Martin, James Harvey Jr & Mary
Department of the
City Clerk
December 8, 1993
Mr. J. H. Martin, Jr.
2383 Netherlands Drive #1
Cleatwater, FL 34623-1808
Dear Mr. Martin:
C I T Y O F C L E A R W A T E R
POST OFFICE BOX 4748
CLEARWATER, FLORIDA 34618-4748
Thank you for providing me with the names of Benjamin G. and Maybelle Coachman's heirs.
I have prepared the affidavit for signature as we discussed in our phone conversation in November.
During that conversation you informed me your intent was to obtain each remaining heir's consent to
grant Right of Interment to James Harvey Martin, Jr. and his wife, Mary Martin in the one (1) remaining
cemetery space, described as Block 3, Lot 13, Space 8. A separate notary portion has been placed with
each signature/witness block. You can forward to each heir in turn with instructions to execute their
portion. Please return the completed affidavit to me.
In addition to the executed affidavit, we will need copies of each heir's birth certificate to show they are
related to the Coachman. We will also need a copy(ies) of marriage certificate(s) where a marriage has
resulted in a name change. This may seem burdensome, but the City must protect the rights of the lot
owners and their heirs. I know you appreciate our position and will comply.
If you have any questions, please call me or my Supervisor, Susan Stephenson, at 462-6684.
Yours very truly,
4
Camille Motley, CRM
Martin t4 M4-
o
"Equal Employment and Affirmative Action Employer'
December,8, 1993
AFFIDAVIT
WE, the undersigned, do hereby attest that we are the decendants, sole survivors and heirs of
Benjamin G. and Maybelle Coachman, deceased, who are buried in Block 3, Lot 13, Space(s) 11 and 12
respectively, in Clearwater Cemetery. We are joint heirs to the one (1) remaining cemetery space,
described as Block 3, Lot 13, Space 8 and wish to grant right of interment in Block 3, Lot 13, Space 8
to James Harvey Martin, Jr. and his wife, Mary Martin.
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 James
H. Martin, Jr. and his wife, Mary Martin.
/ SIGNATURE
Dean A. Martin,
880 Mandalay Ave. #5-718,
Clearwater, FL 34630-1221
WITNESS
/ WITNESS
STATE OF FLORIDA
COUNTY OF
BEFORE ME, the undersigned, personally appeared Dean A. Martin at
, who executed the foregoing instrument and acknowledged the
execution thereof to be their free act and deed for the use and purposes herein set forth, and who has
produced a as means of identification or is personally known to me.
WITNESS my hand and official seal this day of , 19
Notary Public
Print/type name:
Martin
/ SIGNATURE
Margaret Bulger,
407 Sky Harbor Estates,
Clearwater, FL 34619
/ WITNESS
/ WITNESS
STATE OF FLORIDA )
COUNTY OF )
BEFORE ME, the undersigned, personally appeared Margaret Bulger at
who executed the foregoing instrument and acknowledged the
execution thereof to be their free act and deed for the use and purposes herein set forth, and who has
produced a as means of identification or is personally known to me.
WITNESS my hand and official seal this day of , 19
Notary Public
Print/type name:
/ SIGNATURE
James Pickerill,
570-57t Av West, Box 70,
Bradenton, Fl 34207
/ WITNESS
/ WITNESS
STATE OF FLORIDA )
COUNTY OF )
BEFORE ME, the undersigned, personally appeared James Pickerill at
, who executed the foregoing instrument and acknowledged the
execution thereof to be their free act and deed for the use and purposes herein set forth, and who has
produced a as means of identification or is personally known to me.
WITNESS my hand and official seal this day of , 19
Notary Public
Print/type name:
Martin 2
/ SIGNATURE
Eugene G. Pickerill,
9 Fountain Abbey
Pensacola, FL 32506-4115
/ WITNESS
/ WITNESS
STATE OF FLORIDA )
COUNTY OF )
BEFORE ME, the undersigned, personally appeared Eugene G. Pickerell at
, who executed the foregoing instrument and acknowledged the
execution thereof to be their free act and deed for the use and purposes herein set forth, and who has
produced a as means of identification or is personally known to me.
WITNESS my hand and official seal this day of , 19_.
Notary Public
Print/type name:_
/ SIGNATURE
Jack Pickerill
404 Melville Av
Tampa, FL 33606
/ WITNESS
/ WITNESS
STATE OF FLORIDA )
COUNTY OF )
BEFORE ME, the undersigned, personally appeared Jack Pickerell at ,
who executed the foregoing instrument and acknowledged the execution thereof to be their free
act and deed for the use and purposes herein set forth, and who has produced a
as means of identification or is personally known to me.
WITNESS my hand and official seal this day of , 19_.
Notary Public
Print/type name:
Martin
RECEIVED
DEC 0 8 1993 •
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CITY CLERK DEPT.
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James H Martin Jr
2383 Netherlands Dr Apt 1
( Clearwater FL 34623-1803
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