Taylor, Marion Ulmer
AFFIDAVIT OF MARION ULMER TAYLOR
STATE OF FLORIDA
COUNTY OF PINELLAS
Marion Ulmer Taylor, being first duly sworn, deposes and says:
1. She is the widow and heir of John S. Taylor.
2. That Block 2, Lot II, of the Clearwater Cemetery was purchased to
serve as a family cemetery for the Taylor,"~f:~~~;, and Campbell families and
their descendants, and that it continues to do so.
3. That the practice has been and continues to be to allow members of
the Taylor, Rogers, and Campbell families and their descendants to be interred
there.
FURTHER THE AFFIANT SAITH NOT.
'~ ~ ~-,/.s~ t /
Marion Ulmer Taylor (~~
Subscribed and sworn to before me this :2r')r.,.! day 01~1994, by Marion
Ulmer Taylor, who is personally known to me or has/have produced
~ as identification.
d.A ~L
Notary Public
Commission No.
..,~,:!-~Oft..... AVA G. MILLER
i:1.tb.~;% MY COMMISSION N CC321197 EXPIRES
~~ ~ :~: November 4, 1997
~~;;'.....i~.: eoNOED THRU TROY FAIN INSURANCE, lNG,
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March 15.1979
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FLORIDA LOC,U NIl NO.
..INI D%CIDENI-.NAME AR" Ml,.t! LAST Agm
BSI-ANSNI I• LEU" EITLGERALD DRM R. Male
. R INK RACE-.... , WA:,.y EIOCII. A.f-L•n a'.. W UNDf! 1 MBAR UN ER 1 AY DAIS Of BIRTH (Y... 0". r..) 0MINIY OF CLAIM
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• i 70 T?• { .•Dea. 11, 190 T.. P12e11
CITY, TOWN OR IOGTION OF DEATH HOEFIIA?OROTHER If4TITUTIOF4-N- (E/... r 64.1. n.f Haan wt ..w?e)
'b. Clearwater Tf.Morton P. Plant Hospital
I B STATE Of BIRTH h( A.1 M. CITREM OF WNf.I COUNTRY MARRIED NEVER MARRIED, RAVIV04 YOUR (1(.11.. 1a..-Id.. a•..I
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teuALRgIOTNc1 ' 1oI da III. USA is-Harried II. Eloise Jones
wHTRE DECfASE6
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LIYIC. E I If DEATH SOOAI SECURITY NUMBER USUAL OCCWAf4N (Qr. iayf.f cars by Mr1y VIVO OP BUSINESS OE INDUSTRY
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INFORMANT-NAM! fT7f. n pW) MAILING ADDRESS PRIM 04 RAP, NO, CITY Olt TOWN STATE 11F
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DATE STONED /Y.., P., YIJ NOUt OF DEATH DATC $14:640 (MF. C.P. TY.1 HOUR OF DEATH
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?p NAME OF AfSCNDINO PHILCTAH 1 Oi2tE! THAN CERTIFIE! /!». a7..+LJ f B PtONOUNCED DE/W (N.» &W. rld PRGNMNCID DUD fN.w1
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NAME AND ADORt71 Of CERTIFIER IFNYNCIAN, MEDICAL OUVAINERI (11111. M M.0
fx. Cha ter, 0 Becker, M.D., 1745 Highland Avenue, Clearwater, Florida 33516
RFGISfRM DAT! RECEIVED BY REGISTRAR (N.•. Div. T.•1
?O1v°v'?' 78s. (8y.l.•.J' L „ March 21, 1979
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JAN-31-9!6...Wr;P 01509 PM MOSS FEASTER BELCHER RD 913 862 2073 P.01
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?r?1(71
MOSS
,7`1111'} -4 ^^ 1?STER
? L HOMES
1'.0. Box 60, Clearwater, 1-% 34617
DAT,C JAN 31, 1996
TO CITY OF CLEARWATER
ATTN CAMILLE
FROM
DAN O'DELL
TOTAL NUMBER OF PAGES 2 (INCLUDING COVER SHEET)
X LETTER SIZE
LEGAL SIZE
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