Enter a name, company, place or keywords to search across this item. Then click "Search" (or hit Enter).
Go to the Archive Home
Go to Thumbnail View of this Item
Go to Single Page View of this Item
Download the Page Image
Copy the Page Text to the Clipboard
Don't highlight the search terms on the Image
Show the Page Image
Show the Image Page Text
Reset View and Center Image
Zoom Out
Zoom In
Rotate Left
Rotate Right
Toggle Full Page View
Flip Image Horizontally
More Information About this Image
Get a Citation for Page or Image - Copy to the Clipboard
Go to the Previous Page (or Left Arrow key)
Go to the Next Page (or Right Arrow key)
Page: of 259
t
{
4
a
Ys her oAReCOrd of Funeral.
No.2 79 Date Qa42¢ 3 O
aS) BLLD.
19277
Name of the Deceased Laseriae te ta LO,
Charye to
Order Given by
How Secured
Date of vine > aa Ft dG0 Ze
Place of Death
Funeral Services at Vint ;
ae)
2 [Lu
J
Time of Funeral Services
Clergyman
Certifying Physician Capa tt
His Residence
Number of Burial Certi ate.
Cause of Death
Date of Death Dan ae Aa
Occupation of the Deceasedol. aha k—
Single or Marrie
Aged 4 f.. Years, _G. Months, a / a Days.
Body to be shipped to
Size and Style of Casket or Coffin la
whe epk Py Pew
Manufactured by
Metallic Lining.
Outside Box
Number of Handles
—=2
Interment at C choy, Cemetery.
Lot or Grave No. ___ Section No.
1.
2.
3.
4
5.
6. _
(Diagram of Lot.)
Designate all Graves in Lot with Numbers (1, 2, 8, 4, ete.). and mark
space for this Funeral with a croas (+).
Designate place for Monument with a small square (9).
Use space to the right of Diagram for the names of those burfed in Lot.
loves! cheastih grsivahy Pri
LZA490'7
Loe pond Religion -2Ladfoindles
‘Metallic Lining
“* Outside Box
“Grave Vault
“* — Burial Robe ‘
“Burial Slippers and Hose
Engraving Plate 2 o« © 4
Embalming Body (tt anceecccccccsscccecceoe
Washing and Dressing .
Shaving .
Keeping Body on Ice
infecting Rooms a
Use of Catafalque and Drapery .
Price of Casket or Coffin . . . » $i!
Outlay forLot . . «© «© +» «© -«
Opening Grave. . «+ + «© © «
Lining Grave 6
Shipping Charges, prepaid
Removal Charges
Cremation Charges .
‘* Folding Chairs ~ Lecemconass
‘* Candelabrum en eee a
Gloves . .. Ara
Crape te + «© «
Number of Carriages. 3 @$ [Lf 40
Wagon Deliveries
Death Notices in.......Newspapers + . i. 7 oe
(Names of Newspapers)
Flowers 5 unease _
Total Footingof Billi . . . . §$
By Amoant Paid in Advance
Balance
Entered into Ledger, page.. or below.
Total, $) To Funeral Charges. Th,