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Page: of 259
by YA
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Wor /vo7ecord of Funeral. Wasa
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wit Lb Date LEte 2. wt J Nok
a 2 Z
Name of the Deceased. LL XY C2ate _ Name of
Charge to Ched. 2 Care — Charge i ,
Order Given by
& yi HL Order Giv
How Becuved Price of Casket or Coffin $ ie . How Se
Date of Funeral Cs A— oY . Metallic Lining ea Date of F
P " _ Outside Box «© 2 6 6 8 WA = Place of
Place of Death tecsces Lig, Hea fins tie “ Grave Vanit _ _ Pusterad
Funeral Services ot Line Lette “ — Barial Robe . 7 A we
Time of Funeral Services a An~_ ** Barial Slippers and Hose . . . i...... — Time of F'
DTM a Co. . Engraving Plate. . © & « ‘Tecan _—_ Clergy
, Clergyman an QB Lt ce © Ey Embalming Body (with Fluid) —— Certifyin
Certifying Physician Washing and Dressing . : His Resi
His Residence Shaving st meow corner
Number of Burial Certificate Keeping Body on Ice a Number
Cause of Death eet i d Draper en . e . a an .
. Sead ate o,
Date of Death. LA, 1— S707 “Folding Chairs Occupati.
Occupation of the Deceased. ba Candelabrum smi ts a ale wi
Single or Marri ligionl ¢-tZaat Candles =y Sing Vi )
Aged] Ys ‘cars, (2. Months,__.3__ Days. Cloves f. a2 a ue ’
rape . ae: . . . ody to !
Body te beshippedis ———-H Number of Covtans. Ae es tae Size and
Size and Style of Casket or Coffin.. Hane. .. .. JA on
al Wagon Deliveries
Manufactured by Death Notices tit.. Newspapers 6 . i ocr . ooo Manufa
Metallic Linin rg. Fi (Names of Newspapers) Metallic
. OWEPTS wee tneensnetegnnaes ee essere Outside
Outside Box Outlay forLot. . . . L. \$—2 Number
Number of Handles Opening Grave. . . « a .
Interment at. eee. -£7 e7—e Cemetery. Lining Grave ww ww I ceeeseenste fam a Interme
Lot or Grave No.___ Section No. Shipping Charges, p prepaid oe Doe — Lot or G
: Removal Charges «© 6 6 6 ee ee Pe _ —
: Cremation Charges .
2.
3.
on
4.
5. el Ronen)
6. Total Footing of Bill $ ————
(ileueien oles By Amount Paid in Advance «6 6 Ji ane cess fom _ rated
signate all Graves in Lot with Numbers (1, 2, 3, 4, etc.), and mark ¥4
apace for thie Funeral with a piney ‘ie —— Balance «© ew ee ef wart
nate place for M: ith a small
ih right of Diagrasn fot the Soetaoes buried in Lot. . Entered into Ledger, page 0.0.0.. Use 85
Lev. ee: To Funeral Charges..--------Total, $ EY. OF. Cn. Pe A By Cash Meee.