HomeMy WebLinkAboutCemBK1901to1907pg68,69-0046Woo RECORD olp RNERALO h
- REcoRD 0p FUNERAL.
VI/ Date 1l P'
,]y'o. -'— � l� _�__-__ .......___ � o j ate.._ �---
the Deceased -- N � h,
7yame of _
the Deeeasecl•.._._._..--••--�a=�--- -
C/iarge o-------
- -� Price of Casket or Coffin fin e o -'' ----
Order given by
C)zarg ---- - ,
" Metallic Lining given by------....�.�._.___._.___.-._-__-_.._ ... I $
Sow secured _...___.._.._..
-- -' Order � gPrice of Casket or Coffin
Outside Box Sow secured _...._- — - " Metallic Lining
Date of Funeral Grave Vault ------- sr - - - -
- Date of Funeral__•-�
� outside Box
_ .. - ., _
Funeral Services at Burial Robe Grave Vault
- Services at u • . - --
Funeral ervioes Burial Slippers and Hose Funeral Burial Robe
Time of EmbalmingBody(with. _. o Funeral rviees .....•Q-•L u�� - Burial Slippers and Hose - -
_._ ...........................Fluids Time f -- ---
Clergyman __....__..- d Dressing
Washing and Dressing - -- j
__ , Clergyman /),�'�---- f Wash ng anBodwr t )'
Certifying Physician Shaving Cortifytns y c" . g (j-� 41...__ _._ Shaving - -�
g Plz sacaan -
- "'" Keeping Body oft Ice
Number of Burial Ce i cats_. _
Burial Ce>jt� fteate^..._._._..____.•---_._........ Keeping Body on Ice - .�_ -
Death ------- - Disinfecting Rooms Number of /
Cause of eLi�--•--__.______._......_......_. Disinfecting Rooms
f v Use of Catafalque and Drapery Cause of Death,
Date of Death Folding Chairs Death i�1- -�� Lt 0_E`__
__ Use of Catafalque and Drapery ------ ----
Date of / Folding Chairs -
Oecupation of the Deceased Occupation of Candelabrum the Deceased- /(�, Candelabrum
•
Single or Married eligion Candles . . . . . . ��4� - Reli.sion U� _ ' Candles -
Aged Years, Months,. .��Days, Gloves
Single or JlTarried'- d Gloves _
y'ear8, ....%__.... Jllontlzs, ....!.!...._._Days:
Crape Aged_- - Crape - -
Body to be shipped to f g $ Body to be slai ed to ---- - - ---- -" Number of Carriages......._._ _._...._ C$......................._._._.......-_..._
. Number o Carria es ........................_....... O .................. pp
Size and Style of Casket or Cof n_ rse . Coffin.. _
• _.. Hearse.
. d Stt le of Casket or Go rz.................._...__......__-_ �._....._.__._.__ __._....---_._..._..
W Deliverie .. i Szae an U Wagon Deltvenes._..--.------... --
.................. _..__............ _I -
Death Notices in ... .. ...............Newspapers ---- Death Notices in_. �____ ewspaper _....._
Manufactured' byby---------------------
___-...._---,...--_-._..__..____._- --
- ____ ........ _. _ llranufactured by (ya,nesol Newspapers)
Flowers
Metallic Lining (Names o[ Newsprpers) __,__.___._--
Flowers i)fetallic Lining _- Outlay for Lot
Outside Box _ Outlay for Lot outside Box _.. - / Opening Grave _I
Interment at Opening Grave -(a �L.L.r.._Cemetery• Lining Grave
-- _Cemetery. Interment at __�a -.° Charges, Prepaid _-
Lining Grave ( p
Lot or Grave No, Section No
--- - Shipping
f
- ,Sectaon No• Lot or Grave3�_-
Shipping Charges, prepaid Removal Charges
Cremation Charge
s
t Removal Charges ................... -------
Removal
a• Cremation Charges . -- _._.....•___.__.___.__._ .-_--
,
4 -- -_ __._.__.__—...... .................... __...... — — —
8.-.._.._..._......._..__. _ o
____......._..___.--yotaofin o t
a. _.._.....
�I Amount Pa.d m Advance -...
a• ...__. By
Total Footing of Bill 7, l',,liek pool
t't.) By Amount Paid in Advance (nlagram of rot.) Balance
Designateall Craves io 3 •1 etc.), and mark
space for this flincml Designate With numbers (1 2 3 4 Designate all Graves in Lot �pitlr numbers (1, .., ,
Deoa With a cross b n , etc.), and mark 1+see for this Funeral with a cross (•t•)• e
Bn to place for.! g Orb o4tJ•
fonument with a small s Page
Use space to the Balance Designate platy for Monument with a small square (0)• '
riBhtofDia square (p),
UsespacetotherightofDiagramiorthennmesoithosoburiedinLot. Entered-Z(�fnf� Ledger,
Diagram for the names of those buried in Lot.
--___ Entered into Ledger, page..........._..._.__....orbZlow•„ --- � By Cash__...__...___.__---.
TO era Entered
—��_ — `I Gba.9e. II _...................._..._.__._._
_- _
-- - By Cash ._...... ._ ----- ............
ell
__
L -- - -
�--•� .____ /� �� �T.'f.'�/-� �-..C�tA r._i, �- in.•�J_....._..... __""� � � _-........___..__ a.'• s•��.A/.i%zkk� ` ...:.._..... ..__.. ........_.._ I TL" �__---•-•---_ __.._._
�I— ...................._ _. _ ..... .....................
Complletl DY
_.._............-_..__ ............... .........._....-... __
-- F' ✓• FE1N
EMgN, Se Louls, Are., In the ear 1900.
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