Title: Funeral Record for Dixon, Sammol
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Full Citation
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Permanent Link: http://ufdc.ufl.edu/UF00043003/00001
 Material Information
Title: Funeral Record for Dixon, Sammol
Physical Description: Book
Language: English
Creator: Cunningham Funeral Home
Estate of Dixon, Sammol ( 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 #5964
Funding: Funded in part by the PALMM Florida Heritage Project.
 Record Information
Bibliographic ID: UF00043003
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
first)
L) -e^~y/


(Name of Deceased)
OF DECEASED: IF INSTITUTION,
USUAL RESIDENCE RESIDENCE BEFORE ADMISSION:
COUNTY: / 71,1,, -D


STATE:


CITY:
a^^/>9


CIT 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 th) () (Yor (Hour)
DEATH E7
SEX Y I YSOR MA IED [ NEVER MARRIED
D. I OWED DIovORCED (Specify)
E OF BIRTH- AGE 'Months Doys Hours Min.

USUAOCCUPAON I ND OF BUSINESS OR INDUSTRY

BIRHPLE (State/or/Fpin Cory) I CZN WHAT COUNTRY?
7) m e.r /i / Jz <, Q ,-),
FATHER'S NAME

MOTHER'S MAIDEN NAME

WAS DECEASED EVER IN U S. ARMED FORCES? / SOCIAL &EcUBRITY N>

INFORMANT

Address Relationshf

BEARE a .2S, 0/
CAUSE OF DEATH
AUTOPSY YES 0 NO

PHYSICIAN S__

Address
PLACE OF BURIAL Cremation or PBmovpl DATE

Location
County State
CEMETERY OT NO. 7Owner of Lot

BEARERS


(Middle)


S tSI DCICI INSIl
CITY LIMITS?
Yvs n in


STREET ADDRESS; RESIDENCE O M
IF RURAL GIVE EXACT LOCATION / / YES 9l "NO a
Relationship Survivors -
Wife Maiden
Name








---HURCH AFIIAT











CU"a

CLERGYMAN


Address


X,^,/ *> ^/'


A/ I


FUNERAL PLACE / /-. A o./ .0A


rz/


IF CHURCH DID BODY LE ATE YES NO
DATE / Tim ___
VISITING HOURS
FRATERNAL AFFILIATIONS SERVICE- YES .... NO
REMARKS


INTERNATIONAL ASSOCIATION OF MORTICIANS


NO. s~?9

Telephone: 1 .2 o57
2./-/ 27STATE:o
STATE


PLACE OF DEATH
COUNTY:

A/7 A~f/) A)


01=_
L) C) 4 /--? A,7,


! J V f


~E~fb-w -r


C-Awd- las


---~--~


F/


/.-/J>A //-^J




DESCRIPTION OF CASKET AND OUTSIDE ENCLOSURE
LETTER SENT


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

q

LEDGER


(1) SERVICES, including casket
All Facilities and Equipment .....
Personal and Staff Service
professional Service .
Visitors Regiter ....
Acknowledgement Card
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
Certiied Copies .


CARRYING CHARGE


STATEMENT MAILED


Total (1)















Total (2)





Total (3)

GRAND TOTAL


9


SA


NO.





SCORED


~-I I





You will not be charged for any of the items
below that you chose not to use. q
(1) Casket
Removal to Establishment
Preparation Preservation
Staff Service
Professional Service10 0
Facilities Equipment
Obtaining Burial Permit
Visitors Register, Cards
Opening, Closing Grave
Conducting Services
Funeral Car Casket Coach
Outside Enclosure.............
Clothing ....................
..............................

Total (1) S
(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................ JLC P5
Programs ...................




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






Total (3) $
GRAND TOTAL $


9


CUNNINGHAM S'

Funeral Home


J. C. CUNNINGHAM, L.F.D.
434 N.W. 16th Avenue *


A. L. CUNNINGHAM, L.F.D.
Ocala, Florida 32670 Phone (904) 732-5353


9-/7-


Name of deceased hl r. -)arn rne. b1 xn


Deceased is


Age._ 3


of person arranging services.


(Give relationship)

* (1) Services, including merchandise .............. % l O '
* (2) Items involving cash advances ............... $ I L- -5
(3) Total of & 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 $ 10 ILO i

. .n P.,..n. A 300o .O q 1-83


Legal rate of interest after maturity.

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


I, or we, accept and approve the above


Signature of Purchaser


Address


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 Citir and State

Signature of Co-signer with Purchaser Street City and State


vcl+ner


FC1~S~er


--J
w 4~ols3




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