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HomeMy WebLinkAboutCemBK1901to1907pg72,73-0048I. r- 7'_ � RECORD� R�ECORD OF FUNERAL. -- - - / Da e....... �/ � �x. Hanle of the Deceased ,____ ___— ___-• _� anbe Of the I)eceasrd...._.........._..._ -----_ _ --- _ N Charge to __. � e-- -- Price of Casket or Coffin Charg Order given by - given, br/..------...._ _.--...—_ ___ -- Metallie Lining �', Order " FP1Fiow secured— �, •� Outside Box gow secured_.. -••------------ Date of Funeral / / " Grave Vault I31�DateofFtcneral Services aE- Bunal Robe Funeral Services at __�S.U1� Time of Funeral Servi es .--•� - -- ^ Embalmdo BuriatS ippers and Hoset,`d) Funeral Services TameofClergyman Washing and Dressing Clergyman����jj, /Certifying Physician Shaving Certifying physician A2Zd.1 Number of Burial Certt ate -- — - geepirlg Body on Ice Burial Certifceate...__... - • ...•.... _, G � .Nrtnaber of Cause of Death L �b�s-c,.� f`I'`-tt Disinfecting Rooms Death ,�r//Use of Catafalque andDrapery Cause of Date of Death Folding Chairs . . . Date of DeathOccupation of tha. Deceased 1 Candelabrum j ation of the Deceased Occup "�tSingle or .�ifarried_ljj/ '� ty religion %�� Candles . . ,uVel`Single on.Mar'r'ied..r/ift�Aged _Years, .Months, .�4 Days. Gloves Months,.__. --Days. Crape .Aged-_.�_..l__--Years, _._....._._...Body to be shipped to Number of Carriages_ .............._............... p $.......... _ , Body to be shipped to Size and Style of Casket or Coffin Hearse . SizeandStyle of Casket or coffn...__ -Wagon Deliveries ....................... _................ _.Death Notices in....__..................Newspapers .it _..... _,ManufaeEured by_ ,Manufactured._.........................Metallie Linin (Names of Newspapers) ^•'----g Flowers ��,�,..ti„r!�� •Metallic Lining_. — Outside BoxOutlay for Lot — Outside BoxInterment at ` Opening Grave - Interment a-- -Cemetery. i _ Cemetery, wt 6 Lot o� Lining Grave . . . . '1.•J_._Section No• � She ' Cha es r aPp � g rg ,pep __.-...... ..Removal Charges2. Cremation Charges_ ._._._.....--- _../............................ 4. __ ___--s.........._. .....8 �Total Footing of Bill ........ (Dlagnm of Lot.) all spy e for Designate uneralrWith Lot cross ( numbers (t, 2, 3, 4, etc.), and mark Dc;ignato place for 31 (�) Use space to the ri mont with a small, square _ of Diagram for the names of those burl, edinLot. -_ ITo Fu ages - '115 `/� Cha ges--.- Total, $ 0- - ..... ..... ......... By Amount Paid in Advance : Balance Entered into Ledger, page .......... _...__........ or below' Cash (Diagram of Lot.)and maT Designate all Graves in Lot with numbers (1$ 2,3,4, eto.),space for this Funeral with a cross (+)• Designate place for Monument with a small square (G)- L'se space to the right of Diagram for the names of those buried inLo °ro Funeral Charges iT"ot$L._............. ce of Casket or Coffin $I_ ---- " Metallic Lining • • • • �_._. __..._... " Outside Box . . . . I .._... _.._-- " Grave Vault I - . 11 Burial Robe I .__...... -- 14 Burial Slippers and Hose EmbalmingBoMqvith__ ---- ..__.___......_._._.F7uid),l Washing and Dressing . . • • I� -- S/faving . . . I ....... _.-... Keeping Body on Ice . I - !)Wnfecting Rooms Use of Catafalque and Drapery i -- -- do Folding Cbairs Candelabrum I '- --- Candles . . . . ._._.._ Gloves . . . . Crape ... _._.._ Number of Carriages .._.._---- -._.__.- O$........... _............ .. Hearse . • . • . Wagon Deliveries._-.-._..__-_ Death Notices Notices in_._.._.-.-_hie¢uspapers -- — Flowers . Outlay for Lot - opening Grave --- Lining Grave Shipping Charges, prepaid Removal Charges • Cremation Charges . -' ....... .._.._-._------ ---i - — Total Footing of Bill - By Amount Pa;d in Advance Balance I ' a .._-or below., . Entered into Ledger, page y s Cam, in tho year 1900. Complied by F. J• FE1NEAtAN, SL Louts, to., 4 4 Campltty GMAN,SLLouts. Ma, fn the yetar 1900.