luma funeral homes · buma-sargeant funeral home 42 congress street milford, massachusetts 01757...
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![Page 1: lUma Funeral Homes · Buma-Sargeant Funeral Home 42 Congress Street Milford, Massachusetts 01757 508-473-5511 INSURANCE PROCEEDS ASSIGNMENT For value received and for the funeral](https://reader033.vdocuments.mx/reader033/viewer/2022042316/5f055b867e708231d41290a9/html5/thumbnails/1.jpg)
lUma Funeral Homes Buma Funeral Home Buma-Sargeant Funeral Home Buma Funeral Home
480 Church Street 42 Congress Street 101 North Main Street Whitinsville, Massachusetts 01588 Milford, Massachusetts 01757 Uxbridge, Massachusetts 01569
508-234-2362 508-473-5511 508-278-2755
INSURANCE PROCEEDS ASSIGNMENT
For value received and for the funeral services and burial or other disposition of the body of
(the insured), I hereby assign and transfer to
, the sum of dollars (Name of Funeral Home)
($ ) or so much thereof as is available from the proceeds of Policy Number
of the
Insurance Co. which is due me as beneficiary, or by reason of some other qualification.
I hereby instruct and authorize the Insurance Co.
to pay over to t̂he sum of dollars
(Name of Funeral Home)
($ ) which payment shall constitute a release and certificate by me for such assigned and paid
proceeds.
(Signed Beneficiary)
STATE OF , COUNTY.
Dated:
Notary Public:
fax: 508-473-0726 www.bumafuneralhome.com