HomeMy WebLinkAboutCemyBook1-name+YOD0302I
T
9
01
Block No. 0 T
Name
Residence
Certificate No,
Date Sold
Transferred to
Lot No. / Z
Amt. Paid, $
Died Recorded Book
Date
Page
C
Lot No. 3 - />!
Illock No•
Lot No.
Block No.
Name
Ijesidence
Narnc
Arltt, Paid, $
Ccrtilicate No.
Amt. Paid, $
Residence
Certificate No.
Deed Recorded Book Pam
Date Sold
Decd Recorded Book
Sold
Date
; Transferred to
Date
Date
Transferred to
DATE OF INTERMENT
DATE OF DEATH y -
AGE C I0 r -- CAUSE OF DEATH
Year Month Day
PLACE OF INTERMENT
— Grave Permit No. Grave Fee
Lot No.
Block
Page
......... E OF DEATH
r.-- — ..ter — --- � Year
Sex 0 Month Day
- ---
No. of PLACE OF BIRTH Wan M
NAME 07 DECEDENT PLACoa:e, Days
Interment o(u�Gtp s-fti-o
71 ;a4e,�4
7# `
t(q�-5
H H 73.0 '� �� 0 1 -"
19�F�S 6 /� oT s
� oT'
tar,P.eo.�.vR uJ l4� a�•
9 /q¢k 7 9 C� -T—
/ H H 9 �- • , Gv.t,P,/r�a.,. ��� .v �a � 7 Yn /,J l9ull � � ��-u^-�-.� w.�.r.�0 • � a
y i�YIDe �a ciPk`"`t ar is ra �n w riN'/ /� �.t �v ea..�t..e /9f�� 3� o T
GtJ / 9f�3 (/JcthJ Ca.�'c-c • �
7�7
�* ��
_ 6
! ' LIJ,i; v:41v: ' �,✓s.,ti- ,, �'o� _ �� __ rut/z�
./9S3 9--27 . -eA+-A,
dy..��i,lof�,�atc fU��ty (qs3
�-� �� �R s�� s 4 OT
7� q �% • %? e.�t eGY,u/ � ' e �a 6' FS l J 7 �M !.0 14 S` q,-
3 W OAAJ
1 ' (7t7 7
z�,�--w l9-G� /z_ � ��
9- �
I'1 � 965
l!�
Block No.
Name
Int No. y .
Residence
Certificalo No.
Amt. Paid, $
Date Sold
Deed Recorded Bonk Page
Transferred to
Date
Name of Undertaker, Coroner Nearest RelatiTe or Friend REMARKS
or Physician
40 J,.
I