HomeMy WebLinkAboutCemysmBK#3-pg111' RECORD OF INTERMEN
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` AGE Social DATE OF DEATH
No. of SEX Stale Year Month Day
NAME PLACE OF BIRTH LAST RESIDENCE yean Mootlu ,Dap
Interment I i
en
699'a;�'
7000 Gr�11� Q
-700
7 0
CAUSE OF DEATH
DATE OF INTERMENT PLACE OF INTERMENT
Permlt
1 Year Month Day Seellon Lot
CITY OF CALDWELL, IDAHO
LOCATION CRAVE FEE
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v
t�?S 00
Z5�s U J
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t;?& 00
A,
NAME OF UNDERTAKER
NEAREST RELATIVE OR FRIEND
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R E It A R K 3
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