Williams, Christiner N
R xn v i;D
fir R
CITY CLERK DEPT.
April 7, 1995
City of Clearwater
P. O. Box 4748
Clearwater, FL 34618
Attention: Camille Motley
RE: Estate of Catherine Rousseau
Clearwater Cemetery Space B,
Block 15, Lot 17
Dear Ms. Motley:
Please find enclosed copy of Letters of Administration,
filed September 16, 1994 in the Circuit Court for Pinellas
County, in which I was appointed Personal Representative for the
above referenced Estate of Catherine Rousseau. Also enclosed
is certified copy of the death certificate for Mrs. Rousseau.
At this time, I request that the right of interment for
the cemetery lot noted above be assigned to my sister and
myself, to wit:
Catherine Owens
1479 Franklin Street
Clearwater, FL 34615
Christine Williams
641 San Salvador Dr.
Dunedin, FL 34698
Thank you for your attention to this matter. Please let
me know if further information or documentation is required.
Very truly yours,
Catherine J. O ens
Personal Representative for
the Estate of Catherine Rousseau
r
IN THE CIRCUIT COURT FOR PINELLAS COUNTY, FLORIDA
IN RE: ESTATE OF
PROBATE DIVISIQN,r?
File Number ``??
Division
CATHERINE C. ROUSSEAU,
Deceased.
LETTERS OF ADMINISTRATION
c
v?
1 ?-sn
(Single Personal Representative)
w
TO ALL WHOM IT MAY CONCERN:
WHEREAS, CATHERINE C. ROUSSEAU, a resident of 1605 Pike
Street, Clearwater, Florida 34616, died on April 15, 1994,
owning assets in the State of Florida, and
WHEREAS, CATHERINE OWENS has been appointed Personal
Representative of the estate of the decedent and has performed
all acts prerequisite to issuance of Letters of Administration
in the estate,
NOW, THEREFORE, I, the undersigned Circuit Judge, declare
CATHERINE OWENS to be duly qualified under the laws of the State
of Florida to act as Personal Representative of the estate of
CATHERINE C. ROUSSEAU, deceased, with full power to administer
the estate according to law; to ask, demand, sue for, recover
and receive the property, of the decedent; to pay the debts of
_ :.
ffrf :..
-the decedent as 'far as the assets of. -the.,. estate will permit and
the law directs-`? fVV b make distribut4ion of the estate
according t? ?:'.•
' WITN ,hip- end 'a?heseal'. of this court this
day of 1994.
.
lj '••• ?' I JUDGE
?e
ac
9a.
NO;
1k I
1oa.
X Burial ? Cremation (I Removal from State
? Donation El Other (Spacrly)
2ta SIGNATURE OF FUNERAL
PERSON ACTING SUCHSERVICE LICENSEE OR
n 1K)
24. NAME AND
inellas
9" -loan hams)
t?Pecay mry nrp/waf prsds canpafsdj
N1??ry Ca4q p.1a5r1
n Sumsme)
»r. Cn)a own, SIa.. Zlp T Cd)
ids 34616
Oc. LOCATION - City a Town, Slats
Moss Feaster Funeral Home
802 N. Fort Harrison Ave., Clwtr., Fl. 34615
230. On Ine basis :. eaamination andbr investigation, in my opinion tlsam occurred al
2 the lime, is and p18W aM Ous to Ine Cause(s) and manner as stated.
6 (Slgnafure and Title) ?
i 23b DATE SIGNED__ Day,. »1 23C. HOUR OF DEATH
26. MRt 1. Enter tfrdtliseaap, injuries, or comps eons met caused Ine deem
or Man fail ure
'not
Li
t
? w
dl
/??
.
.
s
e r onl he mope of d i
only one reuse on each line.
y ng, b U'eh a9 Cardiac M mplrally ar at. ]hock. "
App palmate mteryal
- IMMEDIATE CAUSE (Final Bet
)
wnsn Onset and
Olasase or wndawn ?
neuainq in death) '41
- DUE OF):
- 10 (ORASA CONSEQUENCE
'SsaWmlally hY CpMmons
.
If ary, kadutp to ERLYING o -
000as. Enbr UNDERLYING (
-
E
Gl1S (Dib7 w injury DUE
70 (DR.
$ A CONSEQUENCE OF):
tn
i
a Inilwl,w evema
rearltRtg in deem) LAST. :. c
)
DUE TO ASA 5 ENCE OF):
e: Staph _aurel?gin "eclon-
(
PART If. otheslgmfic0m Cores twru rnnhlbuting to death but not resunulg in the 278, WAS AN AUTOPSY - r a uma t i C
underlying Cauae ti_n in Pan 1 )
PE RFORMED?
Heart 27b. WERE AUTOPSYTO FINDINGS
failure, (16s or No) COMPLETE
CAUUSESDE OF DE
Renal fail
28. REPORTED
TOM EDICAL
DICA
ure
ATH? (yea or No)
29
IF FEM
N
' EXAMI
.
.
ALE. WAS THEREA
O
PREGNANtti• IN THE PAST 30a. IF SURGERY IS MENTIONED IN PART I Of n IN I ER CONDITION FOR WHICH
3 MO
T (/bsor NO)
No
I
WAS PERFORMED
NTHS) O YES X' NO - 30b. DATE OF. SURGERY (Mo. Day, tea. I
11. PROBABLE MANNER OF 32A DATE OF INJURY 320- TIME OF
DEATH RELATED TO (MOnm, Day War) INJURV? INJURY AT wpgKT 32e. DESCRIBE MOW
CONDITIONS IN PggT I
Y
NJ
R I
(
es w No)
U
Y OCCURRED
ABOVE (Specify); Natural,
aCCidem, sulClde, homicide. -
or urldelermInW. M 9
32e. PLACE OF INJURY - N home, farm. J21. LOGTION Suem ene Hamper or Rural Flow. Number,
Natural s rest. IaC10ry, etc ($ppce?.)
City or Town
St
,
are)
T
IS A CERTIFIED TR E D CORRECT OF THE OFFICIAL RECORD ON FILE IN T
HIS OFFICE
1
,
i
f I)?. ISSUED: April 26
1994
,
Chief t*puty Registrar, Pinellas County S
care Registrar
Mal&
'
WARNING , ANY REPRODUCTION OF THIS DOCUMENT IS PROHIBITED BY LAW
DO N
.
OT ACCEPT
UNLESS ON SECURITY PAPER WITH LINES AND
SECURITY WATERM
.
ARK ON BACK
AND COLORED BACKGROUND AND GOLD EMBOSSED GREAT SEAL OF THE STATE OF
4635995 FLORIDA ON FRONT. ALTERATION OR ERASURE VOIDS THIS CERTIFICATION.
)HRS FORM 1SBeA (6-93)
- -- -
OFFICE of VITAL STATISTICS
?- CERTIFIED COPY
1>?r Frl a CERTIFICATE OF DEATH