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Irrevocable Assignment of Proceeds of Insurance

Irrevocable Assignment of Proceeds of Insurance

  • For and in consideration of the sum of one dollar ($1.00) and for services rendered by HEMPSTEAD FUNERAL HOME/SENKO FUNERAL HOME, Funeral Directors, for and in connection with the burial of
  • I hereby assign, set over and transfer to the said HEMPSTEAD FUNERAL HOME/SENKO FUNERAL HOME, Funeral Directors, the sum of
  • of the proceeds of that certain Policy Number
  • Insurance Company, which may be or is due me from the said company as beneficiary of said policy, or to which I may otherwise be entitled under the terms of said policy. I hereby instruct, authorize and direct said
  • Insurance Company to pay over to said HEMPSTEAD FUNERAL HOME/SENKO FUNERAL HOME the sum of
  • $0.00
  • out of said proceeds upon presentation and release by the said HEMPSTEAD FUNERAL HOME/SENKO FUNERAL HOME of this assignment for the burial of the said
  • and the payment of the said sum of
  • $0.00
  • by the said Insurance Company, which shall be a release and certificate for the said amount so due me out of said proceeds.