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Page: of 313
"176
FUNERAL DIRECTORS REGISTER.
Funeral No. this year, 12.2
Date of Death, Date of
Name of
Name of Deceased,
Place of death, .... Place of
Residence, Residenc¢
Occupation, .......-..---.Occupatiq
Birth-place, a, Se Widow of . Birth-pla
Name of Father,.. DY estty, vee _His Birth-place, * : Name of
, «4
Name of Mother, ... Pez: Bike “&E Rs
. Her Birth-place, *
a Name of
Cause of
Cause of death, Primary,
Cause of
8S dary, . xi
AD, Ht: ©, Sorvew ceessennnnennnnnnenenete Certifyin
; Place of
Cause of death,
Certifying Physician,
Place of burial,
Date of burial,.............. Lot Now.c.cccccsscssssesseseeeeneee Date of
Funeral held at House, or. 4 i Funeral
Put in the Diagram one mark like
this I for every Grave in it. And mark
' eS this Burial with double dagger thus : 4.
Designate site of Monument thus: l
Burial Lot.
¢ State whether White or Black. * Insert Town and State.
ITEMS OF BILL. (Cross out items not furnished.)
Casket or Coffin No. .. Style, Made by ansernssnsil Casket
Length of Casket, seesssus ssssssseeee CHES. Width of Casket, Inches. Length
Box, Pine, Chestnut, Oak, Cedar or Mahogan Box, P:
gany, ,
Robe, Shroud, or Dress No Color, (ge 5. Robe, §
Lining No.... Color, Handles No.. seusstennpnrsorssennees! Lining
Time o Time of Dressing,.......... .Crape on door,
Washing and laying out, Washir Embal
Embalming, cesses _.Preserver and Ice,
Hearse and 2 Carriages......... ; Hearse!
sess Folding Chairs, &..Pair of Gloves,
Personal attendance, .Porters or Help,
Delivering Box to C : Use of Pedestals or Pall, —_ Delive
Badges for Bearers, Use of Candlesticks,.. . sad Badge:
Inserting death Notices in Papers, Inserti
Bill to be charged to Bill t
Date Bill was p ted
Amount forward to next page,
Copyrighted by Guo. W. Dornan, 1884.