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67
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Block
Name
Residence
Amt. Paid, $
Certificate No.
Deed Recorded Book
Date Sold
Data
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No. of NA31C of DECEDENT
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PLACE OF DIRTD PLACE
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Lot No. ) 06
Block plo. � Block No.
Name Name
Residence Amt. Paid, S Residence
Certificate No' Deed Recorded Book I Certificate No'
Date Sold Date ptBe Date Sold
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—� Sex Color CAUSE OF DEATH
OF DEATH Year Month Dar
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Amt. Paid, $
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Certificate No.
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Deed Recorded Book page
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Deed Recorded Book
Page
DateDate
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Date
DATE OF INTERMENT PLACE OF INTERMENT Grave Permit
No. No.
Year )Tooth
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