HomeMy WebLinkAboutCemBK1901to1907pg38,39-0031RECORD Dlp FUNERAL.
No• ' ' t
Nance of the Deceased
Charge to_-
Order given by •---- ---�
Ilow secured. ---
: --------
Date of Funeral
Funeral Service at
Time of Fune al Servic
Clergyman
•Csrlifying Physician - - -
Number of Burial Certificate_-_----------- ........
Cause of Death 14 0A`—
Date of Death
Occupation o he Decease
Single or Married Religion
Aged-1 L_Y•ears, I Months, A,- Days.
Body to be shipped to
Size and Style of Casket or Coin. -
Manufactured by--.
Metallic Lining
Outside Box _
Interment at 1
--Cemetery.
Lot or Grave No._" _.__Section No• t—
(Diagram of Lot.) -_..__...
Designate allGraces in Lot with numbers (1
spaea for this Funeral with across it n Designate 2'3'; e�')• a°d mark
Usos a place for Ionument With a small square
P ee to the rightof Diagram for the names of those buried in Lot.
Funeral Char --
ges----- Total „$
' 14 //c.� . _ 1004 _ _--
_v
Date
RECORD OF FUNERAL.
o the Deceased_..._L/-� Zl .
--�_\ ,Name f
Price of 'Casketr Coffin Cltaree to_------
Metallic Lining � by --- - - ____.._....__.._.
• Order � eiven I Price of Casket or Coffin $ --• • -• -
Outside Box ]TOW secured___ -- { Metallic Lining _........
Grave Vault Funeral` V l I (PiJ `f _..__..__. — Outside Box . . . . _
Date of Grave Vault . . . . . _.._.._....
_11
" Burial Robe �_
Burial Slippers and Hose Funeral Services at G�sCr/` - - -� ,. Burial Robe . . . . . ---- ---
�`� Burial Slippers and Hose
' g y( Time of Funeral Services ��-�..._ �-�----- •
Embaln:rn Bo wrth............_........_..___.__-...Ruid)
Washing and Dressing EmbalmingBody(with...._....._..__..._.__.._..-
• Clergyman _ _-- -�-
Shaving c inff Pltysi n Dressing . . .
Washing and D ing — --
Keeping Body on Ice C'rt fy Shaving
Disinfecting Rooms Number of Burial Certificate .... _....__ ___ .__..._ Keeping Body on Ice .
Death. I - - 1/�-:-- Disinfecting Rooms -
Use ofCatafalque andDrapery Cause of Use of Catafalque and Drapery .
--....- —
Folding Cbairs Date of Deatlt ........ Folding Chairs
" Candelabrum -----
Occupation of tte Deceased_ �' Candelabrum ---'
Candles ° 1 I>selision Candles __--
. .
Gloves Single or Married ��"r- ! y ' Cloves
Crape iigedYears, ...... _.....Jl2onths, ...I.U..........._Days.
$
.. _
Crape . _
Number o Carriages .................... G PP _____.__ Number of Carriag
f 9 $- •..... Body to be shi ed to -------- - -
Hearse . _ Hearse . . . . _
i_ Size and Style of Casket or CofJEn._.........__....------......- - --
Wagon Deliveriesis i.. 4 --
Wagon Deliveries ....................... _._._................................. __ _. -- -- Death No ices in. ' spapers .
Deat t Not es in...&". ewspapers --
lianufactured by --------- __ _ _. -- - I _ _.........__...... _.._._ __..--
- �- of `teR4papin 1
(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
Balance
Enteredinto Ledger, page .....
-•----- I B-v Cash --- —---- ---•-------..._. $
cornPll i ^ _
Y F. J. FErlyEMAN, SL Lours,
Ma, !n the Year
19
00.
_- Metallic Lining
Outside Box..__ —.
Interment at_. - �`l-' .-
.. Cemetery
Lot or Grave No._ ..........._Section No•_
1
:s.
- s.
;t
5. ...._..._____..._............. __.._.....
a. -
Flowers • • • • • • • •
Outlay for Lot
Opening Grave
Lining Grave
Shipping Charges, prepaid
IRemoval Charges ,
Cremation Charges .
(Diagram of Lot.)
Designate all Graves in Lot with numbers (1, 2, 3, a, etc-),
°°d mark
apace for this Funeral with a cross (+)• -
Designate place for Monument with a small square (C)•
Use space to the right of Diagram for the names of those buried in Lot.
_._...._..... I ............ 17o Funeral Charges. —.—...-_.Total, $
Total Footing of Bill • • • • .
By Amount Pa;d in Advance •
Balance