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Page: of 307
Number of Funeral . B) Ag z Be careful to enter name of de193
ceased and number of page
os Number for the Current Year_*7 in index for future reference . Items of Bill, (cross out printéd itéerns not furnished.)
4 Name of Dec’d : bbxiut Door Crape
4 Late Residence VA Suan alley Draperies Candelabra and Candles. . ].. 7
? Age he years 2 A 4 days. Washing & Laying out Remains, Shaving
© Cause of Death Oki the vere , Preservation of Remains.
~ Cert ‘ SL No Casket Nhe Cheea ke Trimming. 40\. 02
Certifying Physician Wl §Or. LOCALE PE Al) . G 21 oo
"Date of Death Chuck, KT L222 ia / a
_ Date of Burial £ id “ 7
od ; IM rte. Church No. Handles
= niki my ‘VOOL cae No.. Plate engraved 3
ats re op a "a Cemetery. . ! Outside Box, (Pine, Chestnut, Oak, Cedar) Z. SO
a leser Walls Seco a PI't’ H'dl’s Corners on Box. :
oe . Delivering to Cemetery anni
.,bocation of Grave [35> No Robe ‘ _
oosigeate NM iprlbact 4 ‘Jouble Crese 3 Prs. Gloves Linen Scarfs.
Show position of monument by ©. .
. Use of . es . ne Se _
TI Flowers Lowry bag Menthe AE)
Inscription Hearse
on Plate. —_~..Carriages to__ord 42).99
L f in. Mcesuremeni, ength to Heel eet in
ve Width at Shoulder.
Bill Rendered to
ae Advertising
When Rendered Cemetery charges
MEMORANDUM Transportation Expenses, &c.
i ‘ Attendance & Assistants
ae : Amount of Bill — 6 7\2
— : Amount Brought Forward HO & Yh OF
is
7 r ~
— Amount Carried Forward HO LYS ad
: PAYMENTS.
uy
.
ITEMS OF EXPENSE. ,
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