HomeMy WebLinkAboutCemyBook1-name+YOD0114Name
j.
C.r:ifrate No..7 / / 9/.6 0. • •1 }irrordai Back /
old It Date
to
F�ri�47
�'�•- c! NAYR u➢ Ihc[➢ENT
Page / 3 /
Lot No. (,
Block NO- %
/�""'" ✓ Block No. %
Name ` � Lot No. �—•
r/__ it / Name mzto- Q,(7 Block No. %r Lot No. O
Residence �{/� Amt. Paid, $ 2S ��
Residence Name
Certificate No,
/.
Residence 4 Nlo le ! i Drcd Recorded Book / 1'a / Certificate No. � Amt. Paid,
ld�/lr' `✓r Page 9�
Hate � Date � 7 '�' Date Sold /'�� � /% /9/3 $25 Certificate No. Z 8�. Amt. Paid,
Transferred to -.- - - ""/'"''"` Deed Recorded Book / Page 9�p
To Date said G+L J1 y / Deed Recorded Book / Pa
t, Transferred to Date / v Page 1 t -
t Transferred to Date
AGE
Yucs or ii:Ar1 PLAQ+oF DEATH Sex Color
Y'.' [Y.e'b myt
DATE OF DEATfr
year Month Day
CAGES OF DEATa
•'d
e
DATE OF INTERMENT PLACE OF INTERMENT
year Month MY Block Lot
f
a v t% (�' �. r.�..-( •: tI ; 11rr�' « ,.i/: a�/r
j ,• ,:, '/,'r(i.[. �(J•p ..A.
e'Aef .ca c.V0 t" /%/�/ Z-- _/_f%1G7ZGClirs.,ry[..�r_•(tCo. ,
44 ;2' /y
�,.w1G GtiRa•Yvar. �4r �Z�v�ra•ruct _ / 9/ 3 /f /
,yid �u44n.�a.
�17 Vtann�. rrwj� ,S l� 16cABJ0 9do 3C v 7 M?
i /o #,W . sApa . ilk, w4wa Jdat. �s /o1)4 � w /y�r /6 r' 19-�1 4 ► 7
r
h4aAAAe& w hl...t:u-1 "a,�) ,� .,. z 6 .. /9zq 9 -�Y /9z it.9 �.3
/4o7.dTwtL , 73 G /9 �• /9J7 a do _ P /q-27 a 2�
rz7 7Y1 ./ 4 a a 3 16-79 � / q 3 d 3 I r
2 6
�� �; � :,��,� �f �Q.�/a.1e.f, �E�°a.�o � � � � ,t •, / y�S� y lr �1>�"��t. _ � /y<�� � �
�f� , , ; , jYit�.ao..v �C•lu.,�f. �< � �•�• — — � (,U . / 99� 6 .Z 9 �.ubeua.s.,e.q C?/�.L.Ay. �', /,a b' % 1
67 -2y C�.i �.s [.err c. S dt e'� / 9 3 9
? � " 3 b 3 V %1W".11.�.t»., JA�„•/fi %�. C�•�u .Yc�,,ey 9 0
ya7�. :`it 2 2-7 ial W l9Of �d1.'teu /9'g34 6 1 2
Glh�- UA.<.Q./ wrwe l//'' dC, e %� yt lei p - n n 7( h 2 7 .� W 1 Y S` l 2 /. Cc-} a �e.� J/v " Ja Q ew / 94 5 07 y
H 313 RC�e/v VC k / IR.tr a,�s �.230 �t s e o /0 771 W / 96 .'
J42 /Y. fcV l3 r e a tC /9¢G D' /S
' ��-�`l�_-r�'.a
6.6 ? 4 w /9y7auk tae"/9g7
-y r /z
tl
71/ JJ 23
C.
7
Grave Permit No. Grave Fee
No.
9 S 1 Ff
7 ? /D
9 y y0
s' J�
q to �S _
9 a'
4. 6 . / 73
7 ;5' /a/
9 7�- ��ar
Ct 7 /(
9 �rls,t
Name of Undertaker, Coroner
or Physician Nearest Relative or Friend
REMARKS
.� So LY• r—r,.pc...�i ��._� .(L'�i 'CcllG� Y
00
/ o 00 �o. v V.E l.iQ G[ G.v✓t/
is WC
/ o � p.�c_.e�i�.t_c.t�.,✓ �/,� yam,
/ a a--Cj �_e e�.�Lc�-t t a V - �/ / /` [ [.tA-ZL/
/o IA., l"_w,a s, [ wAAA�
o 4.0
I s (Y
L)'
3t - Ce) _ a ,