Title: Funeral Record for Smith, Alice
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00041498/00001
 Material Information
Title: Funeral Record for Smith, Alice
Physical Description: Book
Creator: Cunningham Funeral Home
Estate of Smith, Alice ( Estate )
Publisher: Cunningham Funeral Home
 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
Funding: Funded in part by the PALMM Florida Heritage Project.
 Record Information
Bibliographic ID: UF00041498
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
/ast) .i)
\J^/\^-^i ^ jfy^/C


STATE:


(Middle)


(Name of Deceased)
SOF DECEASED: IF INSTITUTION,
USUAL RE EI E RESIDENCE BEORE ADMISSION:
COUNTY:


N O. # 77

Telephone ~ 7

STATE, S 1F /


... / ... L/ c
CITY: R/ RESIDENCEE INSIDE
CITY LIMITS?
SYES [-I NO
STREET ADM SS; RESIDENCE ON FARM?
IF RURAL GIVE EXACT LOCATION U YES O NO
Relati ship Suryivrs









/
7___L/ At-


IC7 .)A 1^ 4 >/ kh?


It t 4



____________-_--

____ / ^ ^^g


CHURCH AFFILIATE
CLERGYMAN M/ A f A


Address


/1P b'Uo)ZL


I /Lc


AUTOPSY

PHYSICIAN


YES -
lt x I,-


NO


Address
PLACE OF BURIAL- Cemation or Removal/ DATE
Cemetery 4" ;, 19-__
Location Stat 1
County P2 iii72 Sta.. J I e
CEMETERY LOT NO. Owner of Lot
Section Grave No.
BEARERS







INTERNATIONAL ASSOCIATION OF MORTICIANS


FUNERAL PLA fr -~ t-/
IF CHURCH, ID BODY LIEN ST YES NOI
DATE ( Time ._ e _,
VISITING HOURS
FRATERNAL AFFILIATIONS ERVICE..YES ---- ....NO O




MUSIC YES NO O
SINGERS


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


-- -- --


.


'Mb ~L- ~71~1 )


~Ln/l~ I




DESCRIPTION OF CASKET AND OUTSIDE ENCLOSURE


NO.


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


(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 ...........


(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



CARRYING CHARGE


SALES RECORD //









o-ta 7 (1


Total (1)_


-4













Total (2)





Total (3)


STATEMENT MAILED


Estate: Yes Q No Q
Executor or Administrator
Address
Attorney
Address


DATE


LEDGER


LETTER SENT


Other:


/bEBITS


CREDITS


BALANCE


I IF -


-- -- ----
n-^ iZ



Sa -





0 i
__-'t~r-H^^Ji ~HiBZ-Z-~Z:d


___ ______________________ ___ 1'--- ___ -
___ ______________________ I--.. ___ -~ -
___ ___ I-.- ___ -


144
1
77
^>


GRAND TOTAL


Term s ..... .. ...


Purchaser


---I----i~


=' ''


______^i mc uV0l


. .. .. .. ...........


. . .


d--/- y~
~-/- ~7(L4




BUIAL PERMIT NO.


FUNERAL SERVICE RECORD
Lost) /
"471U


PLACE OF DEATH
COUNTYi


STATEs


(Middle)


(Name of Deceased)
OF DECEASED: IF INSTITUTION,
USUAL RESIDENCE REE SIDE BEFORE ADMISSION:
COUNTY:


NO.

Telephone

STATEs


CITY OR TOWN; LENGTH OF STAY
IF OUTSIDE CORPORATE (in this place)
LIMITS, WRITE "RURAL":

FULL NAME OF LENGTH OF STAY
HOSPITAL OR INSTITUTION;
IF NOT EITHER, GIVE ADDRESS:

DATE OF (Month) (pay) (Year) (Hour)
DEATH
SEX COLOR OR RACE O MARRIED O NEVER MARRIED
I IO WIDOWED Q DIVORCED (Specify)
DATE OF BIRTH AGE Months Days Hours Min.

USUAL OCCUPATION KIND OF BUSINESS OR INDUSTRY

BIRTHPLACE (State or Foreign Country) CITIZEN OF WHAT COUNTRY?

FATHER'S NAME

MOTHER'S MAIDEN NAME

WAS DECEASED EVER IN U. S. ARMED FORCES? SOCIAL SECURITY NO.

INFORMANT

Address Relationship


CAUSE OF DEATH
AUTOPSY YES O NO O

PHYSICIAN

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


CITY: RESIDENCE INSIDE
CITY LIMITS
YES O NO D
STREET ADDRESS; RESIDENCE ON FARM?
IF RURAL GIVE EXACT LOCATION YES O NO O
Relationship Survivors


- I


CHURCH AFFILIATION
CLERGYMAN
Address
FUNERAL PLACE
IF CHURCH, DID BODY LIE IN STATE YES 0 NO O
DATE Time
VISITING HOURS
FRATERNAL AFFILIATIONS SERVICE..YES ....--NO




MUSIC YES O NO D
SINGERS



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


I




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 ........... -7




(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




CARRYING CHARGE


Terms ....

Purchaser .


Total (1)


Total (2)


Total (3)


GRAND TOTAL


Estate: Yes O No O
Executor or Administrator
Address
Attorney
Address


DATE


Other:


[F--II [F---~~---1 I


DEBITS


CREDITS


,, -,




S.,26 _Z_ 1


,) ( --

-,

//-^ 7^ ^\_______^ Vy ^ 7 0 ___ _


BALANCE


I I---- -III-i- II_


_____ _______________________________ ____ [==. _____


__ ______________ 4- __ -


___________________ i---


NO.


- I


~--I--


I I I 'I----~--


...... ....
.........................
.... ...............


X- /*


/<^ 1^0^.^


j/.- c'//14-.


-^/1 -<<







*(1)















*(2)


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







Total (3) $
GRAND TOTAL $


You will not be charged for any of the items below
that you chose not to use.
Casket 6.
Removal to Establishment
Preparation Preservation
Staff Service
Professional Service
Facilities Equipment .
Obtaining Burial Permit
Visitors Register, Cards
Opening, Closing Grave
Conducting Services
Funeral Car Casket Coach
Outside Enclosure .............
Clothing ..................... 91.



Total (1) S
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 ............ /
Programs ................. j




Total (2) $i o


Name of deceased / /V /

Deceased is /v / of person arrange
(Give relationship)
(1) Services, including merchandise .......... $

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

Total (I & 2) $S/t0 '


CUNNINGHAM'S FUNERAL HOME
A. L. Cunningham, L.F.D. J. C. Cunningham, L.F.D.
PHONE: 732-5353
434 N. W. 16th AVENUE, OCALA, FLORIDA 32670
/


ging services


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


I, or we, accept and approve the above


Signature of Purchaser

Address

City 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

Signature of Co-signer with Purchaser Street c- ...


1 97

Age Z


S .. .


*(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 $/a 2 1) 2g'

Terms of Payment,.- f #^-^ "10 7 -/ /7-


Legal rate of interest after maturity.














11




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