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RECORD OF INTERMENTS
Age Date of Denth _
j _ SEX Soclal CAUSE 0
No. of NAME PLACE OF DIRTD LAST RESIDENCE State P DEATH
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Date of Interment Place of Interment
Permll. LOCATION CRAVE PEE NAME OF UNDERTAKER NEAREST RELATIVE OR FRIEND RZKARI g
Year Month Dal section I Lot i
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