of Burial CertiJZcata Ph sieian g g—"" __..._ Keeping Body on Ice ),, Cortifyin� y Shaving Cause of Death -•- Disinfecting Rooms Nurraber of Burial Cert fi ate__.._...._ -- - Keeping Body on Ice __.. !�-�....._ Disinfecting Rooms . . .-._.-- Data of Dealli� /' •i it f Use of Catafalque and Drapery Crouse of Death t _ Use of Catafalque and Drapery . Folding Chairs Date of DeatTi Occupation of the Deceased Folding Chairs . . . . Candelabrum Occupation of the Deceased Candelabrum Single or. Married_Zeligion Candles e,� / - Single or Married-, -cs:Aeligion . _��!Zu�r Candles - dged_1-Years, ..Months, J& -Days. Gloves � Gloves r l Years .__...Honths, _—(.P _..Days. Crape - g6ed...._L r -- Crape Body to be shipped to � " _ __ ._... _-. _._-_ Number o Carria es.._._____........ © ...................... ._ .._. _. Number of Carriages ......._._........_.. •� $ _ Body to be shipped to � - f g Size and Style of Casket or Coffin______ __ Hearse ����- - Hearse ,Manufactured ,Metallic Lining Outside Box Interment at-----_ r Lot or Grave No._ r ` Cemetery, _._.Section No• _ - V• 4. Wla n B 0 of Lot.) . ........ Designate all Graves in Lot with flambe wpaco for this Funeral with a crows (h,). Designate place for hers (1, 2, 3, 4, etc.), ), and mark Ueewpace to the right meet with a small square --_ ��mmforthe th 01 names of those buriedinLot. •_ % Funea( Chages __.___ Total, $ s -- Size and Style of Ci leet or CofJEn_------ --.________ — wagon Deliveries .__ . . .. .............. ......_....... - Wagon Deliveries.._ ................... _................. _ _ Death Notices in ..... ...................Newspapers Death lyot.-- in l' ..-LNewspapers lianufactured by-...__..___- -------- _. l _-._._..._4rrt_ ._..._.__......-_ I - .. .._..__................................._..... __. (Names of Newspapers ) Flowers , Outlay for Lot Opening Grave Lining Grave , Shipping Charges, prepaid . Removal Charges Cremation Charges Total Footing of Bill By Amount Paa'd in Advance Balance Entered into Ledger, page............. __............ .or below, (Names of Newspapers) metallic Lining% -_ _ j0pening Rowers Outlay for Lot Outside Box _. GraveInterment at + _ CemeterLining Grave ,Lot or Grave No.( ........__Section No.t2sShipping Charges, prepaid \ �.- 1 • Removal Charges _..........._._..__. _. Cremation Charges . . . Y• ....... S 4. _— __.__.___._..____._........_... I Total Footing of Bill . By Amount Pa;d in Advance (ularram of Lot.) and mark Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), Space for this Funeral with a cross (•b)• Designate place for Monument with a email square (G)- Use space to the rightof Diagram for the names of those buried inLot. Cash.._..._._.._ _ _ .____— __..._....._... -�. '.. ._. -. OOA,AUeq by F � "_•�... ---......__.........__ } Louts, Mo, In the Year JPoo. Funeral Charges-----7*01111 $ Balance . • • • • �I__- [ ..Or belO4v.lI Entered into Ledger, Page-- - IIBy Cash__.__.__-__-_- $ �..... Se Louts, Ma, !n Wo Year )900. CanPlied by K �• FElNEMAN,