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Page: of 250
136
ifr (74 Record of Funeral,
nolL? b
Name of the wim
197
Charge to Z a
Order Given by
How Secured Price of Casket or Coffin $ 400 . ]
Date of Funeral Don ate WA 4 Fa Yj Ws Lf “Metallic Lining .
“* Outside Box 3
Place of Death.
% ~ Grave. Vault
Funeral Services aalgh (lanapeede “Burial Robe ,
Time of Funeral Services Ar: f 3 L Fad Zr_) “Burial Slippers and Hose
Clergyman Ve WH, LE Engraving Plate
Certifving Phusici (2 Embalming Body (tt hheeccceccccccceccee-~
er ‘fying Physician Washing and Dressing .
His Residence
Shaving .
Number of Burial Certificate Keeping Body on ke
Cause of Deat J . Disinfecting Rooms ‘
Date of Death So Jif. ff zr, 2 Le Use of Catafalque and Drapery . .
‘ Folding Chairs
Occupation of the Deceased, Lazactt ha B=. * Candelabram ee i
Single or Marri Religion! AtLaad. Candles
Aged_ 4 Years, .. oe Months, LS. Days. cloves i . Lj5) f
Body to be shipped t rape ‘ yt ote '
oe = D Number of Carriages. 2 @$ LY 4)
Size and Style v Casket or Coffin Bearse: « oe ee ge 7 / A se
Wagon Deliveries J2 ᐀
Manufactured by Death Notices in......».. Newspapers . _
Metallic Lining Peg sonontet ed
Outside Box Flowers “ree eae . LL. a
° Outlay for Lot . ee
Number of Handles. Opening Grave . _AA.
Interment ats, LL t C2 A Cemetery. . LiningGrave «© 6 6 8 ew fe Pr\__
Lot or Grave No.. Section No.____. _ . Shipping Charges, prepaid ee
‘ Fi; Removal Charges se ee
a olan Maoh et Cremation Charges . a —_—
BLE Macha DO an
fe
(Diagrarn of Lot.)
Designate all Graves in Lot with Numbers (1, 2, 3, 4, etc.), and mark
Total Footing of Bill
By Amount Paid in Advance
space for this Funeral with a cross (++). Balance a .
Designate place for Monument with a small square (2).
Use space to the right of Diagram for the names of those buried in Lot. Entered into Ledger, PAG! oe erseeesecenenene OF below.}\_.
uct ._. le To Fanecal Charges —oasum Total, 1/49 Van J By Gash 3
tis fre 1904
ao L 31
Name of the Deceas
Charye to —.---——
Order Given by ..-How Secured..
Date of Funeral
Place of Death..
Funeral Services
Time of Funeral Se
His Residence..
Number of sur
Cause of Death
Date of Death
Occupation of the
Single or Married
aged 327. Year
Body to be shipped
ers and § Wye of (
ar bi
Metallic Lining..
Outside Box
Number of
Interment at. we)
G » No. Lot or rave Ne
. 4 .
[2 .
(rt .
—— i
(Diagram of Lot
seamen
\
[
Designate all Grave
@pace) for this Funeral ¥
Designate place for
Une: apace to the rig]
hier VTi