Galonska, Geneva
".
JU~-01-1999 13:38
CLEARWATER CITY CLERK
727 562 4086 P.002
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June 1, 1999
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLASI
I, the undersigned, do hereby attest that Geneva Galonska, deceased, was formerly
known as Geneva G. McIntyre, part owner of property described as Block 15, lot
22, Space 4, Clearwater Municipal Cemetery, and do hereby grant Geneva
Galonska burial rights for this space.
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 Geneva Galonska.
a little (next of
Punta Gorda, FL
w~
STATE OF FLORIDA)
COUNTY OF PINElLAS)
BEFORE ME, the undersigned, personally appeared Barbara Little, who executed the
foregoing instrument and acknowledged the execution thereof to be her free act and
deed for the use and purposes herein set forth, and who has produced
as means of identification.
WITNESS my hand and official seal this ~ nd day of ~
, 1999.
~A
Not y ublic ~
"$.':iN:'f~#;:.. Jill H, Wells
e'~'~'a MY COMMISSION # CC809772 EXPIRES
~'~;'Q.: March 26, 2003
"~.9("f.~"" BONDED THRU TROY FAIN INSURANCE, INC
TOTAL P. 002