Cormier, Steven Patrick
May 4, 1998
AFFIDAVIT
STATE OF FLORIDA )
COUNTY OF PINELLAS )
WE, the undersigned, do hereby attest that we are the record owners of Space(s) Two and Three (2,3),
Lot Fifty-two (52), Block Sixteen (16) located in the City of Clearwater Municipal Cemetery.
WE, grant right of interment to Baby Girl Cormier, deceased, at the head of space two (2)
and make known our desire that Right of Interment in that same space, space Two (2), be granted to our son and
the father of Baby Girl Cormier, Steven Patrick Cormier.
WE, also make known our desire that Right ofInterment in space three (3), be granted to Donna Cormier,
the-Wife of Steven I'citTIckl;ornueraiiifthenlollier- of Ba6y GiirCotlriier.u ..-- ---
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.
~m.v
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( ) Lois Cormier.
(:9
625 McLennan Street
625 McLennan Street
Clearwater, FL 33756
WITNESSES:
Clearwater, FL 33756
SIGNATURE & ADDRESS
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PRINTED NAME & RELATIONSHIP
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/' SWORN TO and subscribed before me this day of ,1998 by
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(SEAL)
Notary
My commission expires: