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Block No. Lot No. 3
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Lot No. (o
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Residence
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Certificate No. / 7✓
Date Sold
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Date
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Block No. <> Lot No.
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Name
Residence ( L
Certificate Noo..7/9- Amt. Paid, y✓O \�
Date Sold r //may- / 7,, 9' / a Deed Recorded Book
Transferred to Date
DATE of INTERMENT PLACE OF INTERMENT
Block Noy Lot No.
Name `I
Residence '�: ; F l et. r e- !-t-e . ?.- .G�le- 4—
Certificate No. �y - Amt. Paid, $
Page G y Date Sold C!'C�Y 2 3 /9 p Dccd Recorded Bno:t /
Transferred to Date
Grave permit No. Grave Fee
Year Month Day Eloek Let No.
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to
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3
7
a
77
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Name of Undertaker, Coroner
or Physician
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Neatest Relative ar Friend
Page .J l
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