Title: Funeral Record for Jackson, John
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00042739/00001
 Material Information
Title: Funeral Record for Jackson, John
Physical Description: Book
Language: English
Creator: Cunningham Funeral Home
Estate of Jackson, John ( Estate )
Publisher: Cunningham Funeral Home
Publication Date: 1982
 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 #5703
Funding: Funded in part by the PALMM Florida Heritage Project.
 Record Information
Bibliographic ID: UF00042739
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_

gS/UrAJf-jA e4


PLACE OF DEATH
COUNTY:


FUNERAL SERVICE RECORD
(Last) (First)

(Name of Deceased)


(Middle)


OF DECEASED: IF INSTITUTION.
USUAL RESIDENCE RESIDENCE BEFOREADMTSSION
COUNTY:


STATE:


NO, 7 3


Telephone


STATE: a/


CITY -R TOWN; LENGTH OF STAY
IF OUTSIDE CORPORATE (in thi place)
LIMITS, WRITE "RURAL":


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


llaIAZZ


eeuv


LENGTH OF STAY

&0 -- ii*-f


DATE OF (Month) (y) (Year) (Hour)
DEATH _
SEX OR OR RACE I MARRIED Q NEVER MARRIED
0" / AXE d, I [ WIDOWED O DIVORCED (Specify)
DATE OF BIRTH J AGE Months Days I Hours Min.

U oUA OCCUPATION KIND OF BUSINESS OR INDUSTRY

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

FATHER'S NAME

MOTHER'S MAIDEN NAME


WAS DECEASED VER IN U. S. ARMED FORCES?

INFORMANT

Address .1 R


-& Zs4?24a


CAUSE OF DEATH
AUTOPSY YES D NO D

PHYSICIAN

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


CITY: RESIDENCE INSImD
/ / CITY LIMITS?
YES Q NO D
STREET DRESS; RESIDENCE ON FARM?
IF RURAL GIVE EXACT LOCATION: YES O NO
Relationship Survivors
, W eis Maiden
Name


______________- .1
CHURCH AFFILIATION
04A d __IYMAN
Address


FUNERAL PLACE
IF CHURCH, DID BODY LIE IN STATE YES 0
DATE Time
VISITING HOURS
FRATERNAL AFFILIATIONS


NO [



SERVICE -YES O....NO O


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







INTERNATIONAL ASSOCIATION OF MORTICIANS


MUSIC YES O NO D
SINGERS



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


-1I


V 4F ;ATI" -




DESCRIPTION OF CASKET AND OUTSIDE ENCLOSURE


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


(1) SERVICES, including casket
All Facilities and Equipment ..........
Personal and Staff Service .............
Professional Service .
Visitor 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


Total (1)


Total (2)





Total (3)


GRAND TOTAL


Teras....................... ............. ................ .... ....

P urchaser ..... .. .. ..... .......... .. ....... ....... ....


______________ ____________


Estate: Yes O No O Other: ....................................
Executor or Administrator .........................
A address .... ............................................................
A ttorney.........................................................
Address
IA .. .. .....


DATE


- A


DEBITS


CREDITS BALANCE


1 1 IZ 1 II- - -


110 I W2


i~s~( (~ *r91~ d


77 1rffl-- -






i-

I-


NO.


-~I I


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