Everett, Herbert and Dorothy
f
MAY-04-1998 11:56
CLEARt.FlTER C I TV CLERK
813 562 4086 P. 002/002
AFF1DA VIT
STATE OF FLORIDA )
COUNTY OF PINELLAS )
.. the W1dersigned, do hereby attest thai I am the Executrix 01 the Wall of Ray H. Everett, dec-1IM who
was the record OWDel' of Space ODe, Two. Three 1114 Four (1.2.3.4). Lot Twenty<<YCD (27), Block Fiw (5) located
in the City of Oearwater Municipal Cemdcl)'.
I, g:r&Dt risbt of interment of CfeDlated remains for Huold Preston. ~-', in space four (4)
and make known my desire to be interrecl in that same space.
I. grant right of interment of ~ remains of in spac:c,two (2).
I, grant right of interment of c:r=alecl remains of D in space ODe (1).
I. further agree to rdcaso. iDdemniiY lIDd hold the City of Clearwater barm1es8 from 1iabili1y in the event
of any claim arlsins from the ue of the above descnDed property.
SIGNATURE
. ~cJ-tlllICI L. fNC~
(and )
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WITNESSES:
SIGNATURE" ADDRESS
PRINTED NAME & RELATIONSHIP
SWORN TO and subscribed before me this
G ev-a./ d, N ~ b. fyu-h>>v
hiln8elfknown to me by Dh~ J, ~
'-f day af H-,i. .L 1998 by
personally to me or bas made
. -
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My c:onunission expires:
(SEAL)
TOTl=L P. 1302