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n 5 4 Dlock No. �3 Lot No, Name Residence \ur. g,.e3denea % ,LoG,..eetCertifwte No. q dmt• Paid, b /S\ Date Sold Cerd(tate No y/ Page 9 8 Jr �l��,l D.rl Rrrnrdrd Bonk / Transferred to Date Sold' Date - - I Tunsferrn) to Na. of Iuerrunt t:eeo: ur Di..cUtn: i'Lua OF B;SnI Lot No. dock No• !/ J Lot No, - - - Homo AraL Paid, $ Resident' -- - - _ _ '' fiutte No, Amt. Paid, $ Dced Recorded Book Cat' Sold Deed Recorded Book Date pat' _ I Transferred to - - - Date_. AoE PLACE OF DEATH Sex Color Ynn Nwb- Days DATE OF DEATH Yeu Month Day CAUSE OF DEATH 0 i Block NO. 44 3 Name Lot No. �f Residence Certificate No Page Amt. Paid, $ Date Sold Decd Recorded Bonk Transerred to f Date DAZR OF INTERMENT PLACE Or INTERMENT Grave Permit No. Grave Fee Name of Undertaker, Coroner yeu Month Day Block Lot No. or Physician Nearest Relative or Friend -yam, y I �� / p �i-ef-� . 6'2.-.�..� 'a4. <e j 9 6 / Pf •i+`y ! ! 9_ I�SfNazcc f�Ii 3 X. - - �'3r /� �a- 91� • o, - y m IfZ 4 7 / 9 4.3 v ? a V-4A, � QA .aa; Q. r�t "aid refl� `j3 4 /9.2� /� b3 Io I 7r1' /930 .2 ;. 67 i Iso 1 4'3 rn / C� � �-�.d.�_ _ .. 70 9 /S- /93o ll1l' 'vl)L'ao- �o�d 8� as /Q3/ /0 r 3-17 3 7V so ' a /� _ -_ /O 00 � v ��� �y,.N•,p�./cc-ue�e-fit! / .. /64. _- /O io �.U. ©.4.c%.Qt.ctiYu. %j, �l•�¢.L(Jt� a Page REMARKS