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Lot No. 7 /
Block No. (p t0
Name
Residence
Amt. Paid, $
Certificate No.
Recorded Book
Date Sold
Deed
Date
Transferred to
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of PLACE OF DIRT"
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NAME OF DECEDENT
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Page
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Lot No. 9 {
Black No.
Nance
Residenco
Amt. Paid, $
Certificate No.
Deed Recorded Book
Date Sold
Date
'transferred to
GG
dock
SO
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Certifi
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Lot No. 50�
Amt. Paid, $
Deed Recorded Book
Date
Page
Block No.
Lot No.
Name
Residence
Certificate No.
Amt. Paid, $
Date Sold
Deed Recorded Book Page
Transferred to
Date
- J•_-- _ - _ - -- _ _ _ - - N N r Name _ - _. __ - - _ Nearest Relative or Friend REMARKS
- DATE OF DEATH F iNTEREIENT PLACE OF INTERMENT Grace Permit Grove of Undertaker, Conner,
AGE Sex Color CAUSE OF DEATiI o. o. ea or Physician,
PLACE. OF DEATH Year Month Day Kenth Day Block Lot
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