Jordan, Linda Kay
From: James J. Klausch To: Camile
Date: 6/19/2000 Time: 9:24:0:-
Page 20f2
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June 13,2000
P,O_ Box 60. Clc;u'Watt'r, Fl.'n7')7
AFFJDA VIT
I1We, Dale Stillwagon and Reta Stillwagon Jordan, are the only remaining grandchildren
of Lucien Stillwagon who is the owner of Block 6, Lot 23, Space 6 in the Clearwater Municipal
Cemetery.
Please take this affidavit as your authorization to inter the cremated remains of Linda
Kay Jordan in Block 6, Lot 23, Space 6 ,
IIW e, further agree to release, indemnify and hold the City of Clearwater harmless. from
liability in the event any claim arising from the use of the above described property for the
interment of Linda Kay Jordan,
SIGNA TURE/
RELA TIONSHIP TO DECEASED
ADDRESS/PIIONE
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b '7 })-- 'f-7Tf! STff.ee T /IJ
5T: fI3TER.~ BUR G; FL. 'JJ1f1
'1;)7 ~3tfr--,1 b31
50/ H!.ll(y/ew /pAJ:)
..IJe:iL.tEjJ/~ ~ 3375/"
1.27- ~1t., 2..5$0
SWORN TO and subscribed before me this 12 Day of June, 2000, by
Dale L. Stillwagon who is personall n to me or has shown proper identification,
II ",nU'I,
lI;,i'.>r:~!~ JAMESJ. KlAUSCH
If:(~-':~ MY COMMISSION' CC 835514
.'~,-,~$f EXPIRES: September 5, 2003
',P,r..w,. . Bonded Thru NotaIy PubUc Underwrirers
SWORN TO and subscribed before me this 12 Day of June, 2000, by
Reta Stillwa n Ji rdan . n y known to me.
<.-$.-'~~"~" JAMES J. KLAUSCH
t:~'Ih.'~ MY COMMISSION # CC 835514
~'~Af EXPIRES: September 5,2003
"~p.f..r..'<(,' Bonded Thru Notary PublIC Und9rwril.."
FAX; (8]3) 562-2022
(Sl,' -+46-2375