McQuagge, ArchieSTATE OF FLORIDA
POLK COUNTY
AFFIDAVIT
I, Archie McQuagge, the undersigned, do hereby attest that I and my sister,
Madge McQuagge Ulmer, are the sole survivors and heirs of Laura McQuagge
(deceased), who was the owner of Block 7, Lot 97, Spaces 1, 2, 3, and-4. Clearwater
Cemetery.
Please take this affidavit as your authority to assign interments rights in Space 4,
Lot 97, Block 7 to my sister, Madge McQuagge Ulmer.
agree to release, indemnify and hold the City of Clearwater harmless from
liability in the event of any claim arising from the use of the above described property as
stated above.
SIGNATURE/ ADDRESS
104
R ETT hT ? O tZiiS t7 R
Archie McQuagge
f'-lula uRnt DA Le , f7L. 3?43z?,??35
( 8103) 967 • 8o33
SWORN TO and subscribed before me this day of .JCQ0Lk ,
200 b Archie McQuagge who produced identification in the for of
R and who did/did not take an oath.
^ 1bli
jpa 11A 4e. Jennifer Mitier Notary Public
,p My Commission DD145923
0???°' ExPres August 28.2008' ?? - O
My commission expires: