HomeMy WebLinkAboutCemyBook1-name+YOD00856
_ Lot No. _S
Block No.
Name J.
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Awl. Paid, $ 7'
Certificate No. /A �-
Date Sold Recordal Book
Date
Transfc•rrrd to
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Block No. .5 d � Lot No.
Name
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Certificate No. ale Amt Paid, $
Date Sold &7/• -1 l y -� D^e ! Recorded Book /
PLACE OF DEATH Sex Color
Yr Months Days Year Mouth Day
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Block No. ? - Lot No.
Name /mot
Residence
Certificate No. �. AmPaid, $�
Date Sold 9�, Jr3/ p 0 S need Recorded Book l
Transferred to Date
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Block No. j
Lot No. llx�
Name
Residence
Certificate No. j' 3 S-
Amt. Paid, $ % N
Pare / // Date Sold 0 a 3 r i / % D 3 ' Deed Recorded Book r Page
Transferred to Date
CAUSE OF DEATH DATE OF INTERMENT PLACE OF INTERMENT
Grave Permit No. Grave Fee
Year Month DAY Block IA: No.
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Name of Undertaker, Coroner
or Physician
Nearest Relative or Friend
REMARKS
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