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Page: of 313
218
FUNERAL DIRECTORS REGISTER.
Total Number to date, LEM. senses
Funeral No. this year, 2. svessssensssnseeeeete
Wlarek 4 Date of Death,
Name of D ee, fof PU eR.
Place of death,... ....!
(0) ti oarpend&. °
Wife of. a a
Birth-place, ...
‘Widow of
Name of Father, VA
His Birth-place, *
Name of Mother, .
Gut
Her Birth-place, *
Cause of death, Primary,
Cause of death,
Certifying Physician, . a
Place of burial,
ier cceseenenverrbrsnsrsennnnsianmntmnrnrrer 65
8 anpy, Loeuerst Deheay, Durstion,
2 OOF. aca
Date of burial,....0.-larrk 16, ¢¢ 22
Funeral held at House, or.. at. tha Shue
Lob NO ...--c-conscscccssoosencee
Church.
Dia of
cee Burial Lot. i Se
{ State whether White or Black.
* Insert Town and State.
Put in the Diagram one mark like
this 1 for every Grave in it, And mark
this Burial with double dagger thus : 4,
—. i Designate site of Monument thos: [—]
ITEMS OF BILL, (Cross out items not furnished.)
Casket or Coffin No. Style, Made by. Ze . dO
Length of Casket, Feet, oe.. cesses Inches. Width of Casket.. Inches.
Box, Pine, Chestnut, Oak, Cedar or Mahogany 4. \00
Robe, Shroud, or Dress No.. Color, Made by rey, hoace z\CO
Lining No. Color, Handles No. Gay Plate No. 72
Time of Dressing, *..Crape on door,
Washing and laying out, Savin gy. ecccsssseesssssssescessseescosessessnnseeessnnerannnesssnnnesescnssseses
Embalming, Preserver and Ice, Pad Z2. \50
Hearse and. AeM(2e. L tong = 47 \=
Time,
Time,
20
Pair of Gloves,
P il attend Porters or Help,
Delivering Box to Cemetery Use of Pedestals or Pall,
Badges for Bearers, : Use of Candlestick
Inserting death Notices in Papers,
hu to’ Baw ebineg hdl ener eres cnieomnsepccpanseaemssroueritatnemnnttnemterinaensnbentiT
Dave Bill was p ted Date Bill was paid
; Amount of Bill, . YW 0
Time of Servi A. M, uP. M,y...
by Guo. W. D 1884.
Forward from last page, 4 ) Jil. J Le S
Amount forward to next page, g It 4 4, a
Total Nu
Date of Dea
Name of
Place of d
Residence,...
Occupation, ..
Birth-place, .
Name of F
Name of Mo
Cause of de
Cause of dea
Certifying P'
Place of b
{ State whet
Casket or (
Length of €
Box, Pine, (
Robe, Shrou
Lining No.
Time of Dr
Washing ar
Embalming,
Hearse and
Delivering
Badges for
Inserting ¢
Bill to be
Date Bill