HomeMy WebLinkAboutCemBK1901to1907pg50,51-00374 50
I
,h'o•s-
Nance of the
Charge to_
Order given by •----
flow secured --
Date of Funeral Z
Funeral Services at
Time of Funeral Y
JZECORD Up FUNERAL.
✓ RECORD OF FUNERAL.
Date .._._
--- - No o tlased-_J: "�i�-GelL�
f
Pace of Casket or Coffin Charge to------ — -- -
i
�-- Metallic Lining s Order liven J Price of Casket or Coffin $
y `k Outside Box Row secured _- --- -- -- - -- - Metallic Lining •
�it%vi Gr ve Yault Funeral_-y"'`� _� -1 � - - Outside Box
al Robe Date of Grave Vault
Funeral Services Burial Robe
Burial Slippers and Hose ��e..�?_tt �,
.-... EmbalmingBody(with..........._..._._.._......._...._..Fluid Time of
Funeral Servic s . _ Burial Slippers and Hose i
� ` ' "t Washin and Dressin i EmbalmingBody (with........ _ ............... ........... .....
F7uid �'.j
g g Clergyman /� Washing and Dressing .
physician _a c�.ws -- w� a� 3 t2............-
Certifying y Shaving s physician _.. ..._. -- - ...._.. , . . . . . . .
Keeping Body on Ice Certifyins y Shaving
Number of Burial rat ------ Burial Cert fleate...._.__----_ •-•---... _-.-
Disinfecting Rooms Number of _ rt Keeping Body on Ice
Death Use
ay Disinfecting Rooms
Cause of - l Death _
-�� Use o Catafalque and Dra er Cause of
Date of Death ! fP y i d !.�—___� � Use of Catafalque and Drapery
Folding Chairs Date of Death ,. Folding Chairs
Occupation of the Deceased " Candelabrum $iCandelabrum
�(�e Occupation of the Deceased
Single or Alarried a 0 ligiun ( Candles Candles
Single or ,Married Religion _
�° Days. 1
&ed-JL-Years, �f—_..Months, Gloves mays_ Gloves . • . • • . . .
.A ed_ `� Years, -..._� .._.. Jllonth.s, t�•�• Crape
Crape . . . . . . . . g
Body to be shipped to
Number of Carriages ......................... ....0$............ . Body to be shipped to — Number of Carriages...__......__.........._ s .-
Size and Style of Casket or Coffin. fen Hearse . . . • f Hearse .
Size and Style of Casket or o n-•--• Wagon Deliveries...--- ---••;; -----•---�---�-
Wagon Deliveries ....................... - ..... ................. _...___--- - _....------- ------ Death Notices in..". f" NewsPapent
Manufactured b Death Notices in__....._._._...._..Newspapers . _ _ .._................
__._-•
fy 11a7lufactured by u_..........._..__...__.--._—.---.--.._-—..---..-----�--games or \ea•.paperil
.......... .................__.___._ __..._ _. - Flowers
Metallic Lining (Names of Newspapers) jileta,lZic LLnLng - -
Rowers Outlay for Lot
Outside Boa: Outlay for Lot - Outside Box ._._.___ _------ Opening Grave
__ =,p __Cemetery.
Interment at � Opening Grave Interment at__�����+' J •�•='` -- Lining Grave .
t CCemeterl/. Charges, prepaid
Lining Grave Section No•_�----- Shipping 9
Lot or Grave No._ _- •-• - ,
�-- - - fNo• �` Lot or Grave No._ °�. Removal Charges
/7 Shipping Charges, prepaid i • nJpm t
�, . 1•> d _ ...�......___.._..._..... Cremation Charges . .
Removal Charges • • J� t •,
z Cremation Charges
.__
...._. -
4.
I IZZj � e__'--_�—_.______
Wlagram or Lot.) .__......._.
Designate all Glares in Lot with numbers (1, 2 3 4
Space for this Funeral with a cross
Designate place for 1fooumoat W.
r ' ' etc.), and mark
Usespaco to the ri with a small
gh_ dDiagram for the names of thuare ou buried in Lot.
Total Footing of Bill
By Amount Pa;d in Advance i' (Diagram of Lot.) 2 3 •1, etc.), and mark
Designate all Graves in Lot with nu
mbcre (1, , ,
- apace for this Funeral with a cross (d)•
Designate place for Monument with a small square (G)•
Use space to the rightof Diagram for the names of those buriedn Lot
i
Balance
Entered into Ledger, page_ ..........._............ or belowi Tolal, $I......__...._..I_ _ ., ,�•-.:_......... _ J.._..._ I4'o Funeral C�iaryes_.___.__
� (k—
_..— I By Cash
Total Footing
o Bill a) _._...- -----•
f
By Amount Pad in Advance
Balance
Entered into Ledger, page.... -.• .._.._. orbeloarl•I
�B cash ------- -------
t/
FEiNFMgg• S4 Louis, MO., In the year 1800.