Guzior, Lydia
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, the undersigned, Delia Mendez, owner of Space 3, Lot 108, Block 15, do hereby Grant
Right oflnterment to my sister:
Lydia Guzior, in Space 3, Lot 108, Block 15 in Clearwater Municipal Cemetery.
I further agree to release, indemnify and hold the City of Clearwater hannless from liability
in the event of any claim arising from the use of the above described property for the interment of
Lydia Guzior.
SIGNATURE
~~~
(Address) ,f tl ~~~ -<s, f', ~ I 14-<:....,
~ /. -nJ (/.(].P_-
Witness
RELATIONSHIP
~
(AddreS~"'S~ L,/'//nnJ A.e-,J .L"':~d r/ 33?;?y
c-f/Jiitl~7?otr7f/lfar 174 i)-(2 t~~
Witness
(Address) ;.::-'~,t ;1 &k /lJ cl S 1:; C t(~ y /? r2 be , jJ.. /2 - t'J () fJ 609_ 39/;)-
/~1~~ q~~~Q>d)
WItness .
(Address)e:2C2::J #6/9SU5 Avo S. ~ P33/6~
I
Dated: 1',- 8' ~ 0 z.