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Page: of 259
Now
05 427/705 Record of Funeral.
190 S Date Let ALL
Name of the Deceased.
Charge to SaOrder Given by ZLn, a Lope!
How Secured Price of Casket or Coffin
Date of Funeral (nek a bef —f VEX y Metallic Lining
Outside Box
Place of Death
“Grave Vault “ZO
Funeral Services Za CALL «Burial Robe . a
Time of Funeral Services L , LO Paw “Burial Slippers and Hose en
Clergyman ae Engraving Plate ‘ . oe _ 3 . fon
— ; ——~ . Embalming Body (with Fluid) _
Certifying Physician Washing and Dressing »© 6 6 6 Wenn _
His Residence Shaving 6 6 _
Number of Burial Certificate Keeping Body on Icé —— _
Disinfecting Rooms eo. © © « He a
Cause of Death L —_—
(fs Use of Catafalque and Drapery . ae
Date of peath Wat AA. 5 L q, “* Folding Chairs. 6 6 ee mm ib
Occupation of the a eet “* Candelabrum 6 ww ew to
: } / /
Single or Marri atigion L 7ted Yandles . o* fe Pi
Aged_cZ 1. Years, f. Months, 23. Days. loves p= ae
, rape 6 ee ee ee ee os
Body to be shipped to y a 72 Namber of Carriages @$ _
Size and ee of Casket or Coffin 0 Hearse. L (7 eae
Wagon ‘Deliveries
Manufactured by {? C. Cr Death Notices in........ Newspapers . . . ..
Metallic Lining (Names of Newspapers)
ide B Flowers
Outside Box Outlay for Lot . ne on
Number of Hi andles..)he f-a-E\ Opening Grave . Ap an
Interment at. 4 2 = lemetery. . LiningGrave © 6 6 8 _.
Lot or Grave No. ___..._.---Section No. Shipping Charges, prepaid _—. — 3
‘ Removal Charges
: Cremation Charges
2.
3.
if
4. oe
. nl SSenalee
an ae Total Footing of Bill $ // . 5
cowlpram nts By Amount Paid in Advance _
Designate all Graves in Lot with Numbers aA, 2, 3, 4, etc.), and mark
space for this Funeral with a cross CF). Balance _—
Designate place for Monument with a 11 ).
Use eraneto the right of Diagram . re ‘e1 tien ofthese buriedin Lot. . Entered into Ledger, page ..000.0..0% below.
SS —== = er —-— >
Vd a . To Fryneval Char eseecccx--------Total, $ ib fo SO en (eee By Cash $ ;
4 {
a '
ible bor /F
Name of the De
Charye £0 once
Order Given byHow Secured..
Date of Funera
Place of Death.#
Funeral Service
Time of Funeral
Clergyman _/
Certifying Physi
His Residence..
Number of Buri
Cause of Death
Date of Death.
Occupation of
Single or Marr
Aged. pAr. ¥
Body to be ship
Size and Style o
Manufactured
Metallic Linin.
Outside Box_.
Number of Ha
Interment at
Lot or Grave N
[3]
(Diagram of L
Designate all Gra
épace for this Funcral
Designate place f
Use space to tho ri;