HomeMy WebLinkAboutCemBK1901to1907pg42,43-00330
,4 C? pipGORD 'DIP FUNERAL
Nance of lice Deceased
Charge to
Order given by
How seeured—
Date of Funeral
f
Funeral Services at
Time of FuneralServices -
Cler¢yma&d2- --h-- — --- _
Certifying PhysicianIx- - —
Number of Burial Certifleate__.-.------------
Cause of Deathjal�----_ _ _
Date of Death °
Occupation of the DeceasedAx4ji
Single or ,,garried.rL%ill4u ion
,iged--4�-Years, _,Months, -4—Days.
Body to be shipped to
Size and Style of Casket or Coffin
Manufactured by
Metallic Lining
Outside Box
Interment at Ce tery.
Lot or Grave NO./ �,_� /_
mil _-_._......
gram oI Lot.)
Designate all Cranes in
space for this Lot with no Funeral With a cross (.p), Deal (1, 2, 3, 4) etc,), and mark
goats place for lloaumeat with a small square W.Usespace to the Nghtof Diagram for the names of those buried inLot.
Total,
RECORD OF FUNERAL.
Date_ l...--
......... - -----_ ✓
ties Deceased_ ._---
------ \ Nance °f -- - --- ----- — -------__.._._.
•a to_
Price of Casket or Coffin ,
Metallic Lining �.
" Outside Box
" Grave Vault
01 Burial Robe ,
Burial Slippers and Hose
EmbalmingBody(ewith................. .............
_........... Fluid) .
Washing and Dressing .
Shaving • • • • . . . ,
Keeping Body on Ice
Disinfecting Rooms
Use of Catafalque and Drapery
00 Folding Chairs
Candelabrum
Candles . . . . . . . ,
Gloves
Crape .
Number of Carriages ............................... cr$.....................
Hearse .
Wagon Deliveries .................... _............snao.........ers.....
Death Notices in.� -
(Names of NewspapFrs )
Flowers
Outlay for Lot
Opening Grave
Lining Grave
-shipping Charges, prepaid .
Removal Charges
Cremation Charges .
Total Footing of Bill
By Amount Paid in Advance
Balance
Entered into Ledger, page.
.......... ..... __.._....orhelow•
. IBy Cash .........
Clw 1 e it 7
give' by.------------__.-__ ......................_.
Order g•eI Price of Casket or Coffin . • • $ ----- -
Row secured- .----------- -- Metallic Lining
__....._. _...
--
o Funeral - --- - Outside Box I •-- �-
Date f -----
" Grave Vault . . . . '
Funeral Services at �• Burial Robe
Funeral Servi es . ._G`+� �........_
Time of Burial Slippers and Hose - - --- -
n
Clergyman '
- -.. .. ..........._............ _...........- mbalmingBody (with .__............. _............ ...._. Raid) -•-_... _. - ..
�,�, -��,y aching and Dressing I ._-_. _...._ ..
6 PIa sician ... ••- -
Certifytns y ...._._ Shaving --_ --__.
Number of Burial Certificate .............._____ Keeping Body on Ice . • • • ----
Death .. Disinfecting Rooms • . , . --
Cause o .
............
7 Use o f Cata falque and Drapery . .
Date of Death 1�_...._.____..__..._ ._
- Folding Chairs ----.......
Occupation of the Deceased.. - // �` •Candelabrum . • • • • ---
elijion(U�1�d/ . Candles ) --
Single or ,Nlarried���t CdlI
s� .. ....._--
,dged..._.�`- -- Years,.__ .....Xonths,. ._..._Days. Glove . .
/'" Crape . . . . . . _....
Body to be shipped' - GJ��i...l) _
, Number of Carriages ---- ----- --•---...._..@$......... _... .—
�cuse `! y
Size and Style of Casket or Ca is ' - Hearse . . . . . . . Wagon Deliveries ...... ..........
_.-_-
Death Notices in._._............._.....Newspapers -
Manufactured by _ —•-_._
_ (Eames o[:7eNsPaDen1
Metallic Lining- - -- Flowers
Outlay for Lot
Outside Box — ( ppening Grave
Interment at Cemetery, Lining Grave . . . . . . .
of or Gcue JV'o._ L _ ---
..._Section No• --•-- Shipping Charges, prepaid
,,i, Removal Charges '
1' '".. Cremation C/ia gees •
s......
ITotal Footing of Bill
By Amount Paid in Advance
(Diagram of Lot.) 13alance -
Designate all Graves in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (+)• or below.
Designate
place e for oMonument
with the all square
(0). uried inLot. Entered into Ledger, page
Use space to -
I
$
_..._....__......._.__. eIo Frr rat Cbarges__._.-.__Total, $I .. ..........
....I___..._....
1p�,9 ---• . _...... `r-..--.__....................
....
_...__....._... _ _ --
_
V
r
...... _.
�.
- _ ....
__.
r 1900*
_......_.---------__..._...__._......_._.. the w
7r-,f
SL Lout,Ca Cornpl(cd Gy F. J. FEINEAfAN.mA1Jeq 6A •--......... ._.............._..... __.----_._._.—•••ErrygMAN, St
Louts, Ma. 1n the year 1000.
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