• under Policy No.
• INSURANCE C O M P A N Y
• on the life of
• for funeral services and merchandise for the deceased in the amount of
• , now deceased,
  $$$
• do hereby set over, assign and transfer unto said Funeral Firm the sum of
• out of the proceeds of said Insurance Policy; and I hereby authorize and direct said Insurance Company to make its check payable to said Funeral Firm for the assigned amount and to pay the remainder of
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