HomeMy WebLinkAboutCemyBook1-name+YOD01451w
I
16
7
lot No
Block No,
Nast
g AM Amt. 1'3id, f
� -' D;;11 il:cBrJrJ Book
Pak Sold Date
Tr,ndcrted to
.,<. �� ---- -- ---- -- - -- ----
NANs of DEIDEET PLACE OF Bmu
55 (&dui Co,
r :..x`& rfo. rt.e.E11k,
talk, �QcI..,C 1.
3 3 60 7n C.AVO^AAl"
Lot No. Z
Block Nog.
Nome t
Residence Amt. Paid, g 2
Certificate No. 3 4 3 - - - -
((((�� -29 �9�y need Recorded Book ! f,
Page / / Date Sold dCJ age
Date
Transferred to
Adz
PLACE OF DEATH Sex Color
Years Months On"
DATE OF DEATH
Year Meath Dar
CAUSE OF DEATH
(� 641444�a, �W� 3'6 44 /S'
Id %% u r
J-u L7 ( C � 74 17, w /y/j 8 /z ,y
& qo
Block No✓r Ent No.
Name
Residence
Certificate No. Amt. Paid, $
Date Sold tl:ed Recorded Book
Transferred to Date
Block No. / Er No. ,u
Name
Residence
Certificate No. Amt. Paid, $
Page Date Sold
Doc•I Recorded Bon':
Transferred to Date
DATE OF INTERMENT PLACE OF INTERMENT
Grove Permit No. Grave Fee
You alowh Blo
ck ock 1� No.
/>o z
5—
el
/'y
/>oy
3 _/G
/8
X
28
/ S
3
s
/9i7.
8-13
/8-
/9;z
/
31
/ 9r
-.ty.2q
ii
/L
2
2
73
z
/
78
a
lq7
/
4
/OX/
/
3
70
Name of Undertaker, Coroner
or Physician
6—
7/.
♦o aye
���le��
Nearest Relative or Friend
Z. 211. Gi'L G' _
M
REMARKS
�� GLrv.tL�
2,41.