HomeMy WebLinkAboutCemyBook1-name+YOD00560
�t
d
Muck No. 3 Lot No. /
Name
Amt. Paid,
Crrlil:c �tt(. No. �,-j
D.ed ltccirded Book
1)..v Fold . '-1s..> d, / D�
Date
'l'rcn:.ATied to
No. of NAME OF DECEDENT PUCK Or BtETa
Interment
Lot No.
Block No. ,i a
Name �/ l�t�_ti� �✓"c9
Residence
/ Amt. Paid, $ D
Certificate N
�� //, Deed Recorded Book
Page /� p Date Sold �r/y
Date / Pam
Transferred to
AGE
PLACE of DEATH Sea Color
Mean Mouths Dsyr
DATE OF DEATH
Year Month Day
I
Block No. , j Lot No.
Name f'
Residence
Certificate NCo�_ �� �!C Amt. Paid,
Dato Sold f%V Uced Recorded Book1 /
Transferred to Date
CAUSE OF DEATH f
Block No, 3 I.ot No. 51
Name, t 2hi �fr p—c eL¢d
Residence 2�ZoC-i.�^
c�
Certificate No.
6 Amt. Paid,
Page /� Date Sold q0e. ///� / % 4'/ J Fred Recorded Bnnk /
Transferred to Date
DATE OF INTERMENT PLACE of INTERMENT
Grave permit No. Grave Fee Name of Undertaker, Coroner
Year Month Day Stock Lt No. or Physician
- -' q1 - %•
/a`O %Ire//119c- 1Ld� % •:?�`. � HQ�,� !�/% - Y � /9p7 � :lG- i9.ej 0 �8
e r
/to- -:? c �, ' It�1lrL 1 �/�e J7 <! ( /9v7 7 2 /'�yr�<i.� LAG /'o/_. 7
r;[ "
7I ,9 o . 7
7
Sc L . a e4Qct�r.efR 9da (o G /2 79is� lO �J IFIV (o'•. 3
,fzy i. �t.7n.
-LIZ 9 6�W)As
.29peo C�- GY lI 23 7yj W /Y37 j / @aet.�r.,ra,,,q G�ymat ' - .1937 7 1
&9(7 a r✓r Oeu 61 16 /fit -jj W 10V 2
✓ 743 ' 71
t
w
I
3 µ
0'R-C46 .i' &'e.
3
'f
/off
/o_ pu
7
7
/p•— Jp [c e[
Nearest Relative or Friend
d
� ���OL-
/ram
e.
REMARKS
51;