PHYSICAL DISABILTY ACKNOWLEDGEMENT FORM
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',iHKlEAS, the under signed, TJILLIAI,~ A. 'JOODHUFF,
has made application for employment as a policeman with
the City of Clearw'ater, Pinellas County, Florida; and,
WHEB.EAS, said applicant has a physical disability,
the existence of which he hereby admits and recognizes;
and,
WHK1EAS, such disability is not su::; h as would pro-
h ibit him from performing reasonable duties as a police
officer but should be recognized and made a matter of re-
cord in order that no claim therefor can hereafter be made
by said applicant in connection with said employment;
NOj, THE~EFOlE, in consideration of the premises and
of the future employment by the City of Clearwater of him,
the undersigned hereby recognizes and admits that at this
time he has a physical disability described as:
"Wrist, ankylosis of, right favorable major"
more particularly described in medical reports dated July 5,
1956, from Dr. James L.West, of St. Petersburg, Florida,
and dated January 4,1957, from Dr. Paul F. :lJ'allace, of St.
Petersburg, Florida, which are in the possession of the City
of Clearwater.
In further consideration of said employment, said
applicant hereby releases said City and any pension fund or
insurer maintained or fu,rnished by said employer of and
from any claim now or in the future for said physical dis-
abilit.v and of and from any such claim resultinp: from Oi1
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directly relating to said disability.
IN ~ITNESS ~HEdEOF, said applicant has hereby set
his hand and seal this 7 ~ day
~iitnesses:
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ST ATE OF FLOHIDA
COUNTY OF PINELLAS
Before me, the undersigned authority, personally
appearedVlilliam A. Woodruff, known to me and known to
be the person who signed the above a~d foregoing daiver,
who being duly sworn acknowledged that he si gned the same
for the uses and purposes therein expressed.
:,litness my hand and seal, this 9~ day of August,
1957.
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Notary ublic ._
State of Florida at Large
Notary Public, St.te of r-'~r1d" tt h~rCl~
Mv commission expires Morch ), 19:: 8.
Bonded by I.m~rican Surety Ca. of ("'.' Y.
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fI~~e~~en~~~e~ ~:~R
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TO: City Clerk
FROM: City Attorney
COPIES: City Treasurer, Secretc;ry of Pension Fund, Personnel Director
SUBJECT: William A. 1lfoodruff, Policeman
DATE: 8/13/57
Attached is an executed release from William A. Woodruff
whereby he relieved the City of future obligation concern-
ing certain physical defects which now exist but which do
not impair his ability to serve as a policeman. The Per-
sonnel Director has a copy of this and r<:r. ~'ioodruff has a
copy. The attached copy should be filed among the City re-
cords in the event it should be necessary later to use it
for the City's protection.
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Att.