[Funeral Home Name]

License No.: [License Number]

This receipt serves as an itemized record of the funeral-related expenses incurred by the Client for the services provided by [Funeral Home Name]. Please review the details below:

1. Funeral Services

1.1 Service Type: [Specify the type of service, e.g., Traditional Funeral, Cremation, Memorial Service, etc.]

1.2 Date of Service: [Date of the funeral service]

2. Itemized Expenses

Description Quantity Unit Price Total
Casket (Model/Type) [Quantity] $[Price] $[Total]
Urn (if applicable) [Quantity] $[Price] $[Total]
Embalming and Preparation [Quantity] $[Price] $[Total]
Transportation (Hearse, etc.) [Quantity] $[Price] $[Total]
Other (Specify) [Quantity] $[Price] $[Total]

3. Total Amount

The total amount for the above services and expenses is $[Total Amount].

4. Payment Details

4.1 Payment Method: [Specify how the payment was made, e.g., Cash, Check, Credit Card, etc.]

4.2 Payment Date: [Date of payment]

5. Liability Waiver

5.1 The Client acknowledges that the Provider is not liable for any changes in state laws, regulations, or taxes that may impact the funeral arrangements.

5.2 The Client releases the Provider from any liability arising from unforeseen circumstances, including changes in pricing, availability, or legal requirements.

6. Governing Law

6.1 This receipt shall be governed by the laws of the state of [State Name].

7. Signatures

By signing below, the Client acknowledges that they have received an itemized receipt and agree to its contents.

Client’s Signature: ______________________ Date: ______________________

Provider’s Signature: ______________________ Date: ______________________