HomeMy WebLinkAboutCemyBook1-name+YOD0143IRVr (� i
j V j Lot No.
I
t I Block No. 'E
I Lot No. 1 Name
Residence
B:-t; inter
Amt. Paid, $
Certificate No.
r need Recorded Book
F ■ g..;drnM ATt. Paid, 1i /J 6"
Date Sold
:ifxni< �o• —' •. O y I'age /s..b _ _ Date
)
.,I R,cor+l.d Ronk / --- _
Transferred to
, s
pate Date ;"n ;t
yr-
I
NArR O DECRD"T
r.i* Cam.
6//9 5 wvto.1.E/
`J l n 4 � �H.
rt ��`'I � �Vd.�t.►c
39sa I11ttae& 511nJL..
Page
AGE
DATE OF DEATH
-�
i. ACE Or BIRTH Pt.AcF. OF DEATFI
Yea"
Mm:6.
WYs
Sex
Color
Yor Dfooth
Day
CAUSE OF DEATH
Cau eFA J"10 t ..
31
/6
7
7Y
W
Ift
[�.t
-
rn
• t
191a c3
� 9
��et.>- lunf,,...�
26
..
"
lyao s
IA-a.1 o
i% Ff
;
v.
a
w
/ 9 ¢ b-. ;L
.2 .
0
Block No. �•
Name
Residence
Certificate No.
Date Sold
Transferred to
AmL Paid, $
Deed Recorded Book
Date
Block No. 16 /J Lot No. i —
Name
Residence
Certificate No, •2 u3 — Amt. Paid, $ /J o,o
Date Sold A
!�/3 /y^/ 2 Deed Recorded Book /
Transferred W--4- Date
DATE OF INTERMENT
PLACE Or INTERMENT
Grave
o.
permit No.
Grave Fee
- - - - - - -
Name of Undertaker, Coronet
or Ph Nearest Relative or Friend REMARKS
Physician
Ynr Tfemh WY
Hloek I.ot
14
0
y°
l 2 o
4/
/
t
s w
-r
yap
s
16
3
a
sy
�a
/T*S'
a
T.
/ 6
q
-
/ o o-a
6P_ . V@aA44L
1