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Certificate No.
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Amt. Paid, $
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Certificate No,
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Certificate No•
Deed Recorded Book
Date Sold
Date
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Name
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Certificate No,
Date Sold
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Amt, Paid, $
Deed Recorded Book
Date
Page
'ip6ACE OF INTERMENT Grove Permit Grave Name of Undertaker. Coroner,
E i DATE OF INTERMENT Nearest Relative or Friend REMARKS
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