Title: Funeral Record for Simmons, Henrietta
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00041633/00001
 Material Information
Title: Funeral Record for Simmons, Henrietta
Physical Description: Book
Creator: Cunningham Funeral Home
Estate of Simmons, Henrietta ( 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: UF00041633
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
(Last) (ir7t)

(Name of Deceased)


(Middle)
'" 4N ? I4


OF DECEASED: IF INSTITUTION.
USUAL RESIDENCE RESIDENCE BEFORE ADMISSION:
COUNTY: ,


PLACE OF DEATH
COUNTYi


STATE:


NO. A7L-)/9

Telephone ,53// t

STATEs


CITY:
(2 AL


/V/ / d- F /w
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: D /V7
DATE OF Moth ()ay) (Year) (Hour)
DEATH /
SEX COR OR RACE O q CARRIED [ NEVER MARRIED
EX e_ e /t-0 I [WIDOWED ] DIVORCED (Specify)
DAT OF BIRTH' AE Months Days Hours Min.
J- I ,7I I I
USUA OCCUPATION OF BUSINESS OR INDUSTRY

BIRT PLACE (Stat 6r Forein country) CITIZEN O T UNTRf?

FATHER'S NAM

MOTHER'S MADE NAM

WAS DECEASED EVER IN U S A ED FORCES? I '" *.. ,, .,

INFORMANT

Address Relationship


CAUSE OF DEATH
AUTOPSY YES O NO D

PHYSICIAN

Address
PLACE OF BURIAL remation Removal DATE
Cemetery __ -
Location
County State
CEMETERY LOT NO. Owner of Lot


Section
BEARERS


Grave No.


(RSIDENCE INSIDE
CITY LIMITS?
YES n NO 10-


STREET ADDRESS; / e / RESIDENCE ON FARM?
IF RURAL GIVE EXACT LOCATION /*t / I 'CY' /c. YES NO O
Relationship Survivors

,_____ --/ / _
zzI" )




_5_11"'


CHURCH AFFILI
CLERGYMAN T


Address


I r ,f


FUNERAL PLACE C4'-
IF CHURCH DID BODY LIE IN STATE / YES O NO O
DATE O / Time / .
VISITING HOURS


FRATERNAL AFFILIATIONS


.SERVICE..YES O.... NO


MUSIC YES O NO O
SINGERS



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


INTERNATIONAL ASSOCIATION OF MORTICIANS


i J I f JJ i -


~C~~c/'t~ ,


. r


.~i~kP~z~PI


~i~L~o~3 ~/J~


^ /t'<





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 ......... .


(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
GRAND TOTAL
Termsche ......... ..


Purchaser


Estate: Yes Q No
Executor or Admini
Address
Attorney
Address


DATE


M-1


strator......


DEBITS CREDITS


BALANCE


I _______ F ,II ______


/,/*1 19011 5-62 IS-C


__ 6: gl .-15

__ __ _ -^ -i-- _


NO.


---I---I---


--


Other.


)-/1 V74





You will not be charged for any of the items below
that you chose not to use.
*(1) Casket .
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 ..................... 7,



Total (1) $
*(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 ............
Programs ................ JJ-L




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







Total (3) -
GRAND TOTAL $


FUNERAL PURCHASE AGREEMENT


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

19-

Name of deceased / r f /' // / 4 Age

Deceased is A (Give relationship)
() Services, including merchandise .......... $ S"

(2) Items Involving Cash Advances ..........$ 4 ,

Total (1 & 2) $/ e f,

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


Legal rate of interest after maturity.


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




By
/A.^^ ^/


I, or we, accept and approve the above


Signature of Purchaser

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

Sigstre of Co-signer wish Purchaser Street City and Stei





You will not be charged for any of the items below
that you chose not to use.
*(1) Casket
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 ..................... -



Total (1) $
*(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 ............
Programs ..................





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







Total (3)
GRAND TOTAL $


FUNERAL PURCHASE AGREEMENT






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


Name of deceased


Deceased is


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


Age-


of person arranging services


*(2) Items Involving Cash Advances $

Total (1 & 2) $

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

I GRAND TOTAL $


Terms of Payment:


Legal rate of interest after maturity.


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


I, or we, accept and approve the above


Signature of Purchaser

Address


Signature of Co-signer with Parchaser Street City and State

Signature of Co-signer with Purchaser Street City and State

Signaure of Co-signer with Ptrchaser Street City and State

Sigwre of Co-sig .r with Pbrthater Strewt C m and-Satoe


'. v -- 1




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