Clark, Frederick F and Thelma KOUIT-CLAIM DEED RAMCO FORM 8 Q.R. 9282 PAGE 1470
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ThtSUlt-Maim deed 8119919
, Executed this 2nd day of December A. D. 1981 , by
Frederick F. Clark and Thelma K. Clark, (deceased)
first party, to CITY OF CLEARWATER, FLORIDA, a municipal corporation
whose postoffice address is P. 0. Box 4748, Clearwater, Florida 33518
second party:
(Wherever used herein the terms "first party" and "second party" shall include singular and plural, heirs, legal
representatives, and assigns of individuals, and the successors and assigns of corporations, wherever the context
so admits or requires.)
_10itnesseth, That the said first party, for and in consideration of the sum of S 2 2 9.5 0
in hand paid by the said second party, the receipt whereof is hereby acknowledged, does hereby remise, re-
lease and quit-claim unto the said second party forever, all the right, title, interest, claim and demand which
the said first party has in and to the following described lot, piece or parcel of land, situate, lying and being
in the County of Pinellas State of Florida , to-wit:
Spaces A and B, Lot
Plat Book 60, Pages
County, Florida
?66, Block 15, Clearwater Cemblteli'y ?-
01 C Jsrl. 1 C;h?
40 P::
3S
29-30, Public Records of Pinellas "!
r;rsa. rl??;fit
CLEhK ?i C tJ1T C ESft
DEC I ? 11 14 W I I
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To -Have and to hold the same together with all and singular the appurtenances thereunto
belonging or in anywise appertaining, and all the estate, right, title, interest, lien, equity and claim uthat-
soever of the said first party, either in law or equity, to the only proper use, benefit and behoof of tite said
." second party forever.
In -ltneSS Uhereof, The said first party has signed and sealed these presents the day and year
first above written.
Signed, sealed and delivered in presence of:
' ..... ........ 1 ----- ------
------------ -
CD
-? -- -----------------------------------------------------------
STATE OF FLORIDA,
COUNTY OF Pinellas
I HEREBY CERTIFY that on this day, before me, an
officer duly authorized in the State aforesaid and in the County aforesaid to take acknowledgments, per«nally apprarrd
Frederick F. Clark
to me known to be the person described in and who executed the foregoing instrument and he ackm?wlydcrd
before me that he executed the same.
WITNESS my hand and official seal in the County and State last aforesaid this 4th, d-1 of
.
Y '.
DCe13eY.' A; 'D: 1ggr. r
i ............ ? .:.... ........ •...
This Instrument prepared by:
f4o:ary lyuktiit„State af-Worida
Andress P. 0. Box 4 748 k I , i.!strument was prepared 6yWy Commission lii;ores July 5, 1985
Clearwater, Fl. 33 518 THOMAS A. BUSTIN, City Attorneyonded Thru Troy Fain - Insurance, Inc.
City- of Clearwater, P. 0. Box 4748
Clearwater, Florida 3.3518
e ., t
349
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740W308
. CEMETERY DEED
u,"_R..4140 mG[1 03
THIS INDENTURE, Made this ---- 6th-------- day of ___ Febru4r_7_____________ A. D., 19_ 74
between the City of Clearwater, Florida, a municipal corporation created and existing under the laws of the
State of Florida, party of the first part, and ___Frederick-F. C 1 ark _ and _The lma _ K . C lark ,_
T(his901S._Greenwood _Av_e.clearwater_-, of the
County of ------ inellas---_-_--____ , State of ___ Florida __, part1es of the second part;
W I T N E S S E T H : That the said party of the first part, for and in consideration of the sum of
s_ Two-hundred seventy_ and_no/100 ($_270)_-, to it in hand paid by the said pard-eS of the
second part, the receipt whereof is hereby acknowledged, has, remised, released, and quit-claimed, unto the
said partiesof the second part, and__tlleir----- heirs forever, all the right, title and interest, which the
said party of the first part has in and to the following described parcel of land, lying and being in Pinellas
y, County, State of Florida to wit: Space _A?B ------ Lot __l6_______ Block ----- 1_5_____ Clearwater Cemetery,
a 00
n as recorded in Plat Book -__60-__ Page_2_a-a0 Public Records of Pinellas County, Florida.
r: 00
This conveyance is subject to the condition that Grantee herein shall not assign or convey said property
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.*ithout the written consent of the Grantor, and to the further condition that said property shall be used
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only for cemetery purposes as human burial sites.
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TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said
gart_le_S__ of the second part ----- tale-ir _____ heirs and assigns forever.
?- v
.: IN WITNESS WHEREOF, said City of Clearwater, a municipal corporation, has caused these presents
to be executed in its name by its Mayor Commissioner, by its City Manager, and to be attested and its
corporate seal affixed by its City Clerk on this the day and year first above written.
Signed, Sealed and Delivered 3,
in the presence of us: ? rtf 1.
o Rl k til cui( fc;.
Z R
I ED
- 1_1 - --- ?- --------------------
AApprove'd as to forma correctness:
OF CLEARW
By ---
Attest: z
CER, FLORIDA
4
- - --
City - Manager.
- - May Commissioner.
{ f - ---
City Clerk. _
Attorney orney
City
7 00 5.
State of Florida,
L. FE 2,1 T
County of Pinellas: - ?ns3a?
Personally appeared before me, H. Everett _Hougen,__Picot_ B.__Floy-d_______-______
and --- __rc,=__Wh_i_t._he_ad__________________________________to me well known to be the persons who
executed the foregoing instrument of conveyance in the capacity of Mayor Commissioner, City Manager, City
Clerk respectively, and they severally acknowledged that they executed said instrument in their respective
capacity by and on behalf of and as the free act and deed of the City of Clearwater, Florida, a municipal cor-
poration, for the uses and purposes therein expressed.
Witness my hand and official seal at Clearwater, Florida, this the - / --------------- day of
-`------=-- - - ---A. D. 19_?_. y? ?• J4i'?
------ -------- ------------ --------------
(Seal) Notary Public State of Florida.
My Commission expires--------------------
co -' c --.
N ch / ???\ " l 11A E N T,A. RY Notary Public, State of Florida at large
F r 7 ' My Commission Expires Sept. 29, 1977
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?'? t\ = h` \ I Bonded by American Fire & Casualty Co.
..--_o pFrENUC 11047
ATH STATE FILE
LOCAL FILE NO.
DECED ENT-NAME FIRST MIDDLE LAST SEX DATE OF DEATH (Mo., Dar, Y•.)
1. THELMA KATHRYN CLARK 2. FEMALE 3. NOV. 21,1981
RACE z
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Whi jAGE-
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!irthd oy I UNDER YEAR I UNDER I DAY I DATE OF BIRTH (Mo., Dar, Y•.) COUNTY OF DEATH
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WR ITE ,
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1,..71 12 1910
SEPT. 7a. PINELLAS
CITY, TOWN OR LOCATION OF DEATH HOSPITAL OR OTHER INSTITUTION-N-- (it not in e:Ne•, eioe ..rest and -be•)
' IF HOSP. OR INST. (lnd-. DOA,
OP/Emer. It-, Inpatient (Spedlr)
7b. CLEARWATER 7c. 2100 NURSERY RD. BLDG. L-20 7d.
STAT E (/1 if.. Cie. -.id- n.,nel
HA SSAC USETTd "- USA ID_ MARRIED Ill. FREDERICK F CLARK
SOCI AL SECURITY NUMBER USUAL OCCUPATION (Give kid of o,k do- d-in, KIND OF BUSINESS OR INDUSTRY
eased)
12. 029-34-83 7 1- HOMEMAKER 36. OWN HOME
RESID ENCE-STATE COUNTY CITY, TOWN OR LOCATION
STREET AND NUMBEIILgPERIAL GDNS 1
I!ftT Jr a LIMITS)
,4d. 2100 NURSERY RD a #L- 20 1... YES
FATH ER-NAME FIRST MIDD LE LAST -EI-IDEN NAME FIRST MIDDLE LAST
O
GEORGE BELL T
.
MARY - ROLT
INFO RMANT-NAME (Ty,, o, Piw) MAILING ADDRESS STREET OR R.F.D. NO. CITY OR TOWN STATE ZIP
17.. FREDERICK F. CLARK 17b.2100 NURSERY RD. #L-20, CLEARWATER, FLORIDA 33516
BURIAL, CREMATION, REMOVAL, OTHER (Specify) CEMETERY OR CREMATORY-NAME LOCATION CITY OR TOWN STATE
MOVAL/BURIAL
R COLEBROOK CEMETERY 02382
MASS
Bc
WHITMAN
1Ba. E 18b. .
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FUNE RAL DIRECTOR-(Sis? e•.J FUNERAL HOME MOSS FUNERAL HOME, INC e
19.. 19b. 693 Soe Belcher Rde Clearwater Florida 33516
20..'i the bear of my_ rh occurred or rune, date and
place and due-ro cruse oted, 21a. On the basis of eaamirtorian and/or invesegar'wn, :n rW opinion death
xcurred ar the time, dare and place and due v the ca-W stated.
s (S:enare•e ud 7itle (Si,-,.,, and Title) 1
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DATE SIGNED e., Day, Yn.
HOUR OF DEATH
' 2 3E DATE SIGNED (Mo., D.Y. Y..)
HOUR OF DEATH
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206. ' ?i -O
7:15 A* E W
M 4 21 It.
21'. M
a
or
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NAME OF ATTENDING PHYSI IAN IF
or
THAN CERTIFIER (Type pant/
° PRONOUNCED DEAD (.Mo., Dar. Y•.)
.° F
PRONOUNCED DEAD (H-0
? 20d. 21d. ON 21.. AT M
NAME AND ADDRESS OF CERTIFIER (PHYSICIAN, MEDICAL EXAMINER) (Type or Paint)
22. Henry Smoak, M-De, 501 S. Lincoln Ave., Clearwater, Florida 33516
REGISTRAR DATE RECEI ED BY REGIST R (Mo., Day, Y•.)
236 ,Ffl
23a. /S:snae.<11
2A. IMMEDIATE CAUSE (ENTER O.VL) ONE CAUSE PER LINE FOR (b), AND (c).] ? Inrerv between onset and death
PART lal
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SA" 6
DUE TO, OR AS A NSEOUENCE OF, I.ft-I be-, onwt and death
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DUE TO, OR AS A NSEOUENCE OF: (Inronwl between ortset and dVeh
(c) PART OTHER SIGNIFICANT CONDITIONS--Conditions on1ributin0 to death but not r.I.,.d 1. cause given in PART 1 (al AUTOPSY (Speedy WAS CASE RE RED TO MEDICAL
II yea - no) EXAMINER (Specify Yea o• Re)
25. NO 26. YES
(Probably) ACCIDENT, SUICIDE or DATE OF INJURY (Mo., Dey, Y•.) HOUR OF INJURY DESCRIBE HOW INJURY OCCURRED
HOMICIDE; ar UNDETERMINED (Spn:)Y)
270. J276. 27c. M 27d.
INJURY AT WORK (Sprerf. PLACE OF INJURY-At home, farm, street, f-1-y, oH,c. build-n0. LOCATION STREET OR R.F.D. No. CITY OR TOWN STATE
o• +o) etc. (SprcilY)
27e. 77f. _ 270.
A CERTIFIED COPY MUST CARRY THE EMBOSSED SEAL OF THE REGISTRAR OF VITAL STATISTICS.
I hereby certify that this is a true and correct copy of a certificate
on file in the office of the Local Registrar of Vital Statistics of the
Pinellas Count Health Departm tt, St. Petersburg, Florida.
Nov. 24, 1981 , Deputy Local Registrar
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CEMETERY DEED
THIS INDENTURE, Made this __6th __ day of __-- Tekb)RgarY ------------- A. D., 19_74
between the City of Clearwater, Florida, a municipal corporation created and existing under the laws of the
State of Florida, party of the first part, and _--Frederick-F. Clark- and-Thelma- K.---Clark,_
-----------------------------------------
_his_ wife:_ Bldg. 19 -_Apt. 1,_ 901 S_. Greenwood-Ave..--Clearwater --------------------------------------------------------- of the
County of ------ Pinellas _________________ State of ___ Florida parties of the second part;
W I T N E S S E T H : That the said party of the first part, for and in consideration of the sum of
Two hundred sevewtV, and no/100 ($270) --------------------------- to it in hand paid by the said part 05 of the
-
second part, the receipt whereof is hereby acknowledged, has, remised, released, and quit-claimed, unto the
said part lesof the second part, and__their____-heirs forever, all the right, title and interest, which the
said party of the first part has in and to the following described parcel of land, lying and being in Pinellas
County, State of Florida to wit: Space _Azg ------ Lot __ 6 C2_______ Block U---- Clearwater Cemetery,
as recorded in Plat Book__ 6 0 __ Page-21!!10 Public Records of Pinellas County, Florida.
This conveyance is subject to the condition that Grantee herein shall not assign or convey said property
without the written consent of the Grantor, and to the further condition that said property shall be used
only for cemetery purposes as human burial sites.
n?' n TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said
p part- le_s__ of the second part ------ their ------ heirs and assigns forever.
v y i
U O `? IN WITNESS WHEREOF, said City of Clearwater, a municipal corporation, has caused these presents
a 'J
% to be executed in its name by its Mayor Commissioner, by its City Manager, and to be attested and its
o
corporate seal affixed by its City Clerk on this the day and year first above written.
f .?
3 Signed, Sealed and Delivered CITY OF CLEARWATER, FLORIDA
r U in the presence of us:
= v By / s / _ Picot _B . _ F_1ovd ------_
G City Manager.
itL-----------
_ ? v ------ - Countersigned:
x
---- / s / Kathryn C . Green Id H. _ Everett _Hougen ............
---- ------------------------------
Mayor Commissioner.
Approved as to form and correctness: Attest:
/s/ R. G. Whitehead
----L_aL__Her?er_t_rL__Brown---------_- ------ City Clerk.
City Attorney
State of Florida,
County of Pinellas:
Personally appeared before me, ---H.--Everett Hougen, Picot B. Floyd
and __ R. _Cz.-Wl1ItebeLraSL_________________________________to me well known to be the persons who
executed the foregoing instrument of conveyance in the capacity of Mayor Commissioner, City Manager, City
Clerk respectively, and they severally acknowledged that they executed said instrument in their respective
capacity by and on behalf of and as the free act and deed of the City of Clearwater, Florida, a municipal cor-
poration, for the uses and purposes therein expressed.
Witness my hand and official seal at Clearwater, Florida, this the---- 18th ----------- day of
---- February ---- A. D. 19_-74_. -/?L- Kthr3?n-G.--Gr-e
(Seal) Notary Public State of Florida.
My Commission expires --------------------
ALpF,NF -
OI
OFFICE OF CITY CLERK
R. G. WHITEHEAD
CERTIFIED MUNICIPAL CLERK
C I T Y OF C L E A R W A T E R
POST OFFICE BOX 4748
CLEARWATER, FLORIDA 33518
February 18, 1974
Mr. 8 Mrs. Frederick F. Clark
Bldg. 19 - Apt. 1
901 S. Greenwood Ave.
Clearwater, Fla. 33516
Dear Mr. 8 Mrs. Clark:
We are enclosing the deed for two spaces in Clearwater
Cemetery.
While it is not legally required, it is advisable to record
this deed in the records of Pinellas County through the office
of the County Clerk at the Court House in case the original
is lost or destroyed.
Very truly yours,
R. G. Whitehead
City Clerk
kg