HomeMy WebLinkAboutCemBK1901to1907pg77,78-0051®� FUNERAL. 7(?
78 REc RECORD OF FUNERAL.
Y /
tom'
Name of the Deceased
Charge to --
Order given
0
Moto -
secured
Date of Funeral
Funeral Sery - -
1 ime of Puraeral Servi(es
Clergyman
Csrtifying PhYsici -
Number of Burial CertL ease-___----•----------'"-
• Cause of Deat1L%� _';�..: =�� •li
Date of Death
Occupation of t eceas
Siirglsor ffarried Religio
,ggedd.Y'ears, tL Months,Days.
Body to be shipped to
Size and Style of Casket or Coffin
Alanufactured by_. �.-
Metallic Lining _
Outside Box _
Interment at
d(,l�etery
Lotor ,y'o,_ -,,--Cemetery
s.
5.
a
Magma, of Lot.) I r1I q rzs• V tt
Designate all Graves in Lot with numbers (1, 2, 3,
Space for this Funeral with a cross (•p), d, ate.), and mm Designate place for ilonumefirwith a small square (p),
Usespaca to the right of Diagram for the names of those buried in Lc
.° uneral Charges , •gas _ To(al,
of the Deceased..-__ �Lrp1 argla�---
- ---- _
?rice of Casket or Coffin C___.............__.__
Metallic Linin Order given by------ --�- Price of Casket or Coffin $i_..__._ _
., g
" - - Metallic Lining
Outside Box flow secured _ - - - - - -
.' Grave Vault e--f- -1?�Q - - Outside Box
Funeral - "
Date of Grave Vault
Burial Robe ---- ,.._
Funeral Services at Burial Robe --
Burial Slippers and Hose Funeral Services .... _ .�1.----......... •_--- .� Burial Slippers and Hose --- -
EmbalmingBody(sloth_....................................... Fluid) Time of r _ _
I � ___ ...... ... _.. - EmbalmingBody(with................ .... ................ _....Fluid) ._..---._..._
Washing and Dressing I Clergyman ! Washing and Dressing i --
I ` rtL i Ph sician, 41. �'^ Y" ram ........_Shaving efyinCyShaving
Keeping Body on Ice ( Burial Certificate..... _ _- Keeping Body on Ice , _
- a Number of eP 9 Y ^.
Disinfecting Rooms�1 Disinfecting Rooms ---
" �t,.�.._.1._ ... ... .......
Cause of DeatlL (._.. _..._.._..._......._
Use of Catafalque andDeapey � �� Use of Catafalque and Drapery
Folding Chairs Date of Death " Folding Chairs . • • - -I --
Candelabrum Occupation of the Deceased Candelabrum
Candles Single or .Married Religion Candles - -
Gloves . . . . . Gloves . . . • • ' . -- -....
Aged---Y'eara, ._.._..__.. .Months, .....L..3.....__Days• Crape
Crape . . . . . . . .
Number of Can•iages._.._.._... @ ....................
1�lumber of Carriages ........._.._._... _......_ @ $.............._ Body to be shipped to_-
Hearse
Hearse . Size and Style of Casket or Coffin _- .
Wagon Deliveries ------- __----------- _._.._.___._. _._ ._. __._. _ .-
Wagon Deliveries ......................._.............. __............ .... _..._j- ....... - -- Death Notices it' ..__...._---- -Newspapers
Death Notices in ................._. -.....Newspapers ..............-- --
;lfrznufaetured lJy---- __.._._. ______-. — �%amesat:iewspaw') —._—
(Names of NCWapayere)feallie Linins_— Flowers
Fowers )-_—.
Outlay for Lot
Outlay for Lot . . . Outside Box _-_ - t Opening Grave
�, ._--Cemetery Linin Grave
Opening Grave . _ Interment at :: 9 LiningGrave Section No•_ 2 t.a f.--- Shipping Charges, prepaid
Lot or Grave .No._-.lL_-•••-••- ---�'�
Shipping Charges, prepaid -' i • Removal Charges
.._----...�."-....�.-`�. _._ Cremation Charges • '
Removal Charges .. -` :.. . _ •------._____.................................. .._ Cremation Charges Charges • Q ...._._..___.__._..__
_._.. _
_____ _... __ ...................._
.
--__._._..._._._____._ f Bill
I Total Footing o
By Amount Pa>:d in Advance
Total Footing of Bill
to
By Amount Patd in Advance all et Let'
Designatea all Graves in Lot with numbers (1, 2, 3, d, etc.), and mark
Paco for this Funeral with a cross (•I•).
Designate place for Monument with a small square (D)-
Balance Use space to the rigbtof Diagram for the names of those burfediaLot.
t _ i
Entered into Ledger, page ....... ..... or below Total, $ .. ............
.__....._._......._..._ `Ia• Funeral Charges M � -.
—_ ..._._ 1 By Cash .......... ._....._. __ _
--.............. ---..
Compiled
NEMAN, St, Louls, Ma, In the year1D00.