HomeMy WebLinkAboutCemBK1901to1907pg56,57-0040C
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'DIP FUNEPIALRE��R✓REcoRD OF FUNERAL,.
Date .... :l �
l / I
Date
the Deceased _ _._._.._.__ y
Nante of --'----��, the
ynze of
Charge to -------
order - - - - - -- —
Price of Casket or Coffin tar fe
;iven b� _-.._....._.....---- _
_ Metallic Lining ,der siaen by -- --- - -___._ Price of Casket or Coffin $I
flow secured-------- Outside Box ---- - --- Meta((ic Lining
Puneral_ ocu
secured _..._... � I
Grave Vault err - -- -- - Outside Box l
Date of ate off+uneraZ._ h _ ,. .
Burial Robe '
l uneral Services at . — 1� f�� _ //
tuzeral Services at _. --� � �--�--1!'G'"`f�-- --- Grave Vault
Pp • --'-�` Burial Slippers and Hose Burial Robe
Time of Funeral Seruiues ______.____- funeral ervices .._. ��1 �jfA Embalm�gBo(dy(gvrt(t. �d Hose•'-•••---•�u(d)
- - -- ........._ EntbalmfngBody(wIith ..................... ...... _. .. Real) ime °f '
Clergyman---- - Washing and Dressing n Dressing
-- lergyman
Certifying Plcysician__---•----- Shaving d Physician _— . _.._........ _ __..__. ...._.__ • . . . . .
Washing and D ing
' Keeping Body on Ice 'ertifyzns - Shaving
Number of Burial Certiflcata_.....-.....-- --- r11mbeT °f Burial Certi cats....____..._.__.._._..._...-•.-•. -. Ice
Keeping Body on
__._...._. Disinfecting Rooms -:_._,:_,.._ ............... ......-_ Disinfecting Rooms
Cause of Deatla f Death.
Use ofCatafalque and Dr•apery Jause oUse of Catafalque and Drapery
Date of Death, " fats of Folding Chairs Death c """- - •� Folding Chairs .
Occupation of the Deceased " Candelabrum iccupation of the Deceased _ Candelabrum
t p , . .
Single or tlarried�lilion Candles Religion..._ ..�, Candles
Gloves l iyzgle or Harried._ r. d " Gloves
gged�Years,-___.... Months, Days. Years, .._........._...... ✓ll ontlzs, ......._.._ _Days. • . . .
Crape iged..._..SC-a-....- Crape
Body to be shipped to ---
Number of Carriages .......................... _ @ $......... 3ody to be slzapped to—__--------- Number of Carriages._..............._._........ C� ....-•••-.........
Size and Style of Casket or Coffin, Hearse asTet or Cofin----—
..........._.......__._._........
Hearse . • • • • ' ' '
iize and Stdle of CWagon Deliveries
Wagon Deliveries ....................... .............. ...._......_.... - - -- Death Notices inewspapers
Death Notices in_ ................ _....... Newspapers _ ._. _._..._....._
Manufactured by_ jfayzufaetured by___....._..___._......._...____._ _._-. _ _ _ ___
(Names of NeRsproape)
_ _..._.._..................................................- Flowers
Metallic Lining (Names of Newspapers) —__,
Flowers Aletallic Linin.9 outlay for Lot
Outside Box Outlay for Lot 9utside Box _ -_-----____ Opening Grave -
Interment at a Opening Grave Interment at_:��� -Cemetery• Lining Grave
Shi in Charges, prepaid
._.._......Cemetery. f Section No•_. �__----�-�- shipping Lot er&we y'o,_ Lining Grave Lot or Grave No• ? .. ---
Removal Charges
--__Section No•_L Shipping Charges, prepaid 1,
....._._.._.
Removal Charges Cremation . ............. ..........................................
C Charges
9 ..._._...________ --
z• Cremation Charges . _.-.._---
-
._...__._ _ _....
.....
___ _.__•_ - _
. -------___ �'-•••-•----'_'_". Total Footing of B((
s_....._.__..--•--..._._. _ _ ...
_ ....._........ By Amount Paid in Advance
—�� 4' - Total Footing of Bill �, .
Balance
—_—_-- -� (DI f Lot )
Marmon of ' - agr m o d mark
'�t) By Amount Pa: in Advance )
Designate d ' Designate all Graces in Lot with numbers (1, 2, 3, •f, etc.), and e
space for SthiaFuoGral es m Lot with numbers (1 space for this Funeral with a cross W • _.._.__.-- -0r
Designate with a cross (d ), ' z' 3, 4, etc•), and mark Designate place for %jonument with a small square (t])
a e._.. b ow.
Uses a• Place forItonumontwithnemalls Balance Usespacetothe rightofDiagram for the names ofthose buriedinLot. FnteredfntOLedger,p9 — -
P e to the rightot Diagram square (0),
-- i
t mforthenamesofthoseburiedinLot. Tot',[, ------------- be
tow,
orinto Ledger, .......... 0
To F, A Ll/A . %� sl es _.__.._
Totah,,S I � � I I _.
—........ _...... .._.__._-------- ._ ------ ._....... __.......__.....
FEINE...A.I_A_.
.......................-..... Luufs, In t w
ur 1900-
Ala'
Compiled A F. J.
`.____�._....._ I ...�._•_.... ..._........�..... _
compiled Dv
" FEnNEMAN St. s Mo.. In me year 1000•