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Certificate No.
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Amt. Paid, $
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Date Sold Date P Certificate No' Deed Recorded Book
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Certificate No. Amt. Paid, $
Page Date Sold Deed Recorded Book Page
Transferred to Date
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DATE OF INTERhiENT PLACE OF INTERMENT I Nearest Relati" or Friend Na. No. Pea { RMIAMW
Block Lot or Phyalelan
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