HomeMy WebLinkAboutCemBK1901to1907pg62,63-0043R50RID OIL FUNERAL
Date.....1`..
�, )l l ,a n_4 • r ,die /�cyt- --
,1ye.—�
]yanae of the Deeeased,&
Charge to-----'
order f'iven by ------
flow secured_--`
Date of Funeral l
Funeral Services at 1
Time of Funer", Services
Cprlifying Physician---=' --
Number of Burial Cerlifleate - ---- -
Cause of / f
Date of Death- t
Occupation of the Deceased l
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772
Rged -Years, ion
Single or ,Married_ -
_ dllonths, ._l�_Days.
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Body to be shipped to
Size and Style of Casket or Co f fin
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RECORD OF FUNERAL.
Date K/
--- �`�
``\�
of tics
(arne
-----
----- _- —
Price of Casket or Coffin •
'barge to..._...._._..__...__...__._ —_
--- ----
•, Metallic Lining
_...__ _. ._...----_........
lyder rsiven by ----'-'�-- _ I
Price of Casket or Coffin $
�� Outside Box
Zow secured ____. _ - —
"• 14fetallic Lining
Grave Vault
�.�.�___- `_..�.._
" Outside Box
44 Burial Robe
)ate of Funeral_. - (
.Grave Vault - y__ —....
Burial Slippers and Hose
,,
Funeral Services - ---
mm
1/�.1'
'Fluu)
u---
Brial Robe ,
EmbalmingBody(•with ........................
�nre of Funer l Service2o,
'
Burial Slippers and Hose _..__ _._..._.._
and Dressing
___r_!-H................_.._............_
EmbalmingBody(with.........__.........................._.
Fluid ): ----------Washing
Shaving
;lergymol'n
Washing and Dressing .
Keeping Body on Ice
,^�rtifying Playsaeaan_ __....._......__.__. ..._..._.........._......_.__
Shaving • . .. _._....
I' M
•
Disinfecting Rooms
Nu»aber of Burial Certifteate......___..___ _---•- --•
/�
Keeping Body on Ice • . . .._
Disinfecting Rooms
Use of Catafalque and Drapery
•` Folding Chairs
. a ...___._.__._. _.. .
Cause of Deatlt_ __ -x�l- -=--- % /�( `� --
t . , _._ _..__.._.... --
Useo Cata al ueandDra er------- --- '
f fy py.
" Chairs _--r
"
Date of Deatlr.
' !
Folding .
----- ----
— Candelabrum •
Occupation of tlae Deeeased._�>t�
•' Candelabrum
Candles
'1���-�-�Reli•sron __--..•----
Candles '
Gloves
Single or ,Marraed
Days.
Gloves
_
Crape
....................Months
Aged....___....._.. Years,... ,................._
Crape _
C$........................-...........
Number of Carriages._..................... ....... @ _... _
Body to be shipped to-_...__--- --- —_.__
Number of Carriages .........
Hearse .
Size and Style of Casket or Coffwa..____ _�
Hearse . . .
Wagon Deliveries_. -.._...--__-
Wagon Deliveries ................. .. _......................... _. _
Death Notices in .... ... ..........._..._ Newspapers
Death Notices in_:__...,:_t_.,::Neuspapers
.Manufactured by � .manufactured by ---- ___..__ _
lya 1 N wapaper
.Metallic Lining-- (Namsa o[ Newspapers etallic LiningFowers
�OyerS 4l
Outlay for Lot
Outside Box Outlayor Lot Outside Boa ____..___ -- � - ----- r Grave
%/� Opening
��,(''��t(� Opening 11.4 L3 __...........Cemetery. Lining Grave
Interment at-� g Interment at_ �l2?��C-•
__.._Cemetery. /� es, prepaid y
Lining Grave Lot or Grave No._ ( Section No•_L_-_.-- - Shipping Charges, P eP
...... //% / Removal Charges • •
Lot or Grave No �;Section
yoTy,hro,�y 4 Shipping Charges, prepaid • 1, /// � _
_....._. G.,r,� - - .
Removal Charges
Cremation Charges
2. Cremation Charges . -----
4. _.._ ._ _._._..._ _..._..... _ _.__.......... _..... _ _. _.. —
_ — ..----- Bill $
......_._.._._._-•_••_ Total Footing of _
5. r3• _
__._--- ---------- -------- - By Amount Paid in Advance
8• T I F B'll
fmagram of Lot.)
Designate all Graces in Lot with numbers (1, 2, 3, 4, etc.), and mark
space for this Funeral with a cross (� W.
Desigoate place for Nj Use space to the rightof DOnument with a small square (13).
gram fora
names of those buried in Lot.
ota ootrng of t
By Amount Paid in Advance
Balance
or MOO
l+n%o.•arr in in T o�nof• nalrP
- (Diagram or Lot.)
D L t with numbers (1, 3, 3, •1, etc.), and mark
Balance • • • '
esignate all Gray es m o
space for this Funeral with a cross (•f•)• ........Or below.
Designate place for Monument with a small square (ose Page � � - �
Use space to the right of Diagram for the names of those buried inLot. E,Etered iritO Le ger, p g
By Cash—_.____
Total, $ --
...I ...........I L_.._'�
2 F..na�af C'iilrufs—_..__—.. ....... __.. �
. _.... ........
_..._......_........_..._.. By Cash ..._._.......------•--
_-
COmplleu,..1. *_........... .I ......... ._I .......................... .
by F• J• rE,NEMgry, St- Louts, Ma, In the year 1900•
...............
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Compiled by F. J. FE,NEMAN. 5:. LouL:, h1a, In t1:u year 1000.
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