HomeMy WebLinkAboutCemBK1901to1907pg30,31-0027P"WW7
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Name of ilia Deceased
Charge to
Order given by --------
ffow secured —
Date of Funeral C
Funeral Services at
r
Funeal Servi%$,
Time of „ /e
RD OF FUNERAL,z Lr.te_. RECORD OF FUNERAL
CertifyingNumber of Burial CertificateCause of Deathe�C��&e�" iDate of Death� e Occupation of the Deceased
Single or Married Religion✓f ed�Years, Months �Da sBody to be skipped torySize and Style of Casket or Coffin
Manufactured by _
Metallic Lining -�
Outside Box
Interment at___
r Cemetery.
Lot or Grave yo G
ectwn Jpu '
4.
'o.
�. µ•��--`�--•�\ fame of the Deceased.___
Price of Casket or. Coffin --
Metallic Lining d rder given by -.__......___.._.__.__._ _ _ ....—___._...._.__...------.- FP?
Outside Box towsecure -•Grave Vault )ate of FuneralL ( Burial RobeBurial Slippers and Hose uneral ServicesEmbalmin Bodt o FuneraServi�:U`r. .�! t.........._..
9 y (•with..._.."ima fWashing and Dressing''l "'-
ergym•aShaving s Physician..11
Keeping Body orz IceafyinyDisinfecting Roomsviti xber of Burial Certi/i,cate_..Use of Catafalque andDrapery ;rrzese ofFolding Cbairs pate of DeathCandelabrum o the Deceased1�1_" -� _'7ccupation f ,,,,� -Candles (A elisionSingle or married. ..%.sGlovesCrape .. Hontlas,.J ........ Dar s.
fg ._.......@$ Body to be shi edtoNumber o Cauca es ...................... ppHearse . Si:e and Style of Casket or Coffiin.Wagon Deliveries ....................... _..........._....._.......Death Notices in.................._.......Newspapers11an.ufactured by(Names of Newspapers)Flowers�ifetallie Lining
Outlay for Lot Outside Box.
Opening Grave Interment at (7Cemetery.
Lining GraveLot or G3,cave JV o..�� .. Section No•_Y' ----
.........Shipping Charges, prepaid •Removal Cbarges
Cremation Charges . ' . �...__.—_— s. ._..__---_-_......----._...._-•--......................__..-- - 4.
.....-_-.._..__.._-_._._.__...._._._.._.-_._-....__......_..__........_..._.._.. iG.. a.�taZ Footing of Bill
wugnm of Lot.) ._...... Dea'gusto a)1 Graves it Lot -BY AmountPaid in Advance space for this Funeralwith a croeithDesignato place for W mbera (l, 2' 3' 1' ate ): andUse Spacetothe S[onument markrightOnum %nthmalsquaw Balance
gram for tha names of thol3)buriedinLotEntet,ed into Ledger, page............._............_ or blow'
. (Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2,3, 4, etc.), and mark
:e for this Funeral with a cross (+)•
Designate place for Monument with a small square (C)•
Usespace to the rightof Diagram forthe namesof those buriedinLot,
ToFuneral Charges_—._.-.-Total,$i......_..........
ice of Casket or Coffin . . . . $ _
" Metallic Lining . . . .
Outside Box
Grave Vault . . . . .
Burial Robe
Burial Slippers and Hose
EmbalmingBody (with... .... _ ........... ..... . .. ..... ..... Ruid ),
Washing and Dressing .
Shaving . . . . . . . .
Keeping Body on Ice . .
Disinfecting Rooms . .
Use of Catafalque and Drapery . . .
11 Folding Chairs . . . . .
It
Candelabrum . . . . .
andles •
Gloves. . . . • . .
-rape . . . . . . . . .
Number of Carriages ...___ ....-..__. (a $......................
Hearse . . . . . . . . .
Wagon Deliveries`._ /-_.._..._.................
nvath Notices in U , ¢ a,
Outlay for Lot .
Opening Grave . . . . .
Lining Grave . 4. 1;,
Shipping L'hJirs, prepaid . `
Removal Charges .
Cremation Charges .
Total Footing of Bill . • • • • .
By Amount Pa;d in Advance
Balance
Entered into Ledger, Page ..__..._.__... or below.
- IBy Cash._ ......_._...__........_........_— $
......_._._..... ............
_.._.__..._.. _._.
_. _... __..............
............._......_........___`..r.
o,...a.
• comp,ley by F --�'_• Cor P cd y . J. FE!NE, AN,
�I / u rl n F 5t s
eMAN, St Lotus, Mo.
, In We year 1000. �_
........... .............
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