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Searle, GertrudeQJIT-CLAIM DEED . RAM.. C0 FORM 8 This Quit-flaunt Beed, Executed this 25th day of April GERTRUDE SEARLE first party, to CITY'OF CLEARWATER ' whose postof Tice address is second party: .A.D. i9go by (Wherever used herein the teens "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.) itnesseth, That lie said first arty, for and in consideration of the stint of $ 85.00 in hand paid by the said second party, tie 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 arid 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: - Clearwater Cemetery - Block 14, Lot 530, Space D as recorded in Plat Book 60, Page 30. A To Ittaue and to bold , the same together with all and singular the appurtenances thereunlo belonging or in anywise appertaining, and all the estate, right, title, interest, lien, equity and claim what- soever of the said first party, either in law or equity, to the only proper use, benefit and behoof of the said second party forever. Tin I ` itneSS laerenf, The said first party has signed and sealed these presents the day and year first above written. Signed, sealed arid delivered in presence of : OR D, ...1??/...----.... ........................•---••-----•-----•--•-------.......-•--••---................... STATE OF FLORIDA, l COUNTY OF )t 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, personally appeared Gertrude Searle to me known to be the person described in and who executed the foregoing instrument and 's ? e acknowledged before me that 'Ske 'executed the same. WITNESS my hand and official seal in the County and State last aforesaid thi 3©t?\ day of April A. D. 19 90. OYYII . f?ferry ?Bt?, ?>t?? ttatf 60 • Arty ComTtsis:?ie?, t?xrnires Coro $, '^?v Thu Lulrunient prcparcd by: Address O C, II J TEXAS STATE BOARD OF HEALTH . B. ^• V. s• T (1) PLACE Ci F BIRTI4 BUREAU OF VITAL STATISTICS ?1 I 1 I . STANDARD CERTIFICATE OF BIRTH 1 ffi V U x d ro i ,o L i a 5 •d t ? u :c i n I 0 I w d Count of ...... ... ...... ............................................ Registration District No .................................. ( File No.......... ..................... ........... ....... 111 Register No............... ........ .......... ...... ... (No ....... -._...................... ..... _...Ward) .................................. ....... City... ..... ................... (No e` e ta ?'L'(J-?.. If child is not yet named, nn!:e (2) FULL NAME OF CHILD ..................... ........ ............... -r....................................................................... ................. isupplentental report, as directed (3) Sex of (4) Twin, triplet, I (5) Number in order (Yes or no) Child _Z or other of birth 1, L (To be answered in event of plural births) (6) Lc (mate and Tax Statement 1983 eepan, -, 3 Employer's identification number 5 sut am a- playee ceased ei N t1 t) ? El C 6 Allocated tips rt h ensation 192.q. (Ycar)_ FATH MOTHER (6) NAME T (14) FURL MAIDEN NAME (9) RESIDENCE (15) RESIDENCE (10) COLOR I'.• "a•7" .? I (11) AGE AT LAS BIRTHDAY ......_....._?.•. .:Y...... (16) COLOR .t I I ., T (17) AGE AT LAS-1 • j "• aen-rnn.w_... G (i2) BIR ' PLACE (18) BIRTHPLACE n?Q G{ 17 (13) O?CUPATION (19) OCCUPATI (20) Number of children born to this mother, including present birth........ (21) Number of children of this mother .......... living ........... .................... (22) CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE" I hereby certify that I attended the birth of this child, 40 was born alive J r? d! M. at on the date above stated. I stillbom . "When there was no attending physician or midwife, then thr, father householdee, etc., should make this return. A stillborn child is one that neither breathes nor shows other (Signature) ------------------------- evidence o, life after birth. I hysician or Mid ife) Given name added from a supplemental Address .----- .. C ........ ----- 1. report-- ....... ------- ......_......._.- ............ 192-....... ...................... - _......................._...........--.. Filed .... -.................--.--...... 192.-•-- t Post Office Address ;?. Kegistrar. Re..istrar. 23. Did you use a on-, per cent silver nitrate solution in the inf ]tt's eyes inunediately after its birth? Yes.._-..?__ Na__.__.._..___... i Control FormW-2 Wad Number r F 5 OMB No. 1545- 2 Employer's name, address, and ZIP code 8 PARAnymc, CORP bFSo UEPTara 'G LA0G€] r. g 8 Employee's social security number 9 Federal income tax withheld 10 Wages, hps, of er comp ..y P 1277 12 Employee's name, address, and ZIP code CfRTRUGE M Sc?tarii;'?a I'g 15597 GEORGE OV CLEARwtTFR. FL 3352(: I The s ` w ! urity oAdaaeo sur6vivorsl andddlsabi?l t% nsuPan 13 Social security wages y? f'4 Gf 16 State unemp/dis wlh l? (7) Date of ?- Birth .................... -............-•--+ •---• - (Month (lla Copy C For employee's records of the Treasury - Internal Revenue Service 4 Employer's State number 942 Suo- void ..p. total [j F-1 7 Advance EIC payment 11 Social security tax withheld 14 Social security tips 17 State income tax 18 State wages, tips, etc. 119 Name of State f L " Eo f'al income tax 121 Local wages, tips, etc. 122 Name of locality Control I Cop y C For employee's records Internal Revenue Service a and Tax Statement 1983 2 Wa W Numbe r ` Department g Form - No. 1545-0008 OMB or t he Treasury- ' 2 Employer's name, address, and ZIP Bode 3 Employer's idenQtification fr b er F s Slate number ::: 4 Employer UIT Co JApTL C1Fr o- void s 3 ' 5 star. em uaed Ploy- Legal O v p emp total El O 0 goK cLWinn FS r.. O ? I 7 Q r 6 Allocated tips 7 Advance EIC payment r ?eT 4 P+1 X14 R g 8 Employee's social security number 9 Federal Income tax withheld lg3?oP E 12 Employee's name, address, and ZIP code g (',f.RTaUOF SFH,RCIDF? J KR97 f'Ft1??F ?lun ? , I ° CIEAR?teTrQ MT. 3IS4C, 10 Wages, tips, other Compensation 11 Social security tax withheld 13 1, r' . C`7 Fp `1? 13 Social security wages 14 Social security tips 16 State unemp/dis w/h 17 State income tax 118 State wages, tips, etc. 119 Name of $late j !/ i CEMETERY DEED THIS INDENTURE, Made this _2!+_th--------- day of __-_Au ? ________ A. D., 19_7_1___ 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 .... ('jertrude-Schroder ------------------------------- ---- 5597_Geor-e_ B1_v_d_._i______-___Clearwater______33516 _ __, of the County of __-_PiizelJ_a_5 -__________________ State of __ loridapart--Y- 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 $_ one _hundre-d-_ _0_ 1Jara--C$10 0 . 0 )____-__--___ to it in hand paid by the said part- _?L_ of the second part, the receipt whereof is hereby acknowledged, has, remised, released, and quit-claimed, unto the said part--y_ of the second part, and____ hex_____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 __ v -------- Lot ------ Block--1-4 -------- Clearwater Cemetery, as recorded in Plat Book-AO ----- Page-29=39 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. TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said part--y---- of the second part ------ es-------- heirs and assigns forever. 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 in the presence of us: ----- ----------------------------- Approved as o fo Van correctness: -- --- -- ------ ?"14?L_- ----- City Attorney FLORIDA ----------- z- y------ Cit Manager. '-------- r or Commissioner. Attest: Deputy City Clerk. State of Florida, County of Pinellas: Personally appeared before me, rI?_Ev?ratt_Haen,___e?r?t_!?r ?te1^him ___._ and __-Lto i1J_e__i3e_11 --------------------------------------- to me well known to be the persons who executed the fore oin *D e p u t y g g 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. C r, Witness my hand and official seal at Clearwater, Florida, this the___! day of --A. D. 19_ (Seal) Notary Public State of Florida. My Commission expires___________________ Notary Public, State of Florida at Larne My Comn4ission Expires S pt. 29, 1973 @onderi k Americaa Eire 4 Casualty Co,