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Page: of 313
105
FUNERAL DIRECTORS REGISTER.
Total Number to date, 1:2. eoeesestbiitt Funeral No. this year, ..#
Date of Death,......... Quake Zee
Name of D 1 a Maye Caren’,
Plave of death, ......... Gone Le
IR PAM LE florrssrenn tenn
Residence,.........:.s..fesseceseeeeeeeeff
Occupation, .........---++
Birth-place, «000 Grace Ye abbey
Name of Father,......... he Ce. © 22K... His Birth-place, *
Name of Mother, Her Birth-place, * ....ssssssssssssssssssssssseeeeersnete
Cause of death,
Cause of death, ' Primary,......... 2
8 Vp -neeeereeee ceeeetnasneanstnensneeenenne DUUPOGIOM ccsccnsensenteneentnern ee EE:
Certifying Physician, ADe fa ‘ BOLE.
ee Lily. —_emeteny vivennnsninsnnnnnnnnnrnmnmmni
. Ly 5
Date of burial, ...........:cccesssssessssseseeeseeeeseeeeneeett Bection Now... Lot No Lb. a"
——— NY
Funeral held at House, or
cesssesaeeeee/Church, Put in the Diagram one mark like
4
&
this 1 for every Grave in it. And mark
peer a a \ =
this Burial with double dagger thus : .
* Insert Town and State. —j Designate site of Monument hus: [—]
{State whether White or Black.
ITEMS OF BILL. (Cross out items not furnished.)
conus Style, SL\CO
Length of Casket,........--ee Inches.
Casket or Coffin No. .........-+--Box, Pine, Chestnut, Oak, Cedar or Mahogany,........ a” savages / IF
J\ce®
1\O7
Robe, Shroud, or Dress B (: ener
Time of Dressing, .........----je.Orape ON OOT,.......ccsceceeeeeenneees
Washing and laying out, ccecesssueesssanneseesse: BDAVING).....-00Embalming...........-..---stasseeme ..Preserver and Ice, .........:.1ecse ;
j
Oe
Inserting death Notices in Papers,
Bill to be charged. t0.....scssssessemeennerntnemmnnnnn eee eS ssccesanpseonsesseouStieo
Date Bill was presented.....cmesnmnsnercsneenrnrnrn ee Date Bill was paid
Amount forward to next page, oF G