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ABC FUNERAL HOME
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charges are only for those items that you
selected or that are required. If we are required by law or by a cemetery
or crematory to use any items, we will explain the reasons in writing
below.
|
Deceased:
|
____________________________________________________ |
|
Purchaser:
|
____________________________________________________ |
|
Address:
|
____________________________________________________ |
|
Telephone
Number:
|
____________________________________________________ |
___________________
Date of Death
_______________________
Date of Arrangements
| Basic Services of Funeral Director
and Staff and Overhead ....................................... |
$______ |
| Embalming ............................................................................................................... |
$______ |
If you selected a funeral that may require
embalming, such as a funeral with viewing, you may have to pay for embalming.
You do not have to pay for embalming you did not approve if you selected
arrangements such as a direct cremation or immediate burial. If we charged
for embalming, we will explain why below.
Other Preparation of the Body
| Cosmetic Work for Viewing....................................................................................
|
$______ |
| Washing and Disinfecting Unembalmed
Remains ..................................................... |
$______ |
| Transfer of Remains to the Funeral
Home ............................................................... |
$______ |
| Use of Facilities and Staff for
Viewing ................................................................... |
$______ |
| Use of Facilities and Staff for
Funeral Ceremony ................................................... |
$______ |
| Use of Facilities and Staff for
Memorial Service .................................................... |
$______ |
| Use of Equipment and Staff for Graveside
Service ................................................. |
$______ |
| Hearse ................................................................................................................... |
$______ |
| Limousine ............................................................................................................... |
$______ |
| Casket ................................................................................................................... |
$______ |
| Outer Burial Container ............................................................................................ |
$______ |
| Forwarding of Remains to Another
Funeral Home ................................................... |
$______ |
| Receiving Remains from Another Funeral
Home ...................................................... |
$______ |
| Direct Cremation .................................................................................................... |
$______ |
| Immediate Burial .................................................................................................... |
$______ |
CASH ADVANCE ITEMS
We charge you for our services in obtaining:
[specify relevant cash advance items].
| Cemetery charges .......................................................................................
|
$______ |
| Crematory charges ..................................................................................... |
$______ |
| Flowers ......................................................................................................
|
$______ |
| Obituary notice ........................................................................................... |
$______ |
| Death certificate ..........................................................................................
|
$______ |
| Music ......................................................................................................... |
$______ |
| Total Cash Advance Items ...........................................................................
|
$______ |
| TOTAL COST OF ARRANGEMENT |
|
| (including all services, merchandise,
and cash advance items) .................................... |
$______ |
If any legal, cemetery, or crematory requirement
has required the purchase of any of the items listed above, we will explain
the requirement below:
__________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Reason for Embalming: ___________________________________________________________________________
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