Beck, Robert WSTATE OF FL IA
COUNTY OF f
AFFIDAVIT OF ROBERT W. BECK
I, Robert W. Beck, the undersigned, do hereby attest that I have been assigned interment
rights by all the remaining survivors and heirs of George. D. Beck (deceased), who was the
owner of Spaces 14, 15 and 16, Block 5, Lot 11, of the Clearwater Municipal Cemetery.
The Affidavit of Daniel Beck is attached. Daniel E. Beck, along with myself Robert W.
Beck are the sole surviving heirs of George D. Beck.
Please take this Affidavit as your authority to assign interment rights in Spaces 15 and
16, Lot 11, Block 5, Clearwater Cemetery to myself, Robert W. Beck.
I 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.
SIGNATU S:
Robert W. Beck
ADDRESS:
417
SWORN TO and subscribed before me thiqmor day
Robert W. Beck, who is personally known thas
2007, by
in the form of
not take an
(Print or type name)
My Commission expires
i
DONALD 0.MCFARLAND
: A. MY COMMISSION N DD 614968
EXPIRES: February 12, 2011
? r Bonded Thru Notify hoc Undewbrs
STATE OF FLORDIA
COUNTY OF &P-
AFFIDAVIT OF ROBERT W. BECK
I, Robert W. Beck, the undersigned, do hereby attest that I have been assigned interment
rights by all the remaining survivors and heirs of George. D. Beck (deceased), who was the
owner of Spaces 14, 15 and 16, Block 5, Lot 11, of the Clearwater Municipal Cemetery.
The Affidavit of Daniel Beck is attached. Daniel L. Beck, along with myself Robert W.
Beck are the sole surviving heirs of George D. Beck.
Please take this Affidavit as your authority to assign interment rights in Spaces 15 and
16, Lot 11, Block 5, Clearwater Cemetery to myself, Robert W. Beck.
I 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.
SIGNATURES:
Robert W. Beck
SWORN TO and subscribed before me this
Robert W. Beck, who is personally known to
ADDRESS:
day , 2007, by
or has prod ed identi ication 1 the form of
/anal who di did not take an oath ?-,
Notary
(Print or type
My Commission expires:
-J39MW 0. MCFARUWD
MY COMMISSION # DD 614968
EXPIRES: February 12, 2011
ura ni NW7FuRic underwriters
STATE OF FLORIDA)
COUNTY OF PINELLAS)
AFFIDAVIT OF ROBERT W. BECK
I, Robert W. Beck, the undersigned, do hereby attest that my brother, Daniel L.
Beck, and I are the sole descendants of Robert H. Beck, our uncle, who is the owner of
Block 5, Lot 11, Spaces 5, 6 and 13, in the Clearwater Cemetery. He is buried in Space
5. Space 13 is vacant.
Please take this affidavit as your authority to assign rights to me to Space 13 in
Block 5, Lot 11.
I 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.
SIGNATURE:
Ro ert W. Beck
ADDRESS:
6F 15r C.J??,:?x
SWORN TO and subscribed before me this day of 2011,
?-
by Robert W.Beck, wh is perAonally known to me or who produc4d identification in
the form of and who did/did not take an
oath.
µE1.
C?1AR?-0'?5? 8 of Florida
r rotary pub DD8277595
Comm?sstion# pot. 01, 2C
MY Comm' expires
Not ublic J1
(Print or type name)
My commission expires: OL -()} 0612