Title: Funeral Record for Simmons, Lottie
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00041057/00001
 Material Information
Title: Funeral Record for Simmons, Lottie
Physical Description: Book
Language: English
Creator: Cunningham Funeral Home
Estate of Simmons, Lottie ( Estate )
Publisher: Cunningham Funeral Home
Publication Date: 1972
 Subjects
Subject: Funeral records
Registers of births, etc.   ( lcsh )
African Americans -- Florida   ( lcsh )
Spatial Coverage: North America -- United States of America -- Florida -- Marion -- Ocala
 Notes
General Note: Cunningham Funeral Booklet Entry #4047
Funding: Funded in part by the PALMM Florida Heritage Project.
 Record Information
Bibliographic ID: UF00041057
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: The Cunningham Funeral Records are part of the Department of Special and Area Studies Collections and its African American History Collections at the University of Florida Libraries.
Rights Management: All rights reserved by the source institution and holding location.

Full Text

BURIAL PERMIT NO.


PLACE OF DEATH
COUNTY:


FUNERAL SERVICE RECORD
Ps< (Fir


(Middle)


(Name of Deceased)
USUAL RESI E OF DECEASED: IF INSTITUTION,
USUAL RESIDENCE RESIDENCE BEFORE ADMISSION:
COUNTY'v.


_Dog3


STATE:


CITY: RESIDENCE INSIDE
CITY LIMITS?
YES s NO
STREET ADDRESS; RESIDENCE ON FARM?
IF RURAL GIVE EXACT LOCATION, .' / l N YES O NO 0
Relationship Survivors


FATHER'S NAME

MOTHER'S MAIDEN NAME

WAS DECEASED EVER IN U. S. ARMED FORCES? W W
A ^ PRIVATE INFORMATION
INFORMANT

Address Relationship


CAUSE OF DEATH
AUTOPSY YES O NO O

PHYSICIAN X e72 2Z

Address (

PLACE OF BURIAL Cremation or Removal DATE
Cemetery 19-
Location
County State

CEMETERY LOT NO. Owner of Lot
Section Grave No.
BEARERS








INTERNATIONAL ASSOCIATION OF MORTICIANS


CHURCH AFFILIATION
CLERGYMAN
Address
FUNERAL PLACE
IF CHURCt,DID BOD IN STATF YES [ NO O
r "ATrY".i"" v/^^ Sx^-X = / /,,0 >., V5.C


VISITING HOURS
FRATERNAL AFFILIATIONS


MUSIC YES O NO [O
SINGERS



FUNERAL DIRECTED BY LICENSE NO.
EMBALMER'S LICENSE NO.
REMARKS:


SERVICE.-YES O- ..-- NO


NO. 0i

Telephone


STATE:




DESCRIPTION OF CASKET AND OUTSIDE ENCLOSURE


Purchase Date Size Our Number Interior No.
Mfr. Mfrs. No. Material Material
Casket Cost Blanket Cost Cover Finish Color
Kind of Vault Type of Vault Finish Cost
SALES RECORD STATEMENT MAILED LEDGER LETTER SENT


(1) SERVICES, including casket
All Facilities and Equipment ..........
Personal and Staff Service .......
Professional Service ......
Visitors Register ... .....
Acknowledgement Cards .................
Funeral Sedan .... .. ....... .
Casket Coach ...................
Outside Enclosure ........................
Clothing .. . .


Total (1)


(2) ITEMS involving Cash Advances
Sales Tax ........... .... ....
Additional Autos
Cemetery Charges ...............
Clergyman ........
Telegrams ........
Long Distance Telephone Calls ...
Transportation ...........
Flowers ... .
Obituary Notices ........ ..






(3) ITEMS ORDERED LATER
Certified Copies .......


Total (2)


Total (3)


CARRYING CHARGE


GRAND TOTAL


Terms .


Purchaser .


I I


Estate: Yes O No ] Other: ...... ...............
Executor or A dm inistrator ................................................
A dd ress . ...........................
A tto rn ey . . . . . . . . . . . . . . . .
Address
A t n .


DATE


DEBITS


CREDITS BALANCE


.___







6c~ f-4


*Ifi --111_________________________-II ~ II i -.-jI iL l


NO.


I- I~-f-~--II----~--1 -


-I-- N7E




FUNERAL PURCHASE AGREEMENT


*(1) SERVICES, including Casket
All facilities and Equipment
Personal and Staff Service
Professional Services /
Visitors' Register
Acknowledgement Cards
Funeral Sedan
Casket Coach
Outside Enclosure ............
Clothing ....................



Total (1) $ j
*(2) ITEMS INVOLVING CASH ADVANCES
To permit Us to Render A Better Service
We Have Advanced the Money on These
For Your Convenience.
Sales Tax ..................
Additional Autos ............
Cemetery Charges...........____
Clergyman .................
Telegrams .................. ___
Long Distance Telephone Calls. .
Transportation ..............
Flowers ...................
Obituary Notices ............ o






Total (2) $
*(3) ITEMS ORDERED LATER
Certified Copies .............







Total (3) $
GRAND TOTAL $ __i


CUNNINGHAM'S FUNERAL HOME
A. L. Cunningham, L.F.D. J. C. Cunningham, LF.D.
PHONES: 622-7836 622-4251
434 N. W. 16th AVENUE, OCALA, FLORIDA 32670

19z


Name of decease Age

Deceased is ___ of person arranging services
(Give relationship)

*(1) Services, including merchandise .......... $

(2) Items Involving Cash Advances ..........$ $

Total (1 & 2) $5 --q 60

*(3) Items ordered later .................... $
Both parties agree any items ordered later
shall become a part of this agreement and
shall be inserted therein.

GRAND TOTAL 3


5, Terms of Payment:


*? Legal rete of interest after matity.


We agree to furnish all services, and
merchandise, indicated above.




By. z


I, or we, accept and approve the above



SSignature of Iurchaser

Address


Signature of Co-signer with Purchaser Street City and State

Signature of Co-signer with Purchaser Street City and State

Signature of Co-signer with Purchaser Street City and State

Signature of Co-signer with Purchaser Street City and State




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