Butler, Theresa
CEMETERY DEED
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00-031497 rES- 2-20
P I NELLAS CO SK 1 080020 P~ : 1 ~~
111I um 1110 1/11/111/1111111111111111111
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THIS INDENTURE made this :3/ day of
of Clearwater, Florida, a municipal corporatio . as Grantor
mailing address is 808 Palm Bluff St. Clearwater FL 33
Florida, as Grantee:
, 2000, between the City
Theresa Butler , whose
County of Pinellas, State of
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 zero zero (00), LOT seventy-seven (77), 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 theit.:heirs and
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assigns forever. ";c ""
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IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name bX. its' MaYOrf(;9n1"mi~'sioner, by
its City Manager, and to be attested and its corporate seal affixed by t City Clerk on the day ant:LyealOfirstab~~e/llYritten.
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By: / ~~' :.' -:.t~:::i~ 0 ~; " ....~~- \
Micha ~. Roberto, City ,;, ~
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STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared Brian J. Aungst, the Mayor-Commissiemer of the City pf"Clearwater,
Florida, to me well known to be the person who executed the foregoing instrument and acknowl~dged. the .e~c~tion thereof to
be his free act and deed for the use and purposes herein set forth.
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WITNESS my hand and official seal this~ day of ~
Attest:
Susan Stephenson, Deputy~i
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Print/type name:
, 2000.C .
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Notary Public
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STATE OF FLORIDA )
COUNTY OF PINELLAS)
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~' 'fA,. day of ~ , 2000.
PAG~S ~ rt. ,
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L:"=:C ~. liD Notary Public
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Print/type name:
A~ Y and Ic~ufficiency:
John Carassas, Assistant City Attorney
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DEED.DOC' _ r",' . ',\- , --
RETURN TO: City Clerk Department c<-= ',~ ~., ,: ----
P. O. Box 4748, Clearvohitet,' Ft-33768_
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9700.0026
Rev. 7/97
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FUNERAL ARRANGEMENT WORKSHEET
NO. ~+-Je~
NAME <Do II ~~ f<1a~ AGE_
First Middle last
DATE OF DEATH /VI(}~ J1 j Ct V'\. 11, :;"00 0 HOUR
L ,
Arrangement Appointment-Day & Time:
OAt F.H. 0 At Residence (Address):
Informant Interviewed by:
City-Town
Specify:
Apparent Cause of Death
Other Circumstances
County
o None
Length of Illness
o DOA
o ER
Certifier of Death Certificate
Certifier's Address
Citizen: ~
Sex: 0 M
BIRTHPLACE
DATE OF BIRTI-f
His Birthplace
Her Birthplace
Father's Name
J
MARITAL STATUS W ,~,d
Date & Place of Marriage
EMPLOYMENT STATUS: 0 Retired (Year
o Presently Employed 0 Not Employed
Kind of Business
No. of Years
Employer
Social Security No. :J....~-
VETERAN: IIJ...M()" 0 Yes Branch of Service
Rank
Service Dates
Service No.
to
Honors-Commendations
k
tJl
INFORMANT'S NAME
Informant's Address
Informant's Phone t..{