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Page: of 159
F FUNERAL R : C 7 RD O
BS (Total Number) arly Number)
Name of Deceased.... Ral Ley
ee 19.4%.%
wht
(What Race)
(Where Born)
hi beacae oa 5 a ..Order Given by wort the..
Charge to Waa adaee me =A Price of Casket or Coffin $ . . 6410.0..
Address 0 ene “ Metallic Lining
How Secured °
O 4 B (State kind)
' A A
. utside Box
2
Date of Funeral de . . (4.2 Vv
" gt; (State kind)
“ t
Residence Wok ae) V abhi. en a (State kind)
Place of Death 3 eo
Seria) Rube
Lit ~~ “ — Burial Slippers and Hose
Funeral Services at her ae
.
: 2 Engraving Plate
Time of Funeral Service 5 Va Embalming Body (with Fluid) . 1310.2.
Clergyman , OOO, ee ee Washing and Dressing
Certifying Physician ..& sMas Deak a.. A Shaving
His Residence
Disinfecting ROOMS -..-.-scccssscssssceessscnesseneeencensseeee . cceeneenens . tennnanees
Number of Burial ae
Use of satalgue and Drapery.
Cause of ear ‘ptacde Az
j Folding Chairs -...--.-.--.-s-s-ss--ssreseceserscenssnseeeees
[licceeeceenenceed] sotenettes
L peionad (Secondary) “ Candelabrum and Candles . eae
Date of Death A.t% Gloves Shaan nant oenenzees Grape Goaccines et csanntees) . ee end
Occupation of the Deceased Qa hacer. Door Crape $=. Canopy $.-— = .
Single or Married. _Sememg...Religion
eer tees Sr are .05.. Q.0..
f
arriages to Cemetery. a
Date of Birth f. LEGS Automobiles to Cemetery...@ $
Aged... she {wean Pte L. hao Months, ...4.....-Days. . Wagon Deliveries ea eee & 10.0.
Name of Father...C@naa foes don City Calls (Coaches) sneeeenneeereernnetiete ere) mn
uke fer Death Notices in.......--Newspapers......-1..---. ]---His Birthplace Pye
Name of Nich ddan ess tech roy ES ee ae, ee (siamenof NewspeDere)
“(Maiden Name)
Flowers
Her Birthplace ....------=RIA Outlay for Lot 1.2.. 2.2..
Body to be shipped to /. Opening Grave or Vault
fe . Q.9.
a : ey cA Lining Grave 1.40.
Size and Style of Casket oy Coffin 7 3 7. ee OLS, METRE Tae Ely i ater,
Ajab { WZ b fl Tent or Awning Charges
Maawactired by
Vault Rental :
Shipping Charges, prepaid
Interment at ...--..-------------ceeecceeeceteeeee cere Cemetery . Removal Charges ..-.---cssssssccssssccssscensesseeeeecsentesenaeenene [focecoeecreeee. annerene
Lot or Grave NO....-.::-+-s-+--++---Section No...---.---+-s-----0---0---= Cremation Charges «..----.--c------c-sseesscnsssneseteeessssnestessen . . aceseceasnseees
1 Porters $5.05. Watchers §$.
iy. ~ . Personal Services
2
J
“0 MUSIC <cccccocccncetescetecccevincoacerssersoscssnseeeosanstenratenesosessiuesoves’ [. -eescnesessncte [enseceeeee
A? 3 Church Charges
¢ 4
Be eh eee a are sea ere renee msmininmncnneeacetasysenctensennseratmemnnstnnserns
6 Total Footing of Bill $. . 29-1.) 5-0
Diagram of Lot or Vault
“ire
Designate all Graves in Lot with porn pr (i, 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 Oe (C) Balance
Use space to the right of Diagram for the names of those
buried in Lot. Entered into Ledger, page.....----------+---+ or below ]}...-----------baal To Funeral Charges.....Total, $ By Cash $