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Name
Residence
port. paid, $
Certificate No.
Deed Recorded Book
Date Sold
Date
Transferred to
Page
Block No•
Nntne
Residence
Certificate NO'
Date Sold
Transferred to
Lot No.
Amt. Paid, $
Deed Recorded Book
Date
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Nam°
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certificate No.
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Transferred to
1
Lot No.
1
Amt. Paid, $
Deed Recorded Book
Date
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Date
Grcre Name of Undertaker. Coroner, Nearest Relative or Friend REMARKS
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