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Page: of 313
162
FUNERAL DIRECTORS REGISTER.
Total Number to date, Z SL eecseseanonrte
Funeral No. this year, vA @
Va aP Years.
cotor Helene Yc Qa. Month.
ip
Date of Death.. A M4 18 GE
Name of Deceased, Mabe 2 Sea at ty
Place of death, .. Dra22 Yu Ley A z Street. Ward NO e..s.nccccecseseneeeeeee es
Beaten, .uisinnons A nn Sex, feral oe ee a
Ocoupation, .....:c. ccc Wife Of ..cccccccsossccucscsvesssvecssssesscsssescesssesscnseesennecnnnnscennnsensnsssnssanennssssssse .
Birth-place, .....cccssseseseee & (PULA, oy Widow Of sccccessssssssssssssssssssseenssnenecenceeeeeses
His Birth-place, *
Name of Father,. Dore Senety , Ar
La '
Name of Mother, ..& Pet ta-te ” Her Birth-place, *
Cause of death, ‘ Primary. Beecend (dere
rs]
is] Cause of death,
Certifying Physician, ......020
Place of burial, .....0.0.:.0-:x © © H
Date of burial.,.......
Duration,....
ry,
Durat
ee o e Merssee2 OO
rosanesassunsesessanusennenuceencennnecessnnsccsannnncccnsssnssssnsseqenae
VOCE’
& “_([email protected]
Cpl 19 L0G.. section No Lot Now secccncnenewnn
CLA PAO.. Church.
Funeral held at House, or.....&<00
Put in the Diagram one mark like
this 1 for every Grave in it. . And mark
Dia of Se this Burial with double dagger thus : t.
¢ State whether White or Black.
*Insert Town and State.
Burial Lot. ; ; o
— rT Designate site of Monument thus:
ITEMS OF BILL. (Cross out items not furnished.)
Casket “or Coffin No. ... Style, G hele bushet Made Dby..ecsscccocssccssesscssessesseeensseeetneeseetsnssnnnessnnnee 20 . ~@o
Length of Casket,.0...00 Feet, .... ...... Inches. Width of Casket, Inches.
Box, Pine, Chestnut, Ouk, Cedar or Mahogany, . , 27
Robe, Shroud, or Dress No Color Made by eg. rere 3?
Lining No. Color, Handles No. Plate Now.. esscccsccccccsseeeseseeseee
Time of Dressing,..... Crape on door,
Washing and laying out, Shaving,
Embalming, Preserver and Ice, ....ssssscsscssssscsssssssessseessssssseeesscecnnnnsecessnsensannannasssssseeens
Hearse and Raw (e~ 6 Carriages. aporvnnennannnnnecie AKO NOS
snus Carriage to call for Timep UL ICELILY ong 42
cusses, Carriage to call for rime eegce , beled bhurs 7p
Carriage to call for Time,
Flowers..
ks Folding Chairs, GPair of Gloves, Sp?
Personal attendance,...
Porters or Help,
Delivering Box to Cemetery
Use of Pedestals or Pall,
Use ot Candlesticks.
Badges for Learers,
Inserting death Notices in Papers, 3\7~
Bill to be charged. tO..cssssccsssssssseesscsenetntitintneetnetannetnenernenseneneintneseesesnennsens antenna eee
Dave Bill was p ted. Date Bill was paid.
sossassste cessnesene Amount of Bill, VHP U0
Time of Services,
onesie Forward from last page, Ye 4 / oe
Amount forward to next page, GT / y / Ss
Copyrighted by Gzo. W. Dorwrax, 1884.
Total Nu
Date of De
Name of De
Place of dea
Residence,..
Occupation, .
Birth-place,
Name of Fa
Name of Mj
Cause of de}
Cause of de
Certifying J
Place of bu
Date of buy
Funeral he]
{ State wh
Casket or
Length of
Box, Pine,
Robe, Shri
Lining No
Time of I
Washing .
Embalmin
Hearse an
Personal
Deliverin
Badges f
Inserting
Bill to by
Date Bil
Time of