Brown Sr., Jasper
INST # 98-336144
OCT 20, 1998 5:19PM
I
PINELLAS COUNTY FLA.
OFF.REC.BK 10275 PG 2651
CEMETERY DEED
I/)TH
THIS INDENTURE made this ~ day of .. ~9~>>~.QatVl(~ the City
of Clearwater, Florida, a municipal corporation as Grantor .' ';; -1", '!'.~ whose
mailing address is 11875-129th Terrace North, Larao, FL County of Pinellas, State of Florida,
as Grantee:
WITNESSETH: That the said Grantor, for and in consideration of the sum of $500.00, to it in hand paid by the said Grantee,
the receipt whereof is hereby acknowledged, has remised, released and quit-claimed unto the said Grantee, and their heirs
forever, all the right, title and interest, which the said Grantor has in and to the following described parcel of land, lying and
being in Pinellas County, State of Florida, to wit: SPACE one (1), LOT five hundred eiahteen (518), BLOCK
fourteen (14), Clearwater Cemetery, as recorded in Plat Book 60, Page 30, Public Records of Pinellas County, Florida.
This conveyance is subject to the condition that Grantee herein shall not assign or convey said property without the written
consent of the Grantor, and to the further condition that said property shall be used only for cemetery purposes as human burial
sites and is subject to such other rules and regulations the City of Clearwater may adopt pertaining to use of said property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said Grantee and their heirs and
assigns forever.
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor-Commissioner, by
its City Manager, and to be attested and its corporate seal affixed by he City Clerk on the day and year first above written.
Attest:
Susan Stephenson, DeplJt City Clerk
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared Rita Garvey, the Mayor-Commissiorler of the City of Clearwater, Florida, to
me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be her free
act and deed for the use and purposes herein set forth.
WITNESS my hand and official seal this I Z'ft"day of
(]tct
,1998. (! 6f.~
~ BRrNttJotary Public
'( f>. CAROLYN L ·
Print/type name: ~ 1I6' "~~.'" if CC 463040
STATE OF FLORIDA ) :2 "E)\PIR~S!M\Y22,1
COUNTY OF PINELLAS) ~Of 't\./ ATU..ni:o~g~~='bo..INC'
Before me, the undersigned, personally appeared Michael J. Roberto. the City Manager of the City of Clearwater, Florida, to
me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be his free .
act and deed for the use and purposes herein set forth.
WITNESS my hand and official seal this I J.. ~ay of @e;;t
(SEAl)
,1998.
11 Il~D~ ~ JJ Li'J . A
ACCT I.I)()() 0 ~ 7 ~
~ Notary Public
- ~'( PIJ. CAROLYN L. BRiNK
REC . . Print/type name: tX~ C"U'AI~~'n...." r.r. 4R~
FEES? ~~ ~ EXPIRES MAV 22, 1999
~ . BONDeD lHRU
MTF Of ,W- ATLANTlC BONOINB co., INC.
PTG
PIC
DOC 3.50
INT
DEED. DOC TO"fAL q.5 1")~
RETURN TO: City Clerk Department
P. O. Box 4748, Clearwater, FL 33758
Approved ~s..toJon:n and legal sufficiency:
~=.~~ . --~ ..-~
John Carassas, Assistant City Attorney
9700-0026
Rev. 7/97
....
."
..
FUNERAL ARRANGEMENT WORKSHEET
NO.
IJbrt4.lv;", AGE!f5:
lasl
HOUR ~:J3
NAME
,M,~!,
--r~
"
I1tw r
(J t-l- Gt Iff
DATE OF DEATH
Arrangement Appointment-Day & lime:
OAt F.H. 0 At Residence (Address):
Informant Interviewed by:
I
City-Town
City-Town
Specify:
Apparent Cause of Death
Other Circumstances
County..p J?
o None
Length of Illness
o DOA
Certifier of Death Certificate
Certifier's Address
Sex: 0 M
BIRTHPLACE
Citizen: ~
DATE OF BIRTH
Father's Name
His Birthplace
Date & Place of Marriage
EMPLOYMENT STATUS: 0 Retired (Year
o Presently Employed 0 Not Employed
Kind of Business
Employer
Social Security No.
No. of Years
-
VETERAN:
~ 0 Yes Branch of Service
Rank
Service Dates
Honors--Commendations
to
Service No.
Informant's Address
INFORMANT'S NAME
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Cfw. F~ -"'.51
Informant's Phone