Yates, Ruby Jean
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October 15, 1993
AFFlDA VIT
STATE OF TENNESSEE )
COUNTY OF Sumner )
I, the undersigned, Sybil W. Martin,ldo hereby attest that I am the widow of Carley C. Yates,. deceased,
who is buried in the Clearwater Municipal Cemetery in Clearwater, Florida. I grant right of interment to Ruby Jean
Yates' cremated remains in the cemetery property formerly owned by Carley C. Yates described as Block 4, Lot
11, at the foot of Space 4, Clearwater Cemetery which has been reserved for use by me.
1 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 Ruby Jean Yates' cremated
remains.
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Lot Owner Signature! Address
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I'WORN TO AND SUBSCRIBED before me on lbi, SLb day of
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,1992,
My commission expires:
(SEAL)