HomeMy WebLinkAboutCemysmBK#3-pg150[lire" eeleiree. "InfuL. Man tine
No. of
Interment NAME
RECORD OF INTERMENTS
AGE Social DATE OF DEATH
SEX PLACE OF BIRTH LAST RESIDENCE State
Yea" blonths Days Year Month Day
-f7l! / 16,
a t I l .770 ?z/ �qj
I
sae 'If jL
r
-act — - ,fir/
a 78ILI
?L/ /yes 1, z 9-
j o -7v
q- ! ._.
CAUSE OF DEATH
CITY OF CALDWELL, IDAHO
DATE OF INTERMENT PLACE OF INTERMENT
Permit LOCATION GRAVE FEE
Year blonth
Day
Section
Lot
61,7
19.E
l r`s1
z
''2�
2-2-1
2
r
/z
Ivy
16
cc9�
z I �
6�
� y
��L
NAME OF UNDERTAKER
^� J_ G G 64�� 1��
oc
oy / / --1/
5� 6j
S G° �f
,11 5 - Dd t i
x% A
5 ' < <
I
NEAREST RELATIVE OR FRIEND It E 31 A R K S
I
9 ' "
f MWA
W/4
-j/ I
///y
�' r