HomeMy WebLinkAboutCemBK1901to1907pg40,41-0032n or FUNERAL
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Name of the J)eccalcd'
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Order given by
How secured
of yunera )a�', L/ a,
Funeral Service I -J
Time of Fungal Sere
Clrtifyinf Plc ysiciant)1#114
jyjanber of Burial Cerjjftca1e_____
Causc of Death_&4��Lp�__
Date of Death Lff e_1
Occupation of he DeceasedA
Single or Married-d440414eligion
Rged Years, Months, ltDarys.
Body to be shipped to
Size and Style of Casket or Coffin
Manufactured i
Metallic Lining
Outside Box —
Interment at_�
Lot or Grave No. I I
1.
2.
8.
4.
L.
RECORD OF MNER,) L.
Date..
Date. A
f
N 0.
...................... ................... t of tile Deceased-.-
Price of Casket or Coffin
if Metallic Lining
Outside Box .
Grave Vault -
if Burial Robe .
if Burial Slippers and Hose
EmbalmingBod y (with.._......_....._....._ ................. Ruid)
Washing and Dressing
Shaving . . . . . . . .
Keeping Body on Ice
Disinfecting Rooms
Use of Catafalque and Drapery
41 Folding Chairs
00 Candelabrum
Candles . . . . . .
Gloves . . . . . . .
Crape . - : - - -
Number of Carriages ................. e
Hearse -
Wagon Deliveries ............. j ............................... ..... .
(Dllgr,M at Lot.)
Designate all Graves.
space for this F in Lot with numbers (1, 213, 4
gusto plate with a cross (+). . , a
De,l late for it etc) and
onume" "Ith a small square (13),
Usespace to the right O'Diagram for the names of those buried in Lot.
To Fu
Tolal, I!,,
1h
Rowers
Outlay for Lot
Opening Grave
Lining Grave . . . . . . .
,Shipping Charges, prepaid
Removal Charges .
Cremation Charges .
. . . . . . . . ................................
Total Footing of Bit[ . - - - - )
By Amount Pa> d in Advance - - o
Balance
Entered into Ledger, page._ ............ ... ........ or below,
St. Louts,Mo., In the Year 1900.
Cjjarffe --
--- . , - --- I
Orders by
Price of Casket or Coffin $ ;
gow secured—
Metallic Lining . . . .
Outside Box
Date Of Pan eral
.
Services at ........
Grave Vault . . . . .
Funeral
Burial Robe . . . . .
o7
ye a, 6ery es _4
Time of F14ne al Se es
Burial Slippers and Hose
with. .. .....
EmbalmingBod Ruid) —
ClereYman 2
ian L
....................................._....Fluid)
y ......... . .
Washing and Dressing
Ph Isician
J
C,rtifyinff Physician
Shaving
Number of Burial Certiflcate_
Keeping Body on Ice . . . . .
Cause Of
Disinfecting Roon's -
Use of Catafalque and Drapery
Date of Death,
Folding Chairs . . . . .
g
occupation, of the Deceased..W__���yv��_
Candelabrum . . . . .
Single or Married4��� Religion
Candies
Ajed.___-,-- years . ................ _..41onths, -..-_.--_-Days.
Gloves . . . . . . . . ... . ......
Crape . . . . . . .
Body to be skipped to ----
Number of Carriages._-- . . . ...... @$ ......................
Size and Style- of Casket or Coffin, .. ... .... ..... .
Hearse . . . . . . .
Wagon Deliveries_.........___.....—._....------_ - -
..... . Death Notices 1n`y .---rwaFaP— *
. ........ .. . .....
J_fajaufaeture .______ (!lam es of liewSPAPM )
difetallic Rowers . . . . . . , ,
Outlay for Lot
Outside Box Grave . . . . . .
Opening
Interment at.-----Cem,eterY-
Lining Grave
Lot NO1S Shipping Charges' Prepaid
Removal Charges1.
- -
...... . Cremation Charges - -
...
3.
4. ---------
................
5. Total Footing of Bill
........... . . .. . .............. By Amount Pa;d in Advance
(Diagram of Lot.) Balance
Designate all Graves in. Lot with numbers (1, 2,3, 4, etc.), and mark
51,3cc for this Funeral with a cross (+).
Designate place for Monument with a small square (0)• led inLot. Entered into Ledger, page. .. . ..... - Or below-
U11 Vats to the right of Diagram for the names Of those bur ----
By Cash—------
$
To eral Charges.---.--- I .
........... . o+*-,-,o ....... . ... ... ......
..... ... . .. .......... . ....... .
.... .. ....
. . ... ... ... ....
.. .. .. ....... .
. . ....... ....
Vj
............. .
7-
. .. ............
.... ... ....
. ..... .... . .... . . . ... . . . . . .......... ...... ............. . . ......... 4-
Louis.
Conlpj,Ld by F. J. St