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CemyBk2-pg48
I Lot No. 3 Block No. Lot No. 2 O " 6 % a G Lot No. �/ Name Block No' Block No. NaI'1e Residence Name Amt. Paid, $ Residence Certificate No. Amt. Paid, $ Residence Deed Recorded Book 'SO'pmt. Paid, $ Dnte Sold raR? Certificate Deed Recorded Book Certificate No. Page Date Date Sold Deed Recorded Book Transferred to Date Date Sold Transferred to Date Transferred to o.: a r+,arise. uLoatu. m+.a aus - - - - N.,. of PLACE OF BIRTH NAME of, PF.CFUl:NT Intrrment 6� 69 K 67131 A-Q r�r�y 7z 6 0 0 _ j f DATE OF DEATH AGE Sta Color PLACE OF DEATH '-- Year Montb Day ]'ton Alonlhe Days Page Block No. Lot No. .Fame Residence Certificate No. Amt. Paid, $ Date Sold Deed Recorded Book Transferred to Date. CAUSE OF DE.tDATE OF INTFR]tENT PLACE OF INTERMENT Grave Permit Grave Name of Undertaker, Coroner, Nearest Relative or Friend TIi 7-enr )tooth Day MockLot No. No. Fee or Pkysielan y •s•- .c /qs� 73 �3 / /eS /96a 1 02a ���a ,2567 C38�`/a 35 — (,� Od 73.11 9 -w ��'nru; lyd© 2 i���7z�� oUA-2 Z. �1 2tJ `/ % .2 1y6/ % J 9 6 7 3�a� Y S _G� .r r .� 'Yrt ?,✓ 1j61 1r Zl l ll'/z 3 �' �� ..�,F�v�a ! ��_ . 27 Pa,,^,e RI 'JAR FS 6 n.