Warden, Eloise T
April 4, 1995
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS )
WE, the undersigned, do hereby attest that we are the decendants, sole survivors and heirs of
Sally D, Trott, deceased, who is the owner of cemetery property described as Block 7, Lot 139 and is
buried in Block 7, Lot 139, Space 2, in the Clearwater Municipal Cemetery.
WE, the undersigned, wish to confirm our authorization to place the cremated remains of Eloise
T. Warden in Space 1, Lot 139, Block 7, in the City of Clearwater Municipal Cemetery.
I, Ruth Koontz, the undersigned relinquish any right, title, and interest in and to Space 4, Lot
139, Block 7 and inform the cemetery to reserve that space for the interment of Matilda (Brancy) lIrott,
a U, S. Veteran upon her death.
______,_ WE, furtber agreemJ:clease,indemnify...ancLhold4beCity- of Clearwat0FcftaHBless-frem+iabiHty-
in the event of any claim arising from the use of the above described property for either interment.
SIGNATURE
Yh~~:J~
Matilda (Brancy) Trott
1433 S. Belcher, Apartment E4, Clearwater, FL 34624
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Ruth Koontz '
Address, City, State, Zip :3 D ~u..r n e. v {;f If;o 'f'7lJ ?
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WITNESSES: I
SIGNATURES RELATIONSIDP
..~.~ ~~ e'tr\?\c,--\.ee..
Name: "Ten.('\(\e. <c..a...-\-of\
Address: 84 \0. {"();:)c:irid Ave..
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ddress .s,~ 'a-'IR ~ /7 ~
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The fe.\egoing ~strument was acknowledged before me this .J..L:. day of~I" /
~ -\:~ O:~ 1~~ (11 J- ' who produced identification ~ the
( (LVI IJIAlI'\ ta VIA E' \ and who did/did not take an oath.
, 1995', by
form of
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(SEAL)
Notary Pub ic,s-',c.,.,
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BOil ~,~"'-~.f i~,t:~:f r,J~:i~,v f i~ 0
r\;c'~ary IJui:dicJ St'ai-e oJ Florida
My COi:lm, cxp;res June 17 1996
Corum No, CC208984
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My commisslO