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Name
Block No. Residence
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Certificate No.
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_ Date Sold
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AGE DATE OF DEATH
?!A:& Cr BdA:B Sex Color CAUSE OF DEATH
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Lot No,
Amt. Paid, $
Decd Recorded Book
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- Date- -
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Block No.
Name
Residence
Certificate No.
Date Sold
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Lot No,
Block No,
Lot No.
Name
Residence
Amt. Paid, S
Certificate No,
Deed Recorded Bonk page Amt. Paid, g
Date Sold
._ Date Deed Itecorded Boo!; Page
Transferred to
Date
Y DATE OF INTERMENT PLACE OF INTERMENT - - - ---
Grave Name of Undertaker
No. Permit No. Grave Fee ,Coroner,
Ynr MoaW Day Block ict or Physician Neare.;t Relative er Ft
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REMARKS
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