HomeMy WebLinkAboutCemBK1901to1907pg66,67-0045I,:
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s
olp FUNERAL
Date....-...... jj
,Na»te of the Deceased
Charge to-`
Order given by•---"' ~`~
Sow secured _-
Date of Funeral
Funeral Services at L
Time of Funera ervwas
Clergyman _
Certifying Physician ----- -
Number of Burial Cerie te--------
It;
-- —_— -'-
Cause of Death
Date of Death E
Occupation of the Deceased `
Single or ,Married e
dged�Years, --T-- Months, Days.
Body to be shipped to
Size and Style of Casket or CoffCn_
,Manufactured by_— _.—
Metallic Lining _
Outside Box_
Interment at4�
__Cemetery.
Lot or-GraveNn.-_1-SeetionNo•-P
1.
. _. _. _..................
t- - - ---- ._..
4.
a,
IDn.Rm of l,ot.) -....
ra
s Designate all eral i h Lot with numbers (t12130 ; etc.), and mark
p�Desi this
aitFuneral with a cross (1,),
g° P1aco for 9Monument with a small Square
? Usespace to the right of Diagram for the nam a t o13D buried iaLot,
6t•.
RECORD OF FUNERAL.
Decettscd_._.._.___
Ya,,,e of the
Price of Casket or Coffin
Charge --
Metallic Lining S
d Orer given by P1
Outside Box
secured _..__--------- --- __--
Grave Vault
Row
of Funeral
" Burial Robe
Date
Services at __ ____..--_ •-•------- - - -
Burial Slippers and Hose
Funeral
EmbalmingBody(211it1t.... ....... ..... ___..._......... Fluid
Time of Funeral Services ......._.__. ..... ..... .........
I
Washing and Dressing •
man_----
Clergy �
Shaving
Certifying y
Keeping Body on Ice
Number of Burial Certiflcate.......
Disinfecting Rooms-
Use of Catafalque and Drapery
Cause of DeatTL._______.._.__..__...__....___.__.._......._ .
Folding Chairs
Date of Death--�-
" Candelabrum
Occupation of tice Deceased. --
Candles • . . .
Single or Xarrced.5./1j _ ��Relirsion _ .------- --
Gloves
Crape . . . . . . . .
�sed_.._ / _Years, ...................... .Months..._.�1-.._._Days.
Number of Carriages. . ct _
g _ $........._..
Body to be shipped to -- - --
Hearse .
Size and Style of Casket or Coffin--•-- ----
Wagon Deliveries ....... ...... ....... _ ..................._._.._..__._----
Death Notices in.__ ............ - ..... Newspapers .
-
11anu
lfanufactured by_ ........... ....—__.__._-.--_
_ ........_.................................................-----
(NamesufNnwapapers)
Flowers •
Aretallic Lining—----'-"`--�---
Outlay for Lot
Ontside Box
Opening Grave
Ilterntent at_-��l�r✓>.� �- ........... Cemetery .
•-••--•
Lining Grave
Lot or•-(sraue-Ns,�=........... ..Section No•.-----
Shipping Charges, prepaid
1. _.__.............
_.
Removal Charges
-•-- ---....._.
Cremation Charges
Total Footing of Bill )'
By Amount Paid in Advance
Balance
Entered into Ledger, page .................. ----.,or below -
c
ash_»........
_ __ ...._...........
homes, cor#'PIIW by F ✓• FE1ryE
MAN, SL Louts, Aro., In
the year 1000.
s....... /...._._._._- _................Q�......(...�
4.i...
ts. ir1N�r-�!-rS�f.�•x .�.�
(Diagram of Luc.)
Designate all Graves in Lot with numbers (i, ?, 3, .,,etc.), and ma
apace for this Funeral with a cross (-
Designate place for \Monument with a small square (0)•
U f Dl ram for the names of those buried inL
i
ice of Casket or Coffin $I -
Metallic Lining _._..........__.._._
Outside Box . -
GraveVault • ! ...._...._.. ...._.__
Burial Robe .
Burial Slippers and Hose
mbalmingBody (with ..__....... ._ ....................... _.. Fluid) ._........ _ ._ _...
dashing and Dressing — -�
'having . . . .
.eeping Body on Ice . • ..........
disinfecting Rooms • .
Ise of Catafalque and Drapery -
Folding Cbairs . • • • • -
Candelabrum
Candles _ • • • • • ' ' '
Gloves . . . . . . . '...... .
Crape . . . . .
C�$.....................
-..._.
Number of Carriages_ .. ........... ___....._.
Hearse
Wagon Deliveries ... ................. __.__..____ ___..__ ...._......_.... -
Death Notices in...__..__-_.-- ewspapers
_ ..............
_.-............
(Names of Newspapers)
Flowers _
Outlay for Lot
Opening Grave .......
Lining Grave
Shipping Charges, prepaid _-__--
I Removal Charges
_..__._
Cremation Charges • -`
Total Footing of
Bill al
By Amount Paid in Advance
.k Balance
r below.)
A. Entered into Ledger, page. o__
se space to the right o ag ------ By Cash ----- ___-_..._.._-_____ $
..... .._. _..._..
......... To Funeral Charges_. ----_.Total. __......... .... ... ... .............. ........._._
,
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