Gargano, KimberlyTO: Dena Manis, Moss Feaster
FROM: Susan Stephenson (727/562-4097)
RE: Kimberly Gargano
DATE: July 18, 2002
I am sending the Affidavit to permit the burial of Kimberly Gargano's
remains in the Clearwater Municipal Cemetery. Please have both Mr.
Chisholm and Ms. Blake sign the affidavit in the presence of a notary. Please
return the Affidavit with original signatures to us prior to the interment
which is scheduled for August 3. I will have the space staked after I have
received the signed affidavit. If you have any questions please feel free to
call me.
July 18, 2002
AFFIDAVIT
We, Robert Chisholm and Bonnie Blake, are the grandchildren and sole survivors of
Remmie R. Chisholm who is the owner of Block 5, Lot 20, Space 8 in the Clearwater Municipal
Cemetery.
Please take this affidavit as your authority to inter the remains of Kimberly Gargano
who is the step daughter of Robert Chisholm, in Block 5, Lot 20, Space 8.
We further 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 for the
interment of Kimberly Gargano.
SIGNATURE/
RELATIONSHIP TO DECEASED
ADDRESS/PHONE
Robert Chisholm
Bonnie Blake
SWORN TO and subscribed before me this day of 12002
by who produced identification in the form of
and who did/did not take an oath.
Notary Public
My commission expires:
SWORN TO and subscribed before me this day of ,
2002 by who produced identification in the form of
and who did/did not take an oath.
Notary Public
My commission expires:
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 9
OWNER 2: REMMIE R CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 8
OWNER 2: REMMIE R CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 10
OWNER 2: REMMIE R CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 11
OWNER 2:,REMMIE R CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 12 t/
OWNER 2: REMMIE R CHISHOLM /
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 13 t/
OWNER 2: REMMIE R CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 14
OWNER 2: REMMIE R CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 9
OWNER 1: JOHN B CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 13
OWNER 1: JOHN B CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 12
OWNER 1: JOHN B CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 11
OWNER 1: JOHN B CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 8
OWNER 1: JOHN B CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 14
OWNER 1: JOHN B CHISHOLM
FOUND AS CURRENT OWNER OF BLOCK: 5 LOT: 20 SPACE: 10
OWNER l: JOHN B CHISHOLM
DECEASED NAME: CHARLES R CHISHOLM
BLOCK: 5 LOT: 20 SPACE: 13
BORN: 09 / 24 / 1926 DIED: 06 / 01 / 1979 INTERRED: 06 / 05 / 1979
INTERMENT NOTES:
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DECEASED NAME: J B CHISHOLM
BLOCK: 5 LOT: 20 SPACE: 12
BORN: 11 / 13 / 1920 DIED: 09 / 05 / 1971 INTERRED: 09 / 05 / 1971
INTERMENT NOTES:
DECEASED NAME: JOHN B CHISHOLM
BLOCK: 5 LOT: 20 SPACE: 10
BORN: 08 / 16 / 1887 DIED: 01 / 30 / 1960 INTERRED: 02 / 02 / 1960
INTERMENT NOTES:
DECEASED NAME: REMMIE R CHISHOLM
BLOCK: 5 LOT: 20 SPACE: 11
BORN: 10 / 09 / 1892 DIED: 06 / 28 / 1970 INTERRED: 07 / 01 / 1970
INTERMENT NOTES:
Page 2 of 2