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Page: of 307
Number of Funeral Py} b
Number for the Current Year_L5_.
Be careful to enter name of de~
ceased and number of page
in index for future reference.
Name of Dec'’d@ZZ2Z4 A Leiceail a TA
Late Residence.. Lnaees Gallnst
Age years
Cause of Death Grewal, hinlh.?
months LO days.
Certifying Physician ADY. LY L1aHww E
Door Crape
Draperies. Candelabra and Candles.
Washing & Laying out Remains, Shaving
Preservation of Remains
Trimming.
eet LALLY fl
Date of Death Cpt LYE L668. :
GE
Date of Burial a “ a
Funeral at House or. AMhiudb en
Place of Burial al © PA
No. Handles
Church.
Cemetery.
Grave or Lot No. Met, eLisSection No
Location of Grave [33~
Draw lines . . . for Graves in the Plot, and
designate this one with a double Cross t.
Show position of monument by ©.
No....Plate engraved
Outside Box, (Pine, Chestnut, Oak, Cedar)
Pl't’ H’dl’s
Delivering to Cemetery
Corners on Box.
No Robe
Prs. Gloves
Inscription
Use of Doz. Chairs
. Linen Scarfs.
Flowers
Hearse
on Plate.
Carriages to
Length to Heel
Measurement. }
Width at Shoulder
Bill Rendered to
When Rendered
MEMORANDUM.
Advertising
Cemetery charges
Transportation Expenses, &c
Attendance & Assistants
Amount of Bill
Amount Brought Forward
Amount Carried Forward ARR
PAYMENTS.
ITEMS OF EXPENSE.
Sigh. enya co all ea Rial AB MD
tems of Bill, (cross out printed items not furnished.) —