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Page: of 259
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"17 Jot ecord of ,Funeral.
239. .
.
Date Get L lh 198.2
Name of the Deceased [ia ae iS Fit 4
Ch ZA
.
arye to ...
&
Order Given by —_ ,
How Secured P rice of en eee +} ee
Date of Funeral LL. Ae [ / LOS “a On tuide ied a —
Place of Death Denies * Grawe Vaolt «9. we 6 Wcmeweel beaten
Funeral Services alot Ch Ofuysrch— “« — Barial Robe a . es Sees
Time of tune Services aa t 7 pu “Burial Slippers and Hos€ 6 6 . ).. soon —
3 , Engraving Plate
Clerg. ah —
preys . / Embalming Body (with
Certifying Physician. Washing and Dressing .
His Residence Shaving ‘
Number of Burial Certificate Fn BodyonIce . . +
, oe ’
>.
Cause of Denti pecazaceieg Method Drapery
— Use of Catafalque an apery .
Occupation of the Deceased ** Candelabrum
Single or Married.. Religion . . Candles
Aged. LLA Years, ...-. Months, Days. Gloves
. Crape 3 a . eae beeenBody to be shipped to Number of Carriages es
Size and Style of Casket or Coffin Beane « a Li
Wagorr Deliveries. ee nneeennnenrnemnnnrr . eee een
Manufactured by ; Death Notices it.. Newspapers» . ) _
Metallic Lining
(Names of Newspapers)
;
Flowers —_ Pn . ees Dee .
Uutside Box. Outlay for Lot . ee a a
Number of Handles : Opening Grave . A\x
Interment at. 2t ha Lh Cometery. Lining Grave 6 6 6 8 nn Zh..
Lot or Grave No.___ Section No. Shipping Charges, prepaid Sees SeesRemoval Charges . ~ an
bw Cremation Charges . eae Le
2. wa Li 1A) _
3.
a
5.
6. _. . Total Footing of Bill
hanes UA By Amount Paid in Advance
Desi Il Graves in Lot with Numbers (1, 2, 8, 4, ete.). and mark
Space for this Funeral with a croas (+6). a aaa “ Balance 6 6 6 8 Pane eveseecencee
Designate place for Mi t with all square (@). .
Use spacato tho right od Bngedi foe ie names of those purtedin Lot. . Entered into Ledger, page.. OF below. . ) . onnennnne
.1To Funeral Charges.. Total, $ 20
By Cash