McKenzie, Patricia AliceAFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, Patricia Alice McKenzie, the undersigned, do hereby attest that I'm the
descendant of Alice Lyon McKenzie, my mother, who is buried in Block 14, Lot 571,
Space 4. My father, Bernard Leo McKenzie, is buried in space 3. My mother is the
owner of Spaces 1 through 4 in the Clearwater Municipal Cemetery.
Please take this affidavit as your authority to assign interment rights in Block 14,
Lot 571, space 1 and 2 to myself and my sister, Margaret McKenzie Hanson.
I agree to release, indemnify and hold the City of Clearwater harmless from
liability in the event of any claim arising from the use of the above described property as
stated above.
SIGNATURE
(Name)
ADDRESS/PHONE
day of go//
SWORN TO and subscribed before me this
by h- Pc K.eAz, A who pr
identification in the form of L. OL-1&04-s 1 es.v? and who di /did not
take an oath. 01
ry Public
PATRICIASULLIVAN
M commission Commission # DD 993869
Y a Expires July 10, 2014
U F n?P`? Bonded Thru Troy Fain Insurance 800-385-1019