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Page: of 313
156
FUNERAL DIRECTORS REGISTER.
Total Number to date,
Funeral No. this year, LZ, ccoccccnnn
or) eid”
Date of Death, LL we 2
Athena. Name of Deceased, ......4 Lp bbea 22K, ‘
Place of death, Jdéwo Street.
Residence,.........+++: is Sex, CH uke.
Occupation, ......ceescssecegg etree Wife of..
Birth-place, 0.0.0.0.. NO Oe eeeeteeesitees Widow of
Name of Father
His Birth-place, *.
/
Name of Mother, .
Her Birth-place, *
Cause of death, ; primary, Clete fLe®. Durati
Cause of death,
0, 8 Mee Certifying Physician, ...... £4
Place of burial, . ly
:
ALOCVP
7
cmevesonnonsnnesni itt SSSESCSESUSI SORT ge ipicgpoicscsatccwensasce Cemetery cessseeeeseeeee
7)
Ld, 2H LLY 2 Section Now..
Funeral held at House, or... mA Zu 4 . Ain ox Church.
Diagram of
Burial Lot. ex
{ State whether White or Black. * Insert Town and State.
Put in the Diagram one mark like
this I for every Grave init. And mark
this Burial with double dagger thus : t.
Designate site of M thus: . ]
1]
ITEMS OF BILL.
Casket or Coffin No. Style,
(Cross out items not furnished.)
Length of Casket.. Feet, ...6.: -sss.0000. Inches,
Box, Pine, Chestnut, Oak, Cedar or Mahogany,
IB WC
Made by
Width of Casket, 0..
— 4. \00
42\CO Ay Yoare
Robe, Shroud, or Dress No. Color, Monde BY rissssscsssscsnacsssssvavassessesnusesescscreewwnines
Lining No. Color, Handles No. Plate! Noe sscscussesseencsvexveasswcaveaness
Time of Dr By ceseecees Crape 0m Woorty.....cccssssesssesssessseessecsscesnesnsesnseennssssesanecsssess
Washing and laying outy.....cssssssssssssssssssssssssssssneeseecesssseeceecsneesssannineseseceeeseee 1 ee eee ere ee
Embalming, Preserver nN ey 5.. cocesscessasiasccnasssasoncsassaruersassovsesvesasiusessteeaiessonnemnsnieeen
Hearse and eee. aa “3 Carriages le
cevesssesssese Carriage to call for
ccs Carriage to call for
...Carriage to call for
Folding Chairs,
Personal attend
(Paix of Gloves, AVVO
Porters or Help,
Delivering Box to Cemetery,
Badges for Learers, Use of Candlesticks,
Inserting death Notices in Papers,
Use of Pedestals or Pall,
Bill to be charged to
Dave Bill was presented Date Bill was paid.
Amount of Bill,
Time of Services,
Copyrighted by Geo. W. Dorwrax, 1884.
ZAG
.. Forward from last page,
Amount forward to next page, 443 J 6
‘Total Nu
Date of De
Name of De
Place of dea
Residence,
Occupation, .
Birth-place,
Name of Fa
Name of Mg
Cause of de:
Cause of de
Certifying I
Place: of bu
Date of bur
Funeral hek
t State whe
Casket or
Length of
Box, ‘Pine,
Robe, Shro
Lining No.
Time of Dr
Washing a
Embalming.
Hearse and
Personal at
Delivering
Badges for
Inserting ¢
Bill to be
Date Bill
Time of Se