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Amt. Paid, $
No.,idence
D^rd Recorded took eate No.
Page
Tz:_. Date Date Sold
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Lot No.
Amt. Paid, $
Deed Recorded Book
Date
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Block No. 2
Name
Residence
Certificate No.
Date Sold
Transferred to
Name of Undertaker, Coroner
or Physician
Lot No. S/
Amt. Paid, $
Deed Recorded Bool;
Date
Nearest Relative or Friend
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