HomeMy WebLinkAboutCemBK1901to1907pg64,65-0044nip FUNEPAL
I. REGORD Date...
Nana, of the Deceased
Charge to
Order Oven bJ-�f-
��-
gow secured-�- .--
Date of Funeral -
at t
Funeral Services
Time of Funeral fServiees
C,rlifying physician�u-q-E�z'-
Burial Certi flc to— . ;
Number of /
Cause of Deat)a
Date of Death l
Occupation of the D,oeased
Singk or •tfarried �' [l ��liYion
Aged Yearn, -_ *nths, -Days.
Body to be shipped to
Size and Style of Casket or Cofn
RECORD OF FUNERAL.
Yo.
anre of the T)eeeasz d......_
�\. Y
Price of Casket or Coffin fin "I it e to------_ `-_
•' Metallic Lining given by _.__.____--•------_.__....._...._._
7rder " Price of Cashet or Coffin $
Outside Box gow secured—- " Metallic Lining
Grave Vault I+'uner.ZI
.... ... -
Da l i� t' - - - Outside Box
Burial Robe to °f ' Grave Vault
u
Burial Slippers and Hose Funeral Services at -.. `��- Burial Robe
+u7xeral Services •' Burial Slippers and Hose
EmbalmingBody (<with......... ........... _.__...... r�;� TL)ne of I'
Washing and Dressing - ------ EmbalmingBody(with ..._ ............._......_.............Fluid
' Clergym Washing and Dressing
Shaving Plz sician _.— ......__.......... _._ ....._...
Keeping Body on Ice Cortifyrn.y6 y -..._... ..... Shaving
___-•- -
Disinfecting Rooms Nfznaber of Burial GertifteateKeeping Body on Ice
qc- _. Disinfecting Rooms , • •
Use of Catafalque and Drapoy Cause of Death )
Use of Catafalque arldDrapery
14 Folding Chairs Date of Deatla 'L� -'---- --- - Folding Chairs
44 Candelabrum 66jlati0�g Deeeased.L.. �'- �• Candelabrum ,
Candles Candles
� Sf)r-�e-�Ia7•r•ied-�.-�,..._._rRelz�aora—.._._ . t
Gloves y ( Days. Gloves
Crape q;ed...:._�- _ Crape .
Number of Car7Yages............_......_1......... @$........... Body to be supped to ------- -- - Number of Carriages... __.... _..._._.. _ ------- -----------
Hearse . Size and Style of Casket or Coffin---- - --- Hearse.wagon
Wagon Deliveries.. ..................... _.................... Wagon Deliveries.____..._.... _.........__.___._....--
-' - Death Notices in... —_.._.___.Newspapers
Death Notices in...._ ....... ..- ..... -.Newspapers , _--._. _........._.._......_ ---
dfanufaetured by __ ,diranufactured by_..._---..___------- ` lNamerof Newspapers)-�— •
_.._..............._....................._......... Flowers
txa ;es ut Newspapers) ,AZel allie Lining' -.-------- -
Metallic Lining Flowers Outlay for Lot
Outside Boy: Outlay for Lot Outside Box _ Opening Grave
�J 1 _._...._Cenetery.
Opening Grave Interment at t sL Lining Grave
Interment at _.____Cemetery. p Charges, prepaid
Lining Grave �......._..Seetaon No•_�..--�-----•--- Shipping '
9 Lot or Grave No. J_ Removal Charges
Lot t)rvsve No. _)I L.- -Section No•, 1
- i Shipping Charges, prepaid ..._.._....._._.____....._._. Cremation Charges .
I_. Removal Charges a. __._..._._.._.. . ..... ................ I ............ _....
__.__
., Cremation Charges . __.__...._...._._._.._..---------
g_._-___.._....__._.._....... .... ........................_........
4. G.
._._...._-_._.___.._................._........_.....____.__..-•------ .. _ ... Total Footing of Bill.
a. �•_.-..__..._...___.__.._.._....___ Rv Amount Psi in Advance.
e• Total Footin olcBill
g
(Dkno,ofLoL) By Amount Paid in Advance
Ueor this all Urores in Lot with numbers (1, 2, 3, 4, etc.), and mark
apace for this Fymeral with a cross (q j, Designate Lace for b[onument ait6 a small square Balance '
Usespace to the ri
ehtef Diagramof bafow•
for the names of those
buried in Lot. Ento-ed into Ledger, page..._ ................... :..
GXa -- _ -
I9oFu04�/11 lti O /�Tofa/LI _ - �- - _I_____.._......I - By Cash..._.-----. _
`
..... ....... ........ _...........
....__.._..__.._.
(Diagram of Lot.) 0 Balance
Designate all Graves is Lot with numbers (1, .., 3 , 4 , etc.), and mark
space for this Funeral with a cross (d•). Or below.
Designate place for Isfonument with a small square (G)• into Ledger, page . .....
space to the rightof Diagram for the names of those buried inLot. Ent --- —
_$
- ----
By �
=1=
a .d
Compiled by F. J. FE)NENAN,
St Loci>• nta• rn the Year
Con'lailed LY F. J. FE)NEIyAN, St. Louls, Ma, in the Year t000•