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
Should be Empty: