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Page: of 159
96
RECORD O F FUNERAL
No wee NO vee. & Date. AfdadhereenliB 19.2.2
(Total Number) (yYfarly Number) VA
Name of Deceased Neva thertetectie> Ma Geo: wae (G 30 rete
(What Race) (Where Born)
belie eda ot ..Order Given by
Charge to Cal..: Price of Casket or Coffin... $ . . . AZ. ZO..
INGER EOSS eo asc nwsn ca asec ee acn eee n ce resntore tapes sns nat cnanmnenconen ss tases tenses te rt Metallic Liming: .....----2----sc-cesceecessssnenenee []ecseccsscenssnen . eseesencess
(State kind)
How Secured “> Oirtside Rax
Dat f F 1 (State kind)
oo ee “ — Grave Vault
Residence (State kind)
Place of Death p Beri) one
f ‘ Burial Slippers and Hose
Funeral Services at E ‘
ngraving Plate 5
Time of Funeral Service....=.8.0 Embalming Body (with Fluid) . 2
Clergyman Asdaaa bs w-. Washing and Dressing. ....--.--scsscsecssscescescoteesttectice . . cneceeeeeetesed. ssteeneess
Certifying Physician cytes Nese bar psx ©} Shavit ge seeccccsscconmccsceonsssorectnecesecnansssestesssecennawssssnneasensteas . aecnereneen. tosh
His Residence Disinfecting ROOmS ..-.--------:sesscsecssssneceescnesenecensetee . ] cccceesteenees . ouseeeeees
Number of Burial Certificate Use of Catala and Drapery.
Cause of Death ahi Bere Folding Chairs ..-:.--sssccsecccseccn-eeoseeesssseneesest [[eecenseeeeen. sromsseees
7 / (teimary) (Secondary) “ Candelabrum and Candles......-.--.-----c-c-ceeese . feeeececeeeeeeee. eee
Date of Death.4 Ca. ZA. Gloves $.
Occupation of the Deceased Door Crape $p.esnsss-ssconveesessee-CAMOPYy $.eccsesscecsseeeeecsecs [fecceeeeeeeseeed steer
Single or Married Religion Hearse ae:
d ‘ati us Carriages to Cemetery. a7 Haeeepeee ee WR . Prerety AN co
Date of Birt Automobiles to Cemetery...@ $.---.-.-2-ssssssscessssene . fescececeesseeed. setters
Aged. L.8. cnc. Wears, edits Months, -------nnenonsonene= Days. . Wagon Deliveries
Name of Father City Calls (Coaches) pyre Hiteecdane
ng Death Notices in.....-.--.Newspapef5....-------s002+ . . oer . eee
His Birthplace cscccctec-ccsusccsccssecenceecennstecnteenemmnnenameentsntetinen tt nmennnntnetecnnnentnnannecsnnne ie eeemtnt] stntcnan
Name of Mother (Names of Newspapers)
(Maiden Name) Flowers
Her Birthplace Outlay for Lot.
Body to be shipped to Opening Grave or Vault
: Lining Grave
Size and Style of Casket or Coffin Evergreen
Lda Tent or Awning Charges
be SINGS ot hoa —, S
ippin: arges, prepai
Interment at neeten-Leet Sime eceenerenonne Cemetery Rewvel es o
Lot or Grave No....::.--2s-cesscee Section NoO...--.-:ecessssssesseseres Cremation Charges
1 Porters $.2..-.-n-.---ceeosseneaes ge Meee rrr . e ana . (ao
Personal Services
2
i
NOIR args eeen cn eae mar I a amease te csagretE tone el einem teckel nat peeense
3 Church Charges
4 wevcceores.
Bo ccccccccucccsecuseuecsesscesuecoessesevesaessecs . tsesssesseaseensesensesssseuranccesemeansummranstcnnnstnanscenssneensssaccassaacanes setae antesess . sek Lis
6 Total Footing of Bill $ . .. Alege.
Diagram of Lot or Vault a.
Designate all Graves in Lot with Numbers (1, 2, 3, 4, etc.), By Amount Paid in Advance
and mark space for this Funeral with a cross (+).
Designate place for Monument with a small square (C) Balance
Use space to the right of Diagram for the names of those
buried in Lot.
Entered into Ledger, page...-.------.--+:--++-+ or below . }..
i rage To Funeral Charges.....Total, $].000 . By Cash Si.) ks