Title: Funeral Record for Roberts, Sip
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00041612/00001
 Material Information
Title: Funeral Record for Roberts, Sip
Physical Description: Book
Creator: Cunningham Funeral Home
Estate of Roberts, Sip ( 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: UF00041612
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.


FUNERAL SERVICE RECORD
S (La (First)
'" A ^C 3L o/


(Middle)


(Nome of Deased)


STATE:


__ OF DECEASED IF INSTITUTION,
USUAL RESIDENCE RESIDENCE BEFORE ADMISSION:
COUNTY: Ik ) //
MA->~-r, iv


NO.

Telephone 6 f >1

STATE
i~/^/


CITY Ok TOWN; / LENGTH OF STAY
IF OUTSIDE CORPORATE (in this pace)
LIMITS. WRITE .RURAL ________
FULL NAME OF LENGTH OF STAY
HOSPITAL OR INSTITUTION;
IF NOT EITHER, GIVE ADDRESS: /)1 \ -
DATE OF (Moth) (pay) (Year) (Hour)
DEATHa 75
SEX j COLOR OR RACE O MARRIED 0 NEVER MARRIED
.-/SV7 / -. I r f,-.. ( oDOWED 0 DIVORCED (Specify)
DATE C BIRTH AGE I Months Days Hours Min.

USU OCCUPATION KIND OF BUSINESS OR INDUSTRY

BIR PLACE /Sta or F r ign Country) CITIZEN OF WHAT COUNTRY?

FAT ERE'S E I S A O

MOTHER'S MtDEN NAME_

WAS DECEASED EVER IN..I S. ARMED FORCES?
y\ eD


INFORMANT 7Z_ I A ,K / y


PS /A rk'rOI


Address Relationship "


CAUSE OF DEATH
AUTOPSY YES O NO [

PHYSICIAN An /z3h K

Address


PLACE OF BURI Cremation or Remo / DATE
Cemetery 9 ( 3 z 9ZL57
Location
County State
CEMETERY LOT NO. Owner of Lot
Section Grave No.
BEARERS







INTERNATIONAL ASSOCIATION OF MORTICIANS


CITY: RESIDENCE INSIDE
S -/\/ // ^ CITY LIMITS?
YES[ NOI-
STREET ADDRESS; / RESIDENCE ON FARM?
IF RURAL GIVE EXACT LOCATION / y7 YES Q- NO O
Relationship Survivos
2,W L). a / 23/.4 en0< A
'
,,"^ /.-!, r,, ,/

















CHURCH AFFILI ION '
CLERGYMAN A C.. CC. A- O ;~


Address
FUNERAL PLACE If a 7 4
IF CHUB DID BODY L N STATF YS NSO
DATE L Time


VISITING HOURS
FRATERNAL AFFILIATIONS


frfIF


SERVICE..YES ....NO O


MUSIC YES Q NO [
SINGERS


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


. PLACE OF DEATH
COUNTYi


f


"" F


w w




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


SALES RECORD


(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


Total (1)

















Total (2)





Total (3)


CARRYING CHARGE


STATEMENT MAILED


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


DATE


rF~-~-----r----


3 v- 1 I IL ,4,az UC.


GRAND TOTAL


Terms .

Purchaser


LEDGER


LETTER SENT

_ I _


Other:


DEBITS CREDITS


BALANCE


IF F : I I _______


Y?-' V I11kl'? V .c


II t-II -~-3-~---1- ~ -


Rr U-


- I


~1 ~~~f~


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

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





You will not be charged for any of the items below
that you chose not to use.
Casket rg>'e,
Removal to Establishment
Preparation Preservation
Staff Service
Professional Service
Facilities Equipment / 0 .0
Obtaining Burial Permit
Visitors Register, Cards
Opening, Closing Grave
Conducting Services
Funeral Car Casket Coach
Outside Enclosure ..........
Clothing ..................



Total (1) $
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 ............ 7 A
Programs ................. /. I
...... ......................


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



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


S00


Total (2) $
"ER


...... .






Total (3) )
GRAND TOTAL $


FUNERAL PURCHASE AGREEMENT






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



Name of deceased A 0 1 0 Q O / e Age

Deceased is 4 '- _4 Z a of person arranging services
(Give relationship)
(1) Services, including merchandise .......... $ 5

*(2) Items Involving Cash Advances ..........S 7

Total (1 & 2) $s--. .02

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

1 GRAND TOTAL $ p,.

Terms of Payment 1


Legal rate of interest after maturity.

We agree to furnish all services, and I, or ue, accept and approve the above
merchandise, i eat o.,ve. ,


nature oPurchaser

By

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 City and State




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