HomeMy WebLinkAboutCemyBk2-pg8Block No.
Name
Residence
Certificate No.
Date Sold
Transferred to
Lot No.
Amt. Paid, $
Deed Recorded Book
Date
C1nC11 eFIMTFFe. G1CCfFt1. l0\MO e.CFI- No, of NAME OF DECEDENT PLACE OF BIRTH
Interment
Page
/ /
Lot No. 6
Lot No. o27
Block No.
Block No. � i�
'je Klock No•
Name
Name
Name
Residence
Residence
Amt. Paid, $_ _ -
Residence
No.
Amt. Paid, S
Certificate No.
Certificate No.
-
Deed Recorded Book
Certificate
Deed Recorded Book Page
Date Sold
Pa$e
� pato Sold
Date Sold
Date
to
Date
Transferred to
Transferred to
Tra"ferred
PLACE OF DEATH
'Ti
Lot No.
Amt. Paid, $ -
Deed Recorded Book
Date
DATE OF INTERMENT PLACE OF INTERMENT Grave Permit Grave Name of Undertaker, Coroner, Nearest Relative or Friand
Block Lot No, No, Fee or Physician
�— Year Month Day I year Wonlh Day
Year, Months Days
�r
MR,�awN �
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W AL y
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Fr
. r r �. 1
.2 w y 3
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6.3. o
1,;2 .3
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27
79. �s�� G
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f3 r / w / Qs7 /,6 �� l 9esJ 3 / 6 6 26 k
6 0 7 �23 � W /y.5� 2 ,2s- c"�`�
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I
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AGS DATE OF DEATH
Sex Color �— CAUSE OF DEATH
Page
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