HomeMy WebLinkAboutCemyBook1-name+YOD0190Lot No. -
Lot No. 57
VI
Lot No./
13:wk No. /
Name
i
Rraidence
Cr tlfieAle No.
p .! l:n'onird pock
pate Sold Date
Traaderredto -
PLACE of BIRTH
P.•sgc
Block
Name
Residence
Certificate No.
I hate Sold
Transferred to
PLACS oiD....ATa
ADTt. Paid, $
D:•ed Recorded Book
Page
Date
AGE DATE of DEATB
Se: Color
Yran Mombs Days Year °lo°th Day
fiioc t
RFidence
Certificate No.
pate Sold
p.,ferred to
1
I
Amt. Paid, $
Dced Recorded Book
Date
Page
DATE
OF Brr[HRMENT PLACE OF INTERMENT Grave permit No. Grove Fee
CAUSE OF DEATB 1 No.
Ym Month DAY Block Lot
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to/L
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Block No.
Name Lot No. -e1-
Residence 11�
Certificate No. 3 7 J
Date Sold (� j7�,�VJ - Amt. Paid,
Transferred to /� / 7p /10 need Recorded Bnnk ( Page
Date
Name of Undertaker, Coroner
or Physician
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Cam. U. l./�iClefit•rfa2f/ -
Nearest Relative or Friend
REMARKS
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