Title: Funeral Record for Burgess, Mose
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Permanent Link: http://ufdc.ufl.edu/UF00043417/00001
 Material Information
Title: Funeral Record for Burgess, Mose
Physical Description: Book
Creator: Cunningham Funeral Home
Estate of Burgess, Mose ( Estate )
Publisher: Cunningham Funeral Home
Publication Date: 1986
 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 #6375
Funding: Funded in part by the PALMM Florida Heritage Project.
 Record Information
Bibliographic ID: UF00043417
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 0
(Last) (First) (Middle) N 0

(Name of Deceased) Telephone: 1.
AfC O EATU BI OF DECEASED: IF INSTITUTION, 2.
PLACE OF DEATH USUAL RESIDENCE EVIDENCE EE ADMISSION:
COUNTY STATE: COUNTY: STATE:
CCCOUNTY STATE:T 1f n
CITY: E C slor INSInE
Os-, A ^CITY LIMITS?
-t' .Z)/YES r NO [I


LENGTH OF STAY
(in this place)


FULL NAME OF LENGTH OF STAY
HOSPITAL OR INSTITUTION;
IF NOT EITHER. GIVE ADDRESS:
DATE OF _(Month) (pay) (Year) (Hour)
DEATH af)a S /__ _
SEX C OR RAE E] MARRIED D NEVER MARRIED
L. I WIDOWED 0 DIVORCED (Specify)
DATE OF BIRTH GE Months Days Hours Min.

USUAL ICUPTION ID OF JSINM OR INDUSTRY
______ _____ I
BIRTHPLACE _te or Foreign Country) CITIZEN OF WHAT COUNTRY?

FATHER'S NAM

MOTHER'S MAIDEN NAME

WAS DECEASED EVER IN U. S. ARMED FORCES? I SOCIAL SECURITY NO



ddreu L, / Relationship


CAUSE OF DEATH
AUTOPSY YESJff NO D

PHYSICIAN _-

Addres Lsr__
PLACE OF BURIAL Cremation or Remove DATE
Cemetery 19f
Location 0 CV
County !QQ State
CEMETERY LOT NO. Owner of Lot
Section Grave No.
BEARERS







INTERNATIONAL ASSOCIATION OF MORTICIANS


Ct!I UK TOWN;
IF OUTSIDE CORPORATE
LIMITS, WRITE "RURAL":


STREET ADDRESS; RESIDENCE O7 FARM?
IF RURAL GIVE EXACT LOCATION: ,. YES D NO 3
Relationship Survivors -
Wifes Maiden
Name &A I --





y^ a

WUq/ -C7-4





", _____ ~___( f a a-






CHURCH AFFILIATION
CLERGYMAN
Address
FUNERAL PLACE
IF CHURCH, DB BODY LIt IN STATF YES D NO h
DATE Q I. Ci
VISITING HOURS
FRATERNAL AFFILIATIONS SERVICE..YES .... NO 0
REMARKS




DESCRIPTION OF CASKET AND OUTSIDE ENCLOSURE
LETTER SENT


S


Estate: Yes D No 0 Other: ......................................
Executor or Administrator ........ ... ................. ...............
A address . .. ....... .;; : . . . . .... ..
A ttorn ey ...... ... ... ... .. .. ... .. ... .. .. ... ... .. ... ... .. ... .. .
A ddress ... ........... .. .. ....................................
DATE DEBITS CREDITS BALANCE


0 VC1inr Vm
ov^V~c5
0 h


I' YfIQC


LEDGER


(1) SERVICES, including casket
All Facilitie and Equipment ...
Personal and Staff Service ......
Pressional Service ..
Visitors Register ....
Acknowledgement Cards
Funeral Sedan ... ..
Casket Coach ..
Outside Enclosure ......
S C 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
Certifed Copies .



CARRYING CHARGE


Total (1)
















Total (2)





Total (3)


GRAND TOTAL


STATEMENT MAILED


NO.





SALE RECORD


_ I


TOT







You will not be charged for any of the items below
that you chose not to use. A M S
*(1) Casket Prices as Marked ......... 4M,00 CUNNINGHAMe
Removal to Establishment F 1 T T
andEmbalming .................... .$300.00 funeral Hom e
(Beyond Marion County)


ei.uu per mIe tnereaiter
Professional Services ................. 300.00
Use of Facilities and Equipment ......... 200.00
Visitor Register ....................... 10.00
Cards ........................ 7.00 per box
Opening and Closing Grave ............. 50.00
Conducting Services ................... 150.00
Casket Coach ......................... 80.00
FuneralCars ..................... 80.00each
Sub-Total
Outside Enclosure Vault.........
Wooden Box .................... /0O 0
Clothing .........................


Total (1)


*(2) ITEMS INVOLVING CASH ADVANCES
To permit us to render a better service, we have ad-
vanced the money on these for your convenience.
Sales Tax ........................
Additional Autos .............
Cemetery Charges .......... .
Clergyman...................... / -
Telegrams .......................
Long Distance Telephone Calls ......
Transportation ............. .
Flowers ........................ ,
Obituary Notices ................. J l .
Programs........................



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


Total(3) $_
GRAND TOTAL $


J. C. CUNNINGHAM, L.F.D. A. L. CUNNINGHAM, L.F.D.
434 N.W. 16th Avenue Ocala, Florida 32670 Phone (904) 732-5353


oI o196


Name of deceased

Deceased is


Age


(Give relationship)


of person arranging services.


* (1) Services, including merchandise ............. /5 ;7
* (2) Items involving cash advances ............... S / 4 /
(3) Total o & 2 ............................... / 7 u
* (4) Items ordered later ........................
Both parties agree any items ordered later shall become
a part of this agreement and shall be inserted therein.


T


(5) Total of 3 & 4 ............................

GRAND TOTAL $/ f" ,-

erms of Pavment: 7 x/. c> L <


gC^ 0"o A -


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 P rchaser
7Yd 4 nJ. J ^


7~itr a


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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