Steis, M Mrs."'
-VTEW
DEPARTMENT OF THE
CITY CLERK
July 7, 1997
CITY OF C LEARWATER
POST OFFICE BOX 4748, CLEARWATER, FLORIDA 34618-4748
CITY HALL, 112 SOUTH OSCEOLA AVENUE, CLEARWATER, FLORIDA 34616
TELEPHONE (813) 462-6684 FAx (813) 462-6488
Mrs. M. Steis
105 Margo Trail
Rome, GA 30161
Dear Mrs. Steis:
Enclosed is an AFFIDAVIT which indicates that you
and your brother are the sole surviving and remaining
heirs of the LEWIS family. It also states your wishes
as to the use and marking of the remaining spaces
(except for space 8).
If the information is correct, you and your
brother need to sign as indicated below SIGNATURE and
have two individuals witness your signatures in the
presence of a Notary Public. Then return the document
to The City Clerk Department, City of Clearwater, P. O.
Box 4748, Clearwater, FL 34618. When I receive the
AFFIDAVIT I will make the information part of our
permanent file.
If you need to contact me for any reason, please
call 562-4098. Thank you.
Camille Motley, Central Records Specialist
cm
Enc.
0
"EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER
• AFFIDAVIT
STATE OF FLORIDA )
COUNTY OF )
July 7, 1997
WE, the undersigned, do hereby attest that we are the sole surviving
descendants and heirs of the LEWIS FAMILY. Francis D. Lewis, deceased, and his
wife Eleanor B. Lewis, deceased, who are buried in Block Six (6), Lot Two (2),
Spaces Two (2) and Three (3) respectively, in Clearwater Cemetery. Also
interred is their father, Francis E. Lewis, in Space One (1).
It is our desire to make known our wish to reserve and mark four of the
remaining five spaces as follows: Space Four (4) for use of Frank T. Lewis,
Space Five (5) for use of William B. Steis, Space Six (6) for use of Myrtle
Steis, and space Seven (7) for use of William B. Steis, Jr., son of Myrtle and
William B. Steis, Sr.
I, further 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 indicated above.
SIGNATURE
Mrs. Myrtle Steis (daughter of Francis D. & Eleanor B. Lewis, deceased)
105 Margo Trail
Rome, GA 30161
WITNESSES:
SIGNATURE
of
Notary
My commission expires:
(SEAL) SIGNATURE
Mr. Frank T. Lewis(son of Francis D. & Eleanor B. Lewis, deceased)
953 Bustle Road
Coolidge, GA 31738
WITNESSES:
SIGNATURE
RELATIONSHIP
SWORN TO AND SUBSCRIBED before me on this day
of , 1997, in County, State of Georgia.
Notary
RELATIONSHIP
SWORN TO AND SUBSCRIBED before me on this day
1997, in County, State of Florida.
(SEAL)
My commission expires: