HomeMy WebLinkAboutCemBK1901to1907pg26,27-002526
RI,cORD OF FUNERAL.
r
Name of the Deceased �Yo-
e to -- _-__ � Vance of the Deceased
Charg
Order given by---' -- - Price of Casket or CoffYn \\ giarge to- -""-
ii Metallic Lining S Fiven by -----
How secured_ /r Outside Box )rder ,
2oty secured..--•----
Date, of Funeral __ Grave Vault . �I �% °�_
Funeral Services at -- Burial Robe pate of Funeral -`
--'� Burial Slippers and Hose Services at -.__.___-_
Time of Funeral Servives.___- tuneral
-.._........_...._' - .... EmbalmingBody(with..............._................. _...Ruid� Time of Funeral Services ............._._._
•...
Washing and Dressing Clerffynsanl-
C9rtifying Plcysician__-__----_----- ...____.____.•__-_ -
Shaving ,rta y Physician....< ..:a!-..._
Number of Burial Ce tifteate_..._....____f �- Keeping Body on Ice Cori f in
Cause of Death-1�1�7/�... Disinfecting Rooms Number of Burial
Data of Death I D�- �•v Use of Catafalque and Drapery Cause of Death_if= --"�=yete am'"
Occupation of the Deceased `. Folding Chairs Date of Deatle - --
Candelabra»; _Occupation of the Deceased _
Single or .�lfarried Religion _ Candles -.Religion
Gloves Sin-gle or Married__
.Aged Years, __........ rlionths, . Days. _ Months . ............._.__Days.
Crape Aged.. Years, -.._......_......
Body to be shipped to
Number of Carriages ...............___.. G ppto—
m--�- -
Size and Style of Casket or Cog -- - $-•••-••••••-__ Body to be shipped
Hearse . .
' size, and Style of Casket or Cofjln_._._-_._____.----
Wagon Deliveries .................. _..._..... ................. _....
._..._
Death Notices in..._........._.._......Newspapers News . --
Hanufactured by_._____ p
MetallicLining _ _._....____..._......... _............... ..........
(Names of Newspapers )
Outside Box --Kowers ,
----___ __ __ Outlay for Lot
Interment 11 �t .
��t:�L..Cemetery, Opening Grave
Lot or (fie No. Lining Grave
-�'---__Seotion No.
-- - Shipping Charges,
I, rg prepaid .
Removal Charges
Cremation Charges .
-• _. ...... ...............
_ _ _..._.__ ..._......_-...... ......... I ........... _.....
..... __....................
!—
RECORD GIF IPUNERAL.
Date_
mtaenm of Lot.) ......... - __... s at -voottng of -Bill
Designate all ., ea in Lot 49 Amount P
apace for this Funeral with aa'd in Advance '
Des; with numbers (1, 2, 3, 4, etc.
gnats a Cr088 (.p),
Usae Placetorrlonumeat )'end Mark
Paco to the rightof Dia with a small square Balance
Bramfortha
—�-1 aamesofthooburiedinLot.'
`3-0 /FC1 i Entered into Led
------' - -- I�1J�7 •ses _ 9er, page ............... or be!
n.o, "Tofat,$I I
s
_.........
,._
_.._.__- ........
omPlled by F ✓ pElNEA,gty, SL~~__.__.. .
_.................. --
Louts, Afa, fa t1,o Year 1000.
,lfanufactured by_.___._------ —
i
dletallie Lining ---
I-- Outside Box ,
- Interment at- _I Cemetery.
Lot or Grave dV'o,�.........-••Seetaon No• 2---
_ 1
.. .
X l
3. - _.....
r
DQ'... _ .._................
Date1(�
'rice of Casket or Coffin . . . . $ -
" Metallic Lining . . . .
Outside Box . . . . .
Grave Vault
Burial Robe . . . . . l
Burial Slippers and Hose
5mbalmingBody (with .... ......... _.... .... _.... ............ Fluid)
Washing and Dressing . . . . .
5having . . . . . . . .
Keeping Body on Ice . .
Disinfecting Rooms . .
Use of -cat a falque and Drapery . . .
Folding Chairs . . . . .
" Candelabrum . . . . .
Candles . . • • • • • '
Gloves . .
Crape . . . . . . . .
Number of Carriages .. @ $.....................
Hearse . . . . . . . .
Wagon Deliveries ._-....__..------ . _._....------ _.----- - ...... _ _
Death Notices in. -_.........._..._..Newspapers .
v.-......... .......................... - - �.-
(Names of Newspapers)
Fl04LCPS _...__....
Outlay for Lot . • • • • - -�
Opening Grave .
Lining Grave . • • • • ' • --
Shipping Charges, prepaid ---
Removal Charges . • • • • - " -
Cremation Charges . ----
_ _----- -- ----------------- ........... ............. _......
Total Footing of Bill
By Amount Pa;d in Advance
(Diagram or Lot.) Balance
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
Tice for this Funeral with a cross (d•)•
Designate place for Monument Avith a small square W. e_. _ ...._.._._.......Orbelow.
m
Use space to the rightof Diagram for the names of those buriedinLot. Entered tntOLedger, Page
—
`By Ca. ........... --... _.._.__.`__...... $
.......... TO Funeral C rges--•—._..Total, $ ..........._. _...
i
�i
..... ___.._-. _...._._
CgrnPt)�'�? by F. J. FE)NEMAN. 5L Loafs, Mo..
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