HomeMy WebLinkAboutCemBK1901to1907pg76,77-0050FUNERAL
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RECORD OF FUNERAL. 77
the Deceased---
Name of of tlae Deceased_.__
Charge__ - - lzarffegiven bU-- Price of Casket or Coffin C
Order g' .+ Metallic Lining S' Order given by Price of Casket or Coffin
_ --- - Metallic Lining . • • • I -
How secured- �--- �' Outside Box LTow secured Meta g ;I
Date of Funeral ` (i6 % / ,< /�, Grave Vault Funeralf - " Outside Box
ar .' Burial Robe Date of i t% « Grave Vault
Funeral Services at p / �- �+
I funeral Services at -• Burial Robe
Time of Funeral Servwrs -,q- pp i Funeral Services ... °1 1-- - - - - « Burial Slippers and Hose
(l/721---- — Burial Slippers and Hose
EmbalmingBody(with.._........ ..... _. Ruid Tzine of �- /
. .. Embalmin Bod (with ........ _.._................._........ Fluid)
CicrgUl► / Washing and Dressing - - - g �/ )i� ClergUman
..•..,..... -.._ , __ /� Washin and Dressing
Physician .. ems, .����zr.et.:�/ 1� 9
Cgrlifying U Shaving �, Certifying physacaan - II
. (( ...... Shaving
Number of Burial Certiflcate___�._-__-•-•- - Keeping Body on Ice Burial Certificate_.__ - Keeping Body on Ice
+ Disinfecting Rooms Number of ��
Cause of Death s�trl�E: '- Death % "-z'`A..'�--.� Disinfecting Rooms
( _ Use of Catafalque andDrapeiy Cause of �1 ,73_(�'Lft_� Use ofCatafalqueandDrapery
Date of Death -" Folding Chairs Death .d
r.- �I Date of Folding G'bairs •.
Occupation of the Demased ' `e � � Candelabrum t e Deceased �� ---- • • Candelabrum . . . . .
,� Occupation of
4-- Candles II r
Single or Alarrieddj&4eligion / _
Gloves I Single or.Alarried!�%(Ceti-�(Relision .tom ;� •=-+�+ Candles
Aged Years, _/4^___ ,Months, ...t,�'__._.Days. I g}ed...._ years, -_,...... .__._� Day . Gloves �
s
Crape Crape
Body to be shipped to -
Number of Carriages .............................. C $ Body to be shipped to —` Number of Carriages ........
_....
Size and Style of Casket or Coffin Hearse . Size and Style of Casket or Coff n_._..._- _ Hearse.Wagon
Wagon Deliveries
Wagon Deliveries
............... _............_.._.__.......__- _._-- Death Notices in.__..__ --Newspapers
Death Notices in ............... -...-.-Newspapers _ _ _ ...... ..... -.....................
ganufactured by f -- ----
lfanu aetured by—•-- ---' - (yamesofNaKapapers)
Aletallic Lining
Outside Box ��//'
Interment at �GFc Cemetery.
Lot or Grave No, Section No.3.
4.
I
- ----.._...----_._ ...... .................. ........
(Names of newspapers) Flowers
Flowers - -- Ifelallie Lining __---- Outlay for Lot
Outlay for Lot Outside Box -- Opening Grave
Opening Grave ° ' /tt _ Cemetery. Lining Grave
OP 9 ii_ Interment at air<� J re aid
Lining Grave . Section No•_�(--_ ......- Shipping Cha)ges, p p
Lot or V o. __Section
_ Removal Charges
iShipping Charges, prepaid i• ,
_....._._.»_.__._.._. Cremation Charges
RemovarCbarges
Cremation Charges .
.
fs.
------""""--�---�--- ��-�� � Total Footing of Bill
li a. _.__._.._-.____..-- B Amount Pa;d in Advance
Total Footing of Bill . • ' $�
(Diagram of Lot.) By Amount Paa'd in Advance
Designate all a ra." fa Lot with numbers (1, 2, 3, 4, etc.), and murk
Space for this Funeral with a cross (+), Designate place for Sionument with a small Balance
Use space to the d t
ghtofDiagmmfortheaameeaothose �)'
---
buried in Lot. � Entered into Ledger, page ........... ... ... ..._ or bzlo
tier
nMCh r
9u - --Total, $
(�IB
(Diagram of Lot.) k Balance '
Designate all Graves in Lot with numbers (1, 2,314) etc-), and mar
space for this Funeral with a cross (• . .... or below•
Designate place for Monument with a small square (G)• age-- " "
Use space to the rightof Diagram for the names of those buriediaLot. Entered intOLe g—e+�' p --
_ $
Total, ;....... .....
n......_ �.._. Iolo Funeral Cliargr� �% V/ / .._ I _..
.........-..._ _ _.. .
-
-- —._..
_... ...- - - ___............ _
..
......_..... year 1900.
'"`-•-.— .�_,,,- - _ _..= '' S4 Louis, M0., in the y •
- _._---......_...._�___.......__—_..-._.. i � Con,pll°a by
Comoued
... .. _.._ ... _.
Y F, J. FEfNEMAN. St Lou)s,
Ma, to the year J8vo.