HomeMy WebLinkAboutCemyBk2-pg46r, M,,aWE"I...ee. u, m.uo oo. - No. of NAME OF DECEDENT
Interment
6335 1�
6 37sti
PLACE OF BIRTH
Block No.
Name
Residence
Certificate NO -
Date Sold
Transferred to
Lot No. 3 1
Amt. Paid, $
Deed Recorded Book
Date
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Noe
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Pt7' Kr Bata gold
�ferred to
Lot No. 07 Z
Amt. Paid, $
Deed Recorded Book
Date
- -- —'---- DATE OF DEATH
- -- - ACE --` ` pATE OF INTERMENT PLACE OF INTERMENT Gnn P
AGE Eoa Color CAUSEOFD?47 Iab Nm
PLACE OF DEATH Year Month Dar Block
Years Months DaYs Tear Month DRY
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Ll ii 6 7 02az s.
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Block No.
Name
Residence
Certificate No.
Date Sold
Transferred to
It Grave Name of Undertaker, Conner,
Fee or PhPiclan
Lot No.
Amt. Paid, $
Deed Recorded Boole
Date
Nearest Relative or Friend
Page
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