Ferrell, Josephine
,.'
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, the undersigned, Sally Simino, owner of Space 1, Lot 49, Block 15, and daughter of
Severino and Filomena Meo do hereby Grant Right of Interment to:
Josephine Ferrell, in Space 1, Lot 49, Block 15 m Clearwater Municipal
Cemetery .
I 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 for the
interment of Josephine Ferrell.
~Z0
(Address)
/~ ro q C?ttS TL~ WC90DS DtC-.
~l-~O\-te-w o.+~~ Fl. .3 3 70C; -:::-d--
The foregoing instrument was acknowledged before me th~. of dtfj.. 2001,
by Sally Simino, who produced identification in _the form ofJJ), ^/131: ~ and
who did/did not take an oath.
(SEAL)
M ".. I . ssion e~~~hllng
y f*: :*~ MY COMMf~f6N # CC849381 EXPIRES
~. .". September 30, 2003
.WJ!'.....,;.,~! BONDEDTHRU TROY FAlN INSURANCE INC
"'"9r,,fi'.'"