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Lot No.
Block No.
Name
Residence
Amt. Paid, $
Certificate No.
Deed Recorded Book
Date Sold
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Date
Page
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Block No.
Name
Name
Name
Residence
Residence
Amt. Paid, $
Residence
Amt. Paid,$
Certificate No.
Amt. Paid, $
Certificate No.
Deed Recorded Book
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Certificate
Deed Recorded Book Page
Date Sold
Deed Recorded Book Page
Date Sold
Pam
Date Sold
Date
Date
Transferred to
Date
Transferred to
Transferred to
PLACE OF DIRTH PLACE OF DEATH
Na or NAME of DECEDENT
Interment
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DATE OF DEATH PLACE OF INTERMENT Gran Permit Cnre None of Undertaker. Coroner, Nearest Relative or Friend IIENARES
AGE �--- CAUSE OF DEATH DATE OF INTERMENT No. No. Fee or Phralclan
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