Title: Funeral Record for Haynes, Nellie
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00042923/00001
 Material Information
Title: Funeral Record for Haynes, Nellie
Physical Description: Book
Language: English
Creator: Cunningham Funeral Home
Estate of Haynes, Nellie ( Estate )
Publisher: Cunningham Funeral Home
Publication Date: 1983
 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 #5885
Funding: Funded in part by the PALMM Florida Heritage Project.
 Record Information
Bibliographic ID: UF00042923
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:

M `/->v Yi Al


STATE:


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

FULL NAME OF LENGTH OF STAY
HOSPITAL OR INSTITUTION;
IF NOT EITHER. GIVE ADDRESS: A, S
DATE OF (Month3 (Day) (Year) (Hour)
DEATH P.
SEX COL[ RACE R [ftRRIED O NEVER MARRIED
X I 1 -/ 1 D WIDOWED 0 DIVORCED (Specify)
DAUE OF BIRTH I E Months Days Hours MIin
/L-/ -/ I B I
USUAL O -UPATIN, IN( 9F BUSINDSJOR INDUSTRY


715 tj *, .i 4`41


I .6d,-t;fcl ,r5h~ ~f 5)It4


BIRTHPLACE (State Forei Country) CITIZEN(OF WHAT COUNTRY?

FATHER'S NAME

MOTHER'S MAIDEN N -

WAS DECEASED EVE IN U. S. ME FORCES? I SOCIAL' SECURITY NO

INFORMANT

Addreu Relationship


CAUSE OF DEATH
AUTOPSY YES N O

PHYSICIAN

Address
PLACE OF BURIAL Cremation or Removal DATE
Cemetery / --_____9W W-
Location
County State
CEMETERY LOT NO. Owner of Lot
Section Grave No.
BEARERS







INTERNATIONAL ASSOCIATION OF MORTICIANS


(Name of Deceased)
OF DECEASED- IF INSTITUTION.
USUAL RESIDENCE RESIDENCE BEFORE ADMISSION:
COUNTY:

CITY: -


FUNERAL SERVICE RECORD
4 (Lost) i
o', A e_,<- lye


STREET ADDRESS; Of V.0' Alu J A RESIDENCE r FARM?
IF RURAL GIVE EXACT L 'T16 YES t- NO
Relationship Survivors
Wifes Maiden
&nOX <4 4Z. "r A,&


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I 4/ 1 ^..,^^ c L /bf. ^_,., =.s,//,


- / J =


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Z' L-1, 4r 4- .


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it'-,


I I -


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CHUR H .F F'AAr L (II









_ _IInrU AccIIIU ki ,r7


CLERGYMAN Z
Address
FUNERAL PLACE AL' ,,5


I -). 'A


IF CHURCH DID BODY LIP Il STATF YES NO
DATE Tim s
VISITING HOURS
FRATERNAL AFFILIATIONS SERVICE..YES .... NO O
REMARKS


We r -_


0


--r----! ,,, ~ -- --~ ----


r

n A Bd.~~ f


kwAglaf


L


"


Telephone: 1. 7x
2.1
STATE: l/
RSI DNCE INSIDE
CITY LIMITS?
YES l NOt




DESCRIPTION OF CASKET AND OUTSIDE ENCLOSURE
LETTER SENT I


II I __


Estate: Yes 0 No 0 Other:....... ............... ............
Executor or Administrator ..........................................
A dd ress .... .. ... ................. ..................... .. . . .
A ttorn ey . .. .. ... ... ... ... .. .. . ... .. .... .. ... .. .. .. ..... ..
Address .. ....................................................
DATE DEBITS CREDITS BALANCE






-- :


I-f *1 4-f


- |


(1) SERVICES, including casket
All Facilities and Equipment ..... .
Personal and Staf Service
Profeional Service ..
Visitors Register ...
Acknowledgement Cards
Funeral Sedan ....
Casket Coach ......
Outside Enclosure .........
C lothing .............. .. .. .




(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


LEDGER


Total (1)
















Total (2)





Total (3)

GRAND TOTAL


9


STATEMENT MAILED


I I


NO.





SALES RECORD






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 0i
Obtaining Burial Permit
Visitors Register, Cards
Opening, Closing Grave
Conducting Services
Funeral Car Casket Coach
Outside Enclosure............ ZA6 0o
Clothing ....................



Total (1) /d
(2) ITEMS INVOLVING CASH ADVANCES
To permit us to render a better service, we have
advanced the money on these for your conven-
ience.
Sales Tax ....................
Additional Autos .............
Cemetery Charges ..........
Clergyman ..................
Telegrams .................... -
Long Distance Telephone Calls ..
Transportation ................
Flowers......................
Obituary Notices............... /
Programs ......................



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







Total (3) S
GRAND TOTAL $


CUNNINGHAM S'

Funeral Home


J. C. CUNNINGHAM, L.F.D.

434 N.W. 16th Avenue *





Name of deceased

Deceased is


A. L. CUNNINGHAM, L.F.D.

Ocala, Florida 32670 Phone (904) 732-5353


anflc~te/


et~1c~2~>


(Give relationship)

* (I) Services, including merchandise .............. % / 0

* (2) Items involving cash advances ............... / -
(3) Total of I & 2 ............................

* (4) Items ordered later .........................
Both parties agree any items ordered later shall become
a part of this agreement and shall be inserted therein.
(5) Total of 3 & 4 ............................ $

GRAND TOTAL S


Terms of Payment:


Legal rate of interest after maturity.


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


of person arranging services.


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 City and State


,9, _


Age


I, or we, accept and approve the above


-F r


---


i




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