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Page: of 159
RECORD OF FUNERAL
ee Oe No. Be Date nn Ltn acl me
(Total Number) K Yearly Number) a
Name of Deceased....(\ AIAG. Ah Cita. Coots * lL ck& <a J
<<] ve Born)
eee (What Race) (
Son---Daughter of rder Given by
. a hew..!
Charge to -.. @.% 1, Oa
Price of Casket or Coffin $
Address .~%.-c [eee eeret anennennee spose “Metallic Lining
Wife---Widow t
(State kind)
How Secured ...-.------é Outside Box
Date of Bererat. mere . (State kind) “ Grave Vault
Residence . = (State kind)
eS «Burial Robe
Place of Death..‘ 5 ; :
Burial Slippers and Hose
Funeral Services at. Leta. U . etewicce-steennnnsennennncsnennenncensenense ac tae Cai eck go Polo
Time of Funeral Service..--Q forcement Embalming Body (with Fluid)
Clergy man .---------r-rm-neoe-* Washing and Dressing
Certifying Physician 2M: rs Shaving
\, His Residence Dr aerctecPl chee.. NAA ct vvvevenennernnnvrnnnnnnoncnnnnnns Disinfecting Rooms
Nember of Burial ee of Lae ra Use of Catafalque and Drapery
Cause of Deat Fes tlst gd Folding Chairs
ae apeete 4 (Secondyry) “ Candelabrum and Candles
y. . = :
Date of Death.. J A.pe.B.:
Occupation of the i VWirsasen.:
Stretenor Married.. Religion ¢ &.: ae. 7 Bs
5 ; arriages to Cemetery ?
Date of Birth.. Ax tend Ai dG Tem 8 Automobiles to Cemetery...@ §
Aged.9.bf..Yea heal i 2s Months, ..------+---+-+-Days. . Wagon Deliveries
Name of Father. eee oe ee City Calls (Coaches)
His Birthplace poms ek: oF Death Notices in.......--Newspapers
Name of Mother. Ct ha srnntte WMS aaa oe (Names of Newspapers)
(Maiden eid Flowers
Her Birthplace pow meee Outlay for Lot C% A
, Body to be shipped tpk eee Ber er teh eek ace Aer Opening Grave or Vault
; Lining Grave
Size and Style of Casket or Coffin Evergreen
Tent or Awning Charges
Vault Rental
Manufactured by\ Shipping Charges, prepaid 4°
Interment at i Cemetery . Removal Charges -. pact enn en sacha, Hoe
Lot or Grave NO.. Section No...------.--csesretre* Cremation Charges
1. Porters $.-.20--c-c<c<ne-cereee--< Watchers $.
‘ Personal Services
dv" MUSIC ccomeesacscsossvsccescoseanemencnecnecnsesnecnsensnssesnsansnanesanencennors [frerearetenmneees . weesrencs
4, . \-¥ 3 Church Charges _Calacct se.. berkeley Be ST ase Ale sel
b 4 frtegiings is act =f ttt
5
od pth
Total Footing of Bill Pl. fxhe coe
Diagram of Lot or Vault ro
Designate all Graves in Lot with este (i, 2, 3, 4, ete.), By Amount Paid in Advance.....-.------s----ecsersesceees . ececscceerttteen . ooeeteneen
and mark space for this Funeral with a cross (+
il thes (Cc) Designate place for Monument with a sma Balance
_Use space to the right of Diagram for the names of those
buried in Lot. Entered into Ledger, page...------------+--+---+ OL below . nav-------s-----. -n--------To Funeral Charges..... Total Sl . lap oo Me By Cash ¢