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Page: of 313
FUNERAL DIRECTORS REGISTER.
Total Number to date, U . easswsaeegensencowson
Funeral No. this year, Hu. eeseeeseeeeeeuneenenese
ra ZL.Date of Death,. Aogh 22 7,
Name of D : eee
Place of death, on Won
Sex,. ake nee Single,..
Wife of.
Birth-place,
Widow of
Name. of Father,
His Birth-place, *.
Name of Mother,
Her Birth-place, *
Cause of death, Primary, Ae fret. heecce) Darth ,
c a.
Cause of death,
Certifying Physician,
Place of burial,
Date of burial.. AK: rae
ZUR
Lot Nou.. ssccssneeseeeee ein
Funeral held at House, or.
¢ State whether White or Black.
*Insert Town and State. — 1
Put in the Diagram one mark like
this 1 for every Grave init, And mark
this Burial with double dagger thus : 3.
Designate site of Monument thes: [7]
Casket or Coffin No.
Robe, Shroud, or Dress No.
Lining No.
Time of Dressing,
. ITEMS OF BILL, (Cross out items not farnished.) Mt
Style, Made by. O67 . \7?O
Length of Casket).. Feet,..... . Width of Casket, 0.0.. Inches.
Box, Pine, Chestnut, Oak, Cedar or Mahogany, 4L\OP
Color, Made by. AOL. have 4\TO
Color, Handles No. Plate WN iy ecsenceeconeeoneneesiaadivontconsl .
Crape on door, Gog Fegewe, Cleats. e fw?
Shaving,
Washing and laying out,
“7 GO
Embalming, Preserver and Ice,
Hearse and. eaww 22.360 g 1e.Time,
Time,
Pair of Gloves, ,
P 1 attend: Porters or Help,
Delivering Box to Cemetery Use of Pedestals or Pall,
Badges for Bearers, Use of Candlestick
Inserting death Notices in Papers,
Bill to be cl Cecccresescccsnussesessecsncssesseseessstessnssnseseecenscnnseeeecenstenseseercensanesssesnanassscsesunnsseeretine ce
Dave Bill was presented Date Bill was paid,
Amount of Bill,
Time of Servi A. M. P. M.,. .. Forward from last page,
Amount forward to next page,
Copyrighted by Guo, W. 1884.
"Cause of
Total
Date of
Name of
Place of ¢
Residence
Occupatio
Birth-plac
Name of
Name of
Cause of
Certifying
Place of
Date of 1
Funeral
¢ State
Casket
Length ¢
Box, Pin
Robe, SI
Lining 1
Time of .
Washing
Embalm
Hearse
Persona
Deliveri
Badges
Insertin
Bill to
Date B