Ruth Darby Paine
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AFFIDAVIT
October 2, 1996
STATE OF FLORIDA
COUNlY OF PINELLAS
I, the undersigned, do hereby attest that I am the descendant, sole survivor and heir of JOEL
BYRON PAINE, deceased, and HENRIETTA DARBY PAINE, deceased, who are buried in
block five (5), lot nine (9), spaces one and two respectively, in CleaIWater Cemetery. As heir to
the interest and/or control in the remaining space, space three (3) of block five (5), lot nine (9), I
authorize the interment of my aunt, Ruth Darby Paine, (daughter of Joel and Henrietta Paine) in
block five (5), lot nine (9), space three (3).
I, further agree to release, indemnity and hold the City of CleaIWater harmless from liability in the
event of my claim arising from the use of the above descnoed property for the interment of Ruth
Darby Paine.
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29 Jersey Street
San Francisco, CA 94114
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WITNESSES:
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Sworn to and subscnoed before be this second day of October, 1996 by Cynthia Baron (niece)
who has made herself known to me by :J;r. t....-l CL--IW~. (Identification)
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