Koontz, Glenn H and RuthAFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
We, Mary Kay Wells and Barbara Anne Koontz, the undersigned, do hereby attest that
we are the descendants, survivors and heirs of Glenn H. and Ruth T. Koontz, our parents, and
Oliver and Draxie P. Snodgrass, our grandparents, owners of Block 15, Lot 5, Spaces 1-4 in the
Clearwater Municipal Cemetery. Our parents are buried in spaces 1 and 2 (urn burials) and our
grandparents are buried in spaces 3 and 4 (full burials).
Per the City of Clearwater Rules and Restrictions the maximum capacity of a space is
two burials provided at least one person is cremated or two cremated remains.
Please take this affidavit as your authority to note the right to property described above to
us and our spouses.
We authorize the granting of interment rights in Block 15, Lot 5, Spaces 1-4 as follows:
Space 1 = James Franklin Wells (urn)
Space 2 = Mary Kay Wells (um)
Space 3 = Barbara Anne Koontz (urn)
Space 4 = Etta Wadene Brenton (um)
We 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 as stated above.
SIGNATURE/
Mary Kay a Is
ADDRESS /PHONE $5-0 - 3 2 2 - DB-
-2�Q ,..,,y , FL 31.3 09
p-1 2 Fo5sy + Ply
L , FL . 3 343y g/3 -11/S--?7°21
Barbara Anne oontz
f: 13
SWORN TO and subscribed before me this !day of 4n ,20/7 by Mary
Kay Wells who produced identification in the form of a= I. DYI vc'S /kola and who did /0
not take an oath.
BAILEE ANNE BEARDEN
MY COMMISSION M FF 160933
EXPIRES: September 17, 2018
Bonded T ru NNnY Pubac Underwiitsfs
otary Public
�I -/-7- aol$
My commission expires:
SWORN TO and subscribed before me this4Li day ofJWA-it , #0)"1 by Barbara
Anne Koontz who produced identification in the form of and who did /did
not take an oath.
MARII.EX J. RIVERA
NOTARY PUBUC
STATE OF FLORIDA
Comm# FF939742
Expires 11/30/2019
Wit'
Notary Public •
MARILEX J. RIVERA
NOTARY PUBLIC
STATE OF FLORIDA
C:. •ft FF939742
Expir. 11!30/2019
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CEMETERY DEED
THIS INDENTURE, Made this _____~Z~l}_____~ day of ____~_4!P.t..mb~_~___________ A. D" 19J_Ij.___
between the. City of Clearwater, Florida, a municipal corporation created and existing under the laws of the
State of Florida, party of the first part, and __~~_~~~_!!~__15~_~!l.!~__~~__~~_~~_~~C?~~~_L1!~~_~!f e ,
___~!t~~__~_.__K~&.l!~_CID.~_AY~!..L_!t~~.&L_~J__~-P.t..!.__7.-,-_______CAe___:{'ilJ~:t_fn'______________, of the
County of ____R!E.~.!~~I!!___________________, State of ____~J..Q~i.c;J~______, parti.eJl of the second part;
WIT N E SSE T H: That the said party of the first part, for and in consideration of the sum of
$__~_~_~~.!!.~~~~__~_~!~~'!~__~~~~_~.!__~~~_!~_~~Ql__, to it in hand paid by the said part~_~~ of the
second part, the receipt whereof is hereby acknowledged, has, remised, released, and quit-claimed, unto the
said parti.eJl of the second part, and___~e.ir____heirs forever, all the right, title and interest, which the
said party of the first part has in and to the following described parcel of land, lying and being in Pinellas
r'
County, State of Florida to wit: Space __.c.sIL____ Lot ____5._______ Block_-.l.5._______ Clearwater Cemetery,
as recorded in Plat Book___~Q___ Page_~!:~_Q 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
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~ ~>,.Q ~ TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said
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a co", parL__!!_t!_ of the second parL______~__~_______ heirs and assigns forever.
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@ ~ ;:: ~ to be executed in its name by its Mayor Commissioner, by its City Manager, and to be attested and its
~ ,~~
E ~] ~ corporate seal affixed by its City Clerk on this the day and year first above written,
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.- (iJ .......... ........
.;?Z ~ ~ OJ Signed, Sealed and Delivered
~ tS G in the presence of us:
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only for cemetery purposes as human burial sites.
IN WITNESS WHEREOF, said City of Clearwater, a municipal corporation, has caused these presents
CITY OF CLEARWATER, FLORIDA
___~S~__~~~__~_~!!l_~~ll___________________.
By __Lp_l__~~_qQjt_~_~__I~_~Ys1____________
City Manager,
Isl Kathryn C. Green
Countersigned:
181 H. Everett Hougen
Approved as to form and correctness:
Mayor Commissioner,
Attest:
181 R. G. Whitehead
____Ls~_Jie~b~~t__~_~__~~~~p___________.
City Attorney
City Clerk,
State of Florida,
County of Pinellas:
H. Everett Hougen, Picot B. Floyd
Personally appeared before me, __________________________________________________._______________
R. G. Whitehead
and ___________________________________________________________to me well known to be the persons who
executed the foregoing instrument of conveyance in the capacity of Mayor Commissioner, City Manager, City
Clerk respectively, and they severally acknowledged that they executed said instrument in their respective
capacity by and on behalf of and as the free act and deed of the City of Clearwater, Florida, a municipal cor-
poration, for the uses and purposes therein expressed,
Witness my hand and official seal at Clearwater, Florida, this the_____ZIh__________________day of
October 74
____________________A. D, 19______.
(Seal)
-I-s/--K-at-h-Py-n.--G---G-re-en ---- - -.-------- - ------
. Notary Public State of Florida,
My Commission expires___________________