RUTH MILLS ARTHUR MILLER JR AND ALICE MAE RAY
., ;.;11 "'i::'~~~~~~19 this jndrnlur'
INs,r t 91-081285 PINELLAS COUNTY FLA.
AF"'".l 1, 19_9_1_,., ._6, ._..,O'7F'M OFF I=-EC BK
n . ----~,~ -.... " ?r'529 PG 205
(\Vhnr.n"r .u'COrd herrin ,tlit' tf'''I1!; "fj,~t party" a!H1 1'1;(,(,011(1 party" ~hAII im:ltult. c;in~111ar 311(1 pima!. hf'iB, I(,'lal
rf'pt~"e~Hatl\'rc;. a,~d a'!lu~n~ of individuals, and Ill,. !'lUTt:c;sors and R!l.'\i,a;n! of cnrpll..ation~. whf'rf'\.'u thf' ronl,....t
!'in admlu or nqmrr!l.)
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~o FORM 4",.
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Mn,[p lItis 27th,[(IY 0/ March, ' A. D, II) 91
BETWEEN Rl.ITH M. t-lILLS, a married woman; ARTHUR MILLER, JR., a married m
ALICE MAY RAY, a married woman, and GERTRUDE M. CLARK, a married woman
of III(' COllnl)' of Pinellas ,ill tll(' Stull' of Florida ' purt ies of tlte first part. and
CITY OF CLEARWATER, FWRIDA
of ,II(' COllllly of Pinellas ,in 111(' Slnle of Florida
P.O. Box 4748, Clearwater, Fl. 34618
, whose post office address is
pori
of IIII' s('collcl purl,
y
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1'llOt ,1". said part ies of tlte fir..t IJClr!, for and in consideration of the sum of
ten and --------------00/100--------- Doiiars.
10 them in hand paid I)y Ille said part y ofthp second part, lIte receipt wllereof is herehy ac1mowl-
ed[Jed, Ila ve wanted, harfjailled, and sold to lIte said part y of tIle second part, their heirs
u1\(1 assifllls fOfl'l!I'r, tIll' Fo!lowilll/ dpscril'l'd lalld, si/utlll', alld ')(!irt!l ill tlte Courlty of Pinellas
Stute of Florida , lowil:
Lot 8 and 9 of original Lot 2 of R.H. PADGETT SUBDIVISION as recorded in Plat Book 5,
Page 27 of the Public Records of Hillsborough County, Florida, of which Pinellas
County was formerly a part, and being more particularly described in attached
Exhibit "A".
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Parcel numbers 15/29/15/65214/002/0080 and 15/29/15/65214/002/0090
Grantors social sec. /I ~ ;2 Lv 5 - 40- q'-j '-I S (RUTH) ~~S- 50- q ~ 5g
:<17- 36'" 15"77 (ALICE) v ~f+' 7- ?J&- (Ie '71 (GERTRUDE)
( THUR
Property is not the homestead of the Grantors, they in fact resided at:
!I
./ JJ1L~...} fl t IV\ 6lu~1.J\:: ') U I e [Ut.uYlLUJc) I ,)-1, ,:) l.! (f' /5
,!065 WWJh(;}[~~("\ at'G" C~o.(w(.d<.Y, Fe 3LI f.r, I t,.<
/LfS-t UJ?J..tId~ vii. (!6~ -1':./ 3-'6/..5--
I I r' n I / -j' / .
vI 5L c~2u 1m 01) lV, P (jj~,U)fJ tJ ,t) (\.IC 34/p }Lr
Subject to taxes accruing subsequent to March 28, 1991 and easements and restrict.ons
of record.
(RUTH M. MILLS)
(ART!RJR MILLER, JR.
_(ALICE MAY RAY)
(GERTRUDE M. CLARK)
And tIle said purl ies of tile Firsl part do IlCrehy fully warrant tile Iitle 10 said land, and will defend the
same against tIle lawful claims of all persolls whomsoever,
In lttUness 1tfhrttof, The said part ies of the first part ha ve hereunto set
hand S and seal s tile day and year first ahove written,
their
STA TE OF FLORIDA,
COUNTY OF Pinellas
~ARLEEN F. DEBLAKER, CLERK
_f<~ (;Ql3r~__l,J~R I F!_E II BY: ~
r"lIEREBY"~-n"Y that on this day, berore me, an
officer duly authorized in the State aforesaid and in the County afore~lIid to take acknowledsments, personal!! !,pp'cared
RUTH M. MILLS, a married woman; ARTIRJR MILLER, JR., a married man; ALIC.t!;MAY RAY,
a married woman; and GERTRUDE M. CLARK, a married woman
to me known to be the person Sdescribed in lInd who executed the foregoing instrument and
before me that theyexecuted the same,
WITNESS my hand and official seal in the
March, A, D, 19 91
'r-; "" This l~fmm~r.' "I'1I~ rnp;\W' !no:
'\, .' lb' STEWART TilL!' OJ ('''E""n~'), 'T'"
(clv{ \ I By: ~...L..-ST....-GERMAIN
'PI' ."J I.~.I)I) ('(Hlr' S:r,:,,1
11/1S Imll1ll11mt p"pnfCl'('f/:1ntMrr. H q[.:;'
Address (',0, n,,:, ,rr. ,
('If'~.r''~Q~t';., } ~_ ,f.:-d l
\\rhfch !rl'!tT~: ."cr.~ '.l ~v: p~": ;'.:'!<,! ;-~'~ .!':....~:;1.:'L~'~
to wrilin~_ oi R lh~;~ In.?.r.Jli),~ ~,~! ~";':>':,/.
they
acknowledged
27th day of
.......m'/lldl.c:d~...
ot.aI\X:..pubJ),e'state of Florida
~~~'.coriirTdssion,?xpires ;/ /-- ') - '7' Y
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.
. PIN
: - ELLAS COUNTY .
. OLE. REC . Bt( 7"'-'" FLA.
'~--~n\J'''' 9 F'G 206
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Lot 8 in Lot 2 of R.H. PADGETT'S SUBDIVISION of the Southeast
quarter of the Northwest quarter of Section 15, Township 29
South, Range 15 East, according to plat therof recorded in Plat
Book 2, Page 63, Public Records of Hillsborough County, Florida
of which Pinellas County was formerly a part, also according to
map or plat thereof, recorded in Plat Book 4, Page 32 of the
Public Records of Pinellas County, Florida.
Lot 9 of a re-subdivision of Lot 2 of THE REVISED MAP OF R.H.
PADGETT'S SUBDIVISION, of the South~ast quarter of the Northwest
quarter of Section 15, Township 29 South, Range 15 East,
according to the map or plat thereof as the same is recorded in
Plat Book 4, Page 32, Public Records of Pinellas County,
Florida. ALSO DESCRIBED AS:
Lots 8 and 9 of original Lot 2 of R.H. PADGETT SUBDIVISION as
recorded in Plat Book 5, Page 27 of the Public Records of
Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page 32 of the Public Records of Pinellas County, Florida L;SS
the following described parcel.
Begin at Southeast corner of Lot 8 of original Lot 2 of R.H.
PADGETT SUBDIVISION Section 15, Township 29 South, RAnge 15
East, as recorded in Plat Book 5, Page 27 of the Public Records
of Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page 32 of the Public Records of Pinellas County, Florida, for
a point of beginning; go thence West along South lot line 45.5
feet to Westerly lot line of said lot, also being Easterly right
of way line of Washington Street; thence Northerly along said
right of way line 45.5 feet to a point; thence SoutheasterlY 65
feet to the Point of Beginning.
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26129077 J MD
01
RECORDING
DOC STAMPS
FEES PAID
04-01-91
17. .,,1 a~'j
Ja.:.."ta..ii-
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$i'''''U r..-,
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$f : OC
5
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TOTAL:
('H!:"1'I'" AM'" T
" ,...'",~ , I'll. ,ENDERED:
:"~\~GE :
$f49:0C
$"- 'L,
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Qrder No. 91030019
,f""-Dates March 28, 1991
NOTICE
By reason of facts known 10 1M title company J 1M \n:!enl&ned proposed Insured ..:Jcnow-
ledles that the followInc preprinted Schedule a polley exceptiones) .W net be deleted from
.
1be pollCJ'
.
FENCE encroaches outside lot line along. the westerly boundary.
Y/fZLH j #WJ(VI '
FOR:
swu TO All]) SmSODED JEFOn e, mIS 28th DAY 01' March
1991. ~~
~y POBLIC
NOTA " ~~~SSIOR IXPII%S:
M RY PU8I..,c" "I Ie'),: i'!.:)"IDA,
.~OMMISSION EXPlHES: MAR, 2, 1993
!.IiQ l'tiRu_ .NQ.TARY pus..tc &.INg.RWRJT.&:~"
.-----.
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,;. LY~-~~~'~~a /"G'
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A SURVEY OF: lots 8 & 9 of original lot 2 of R. H. Padgett subdivision as recorded
in Plat Book 5, page 27 of the Public Records of Hillsborough County, Florida, of
which Pinellas Co\D1ty was fonrerly a part, and revised plat as recorded in Plat Book
4, page 32 of the Public Records of Pinellas Co\D1ty, Florida LESS the following
described parcel.
Begin at Southeast comer of lot 8 of original lot 2 of R. H. Padgett subdivision
Section 15, Township 29 South, Range 15 East,as recorded in Plat Book 5 page 27 of
the Public Records of Hillsborough Co\D1ty, Florida, of which Pinellas Co\D1ty was
fonrerly a part, and revised plat as recorded in Plat Book 4, page 32 of the Public
Records of Pinellas Comty, Florida, for a point of beginning: go thence West along
South lot line 45.5 feet to Westerly lot line of said lot, also being Easterly right
of way line of Washington Street; thence Northerly along said right of way line 45.5
feet to a point; thence Southeasterly 65 feet to the point of beginning; containing
1035 square feet, rrore or less.
. I HEREBY CERTIFY THAT THE SURVEY REPRESENTED HEREON MEETS THE MINIMUM
REQUIREMENTS OF CHAPTER 21 HH-6, OF THE FLORIDA ADMINISTRATIVE CODE.
DATE: ~-:'/5-9/
EVANS LAND SURVEYING
2.::"'~?~ MAIN STREET - UNIT.At'
DUNEDIN, FLORIDA 34698 PH: 734 - 3821
8dat-~~4='Y ..::f~-RYcY
DWN. BY: J~6'
INY. NO. ~./.h';'~
~TRACT FOR SALE AND PURCH~
I~ III h M, t1 j 1 ]~; all d A r I Ii 111- ~1 ill., r, 1 r ,
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, 11 ~)L~ (\,I('eo St r"t'I, Cl (';trwal ,:-;.., r17;'. id,I3idi I ()-:~2r) I
J:. -<
N1d Ciey o[C](:'an.latpr, Florida ,r.!~::!l!(l,
~ P.O. Box 4748, Clearwal,'f, FL,.ida 311618 WI~.oe 462-661H ),
~eby Agr.. that the Seller ahallaell and Eluyef shallllUY the tolklWlng It,al plop,.rty ("~'!'!'2[~.t[) and t""rst1f1ll1 J'ltOOt'ny ("t!:~,)(I~I~.'llcOl"'ct,>It<ly "~~1.t.) UIlOf\ the tOlIOWIIl\j
..,,,. 8Ild condlllOlla whlcl\ INCLUOE; the Standdrdt. 1,)( Aaal b.lal" lrdlllodCllO'''- p<lnl.." on It'" rtlV"rbe 0' "lldChtt<J rSliJ.ld"r(I\~)") ."lC ,ny &OOdrl(!um 10 llllti trlllllumunl -
! !,Itt
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I.
Pi IH'11 as Co..mty,Flonda
ett Suhdivision as l'pcord,'d in rbl Book 5 Pa e 27 of the Public Records
County WclS fOl1ll'd y a part and n v iSI~d Plat as reliot'ded in Plat Book 4,
Floridil ).'S,.; a IriaIl ~ll~ in tlK' Sour\~st corner of Lot 8 containing 1035
TO CONDUCT AN ENVIRONMnNfAL
CAFIOnCTORY $75,000,00
....,...............,......,......,..,...:......$ - -
II.
in Ihe "mount ot
5>
N/A
Deposil(s) to be held in escrow by
Subjecl 10 AND IIIiSUmpllUl1 of rnortUdi/tl In Uuod slandlng in tllllOl' 01
N/A
N/A
N/A
$75,000,00
h"~,,,g an &..pro.trT,al~ prese,,1 IJrin~IPal balance 01 5>
Ie) Purchase money mortgage and morlgage nole bealln\) annuallnleresl at _ '\It on terms sel 10r1rl herein, in amount 01 , " SO
(d) Other: - $
leI Balance 10 clo~~ (U.S, cash, LOCALLY DRAWN certilted or cashier'S check), subJecl to "dJuslmenls and pro' ..loons........ ... ...........' SO
III. TIME FOR ACCEPTANCE; EfFECTIVE DATE: II Ihis oller is nol execullld by and delivered 10 all parties OR FACT OF EXECUTiON commun'caled In writing blltW8lln the parliel
on or before Febn.aary 25 , 1991 , Ihe deposit(s) will, at Buyer's option, be relurned 10 Buyer and Ihe oller withdrawn,
The dale oi this Contract ("Ellective Dille") will be Ihe date when Ihe lasl one 01 Ihe Buyer and the Seller has signed this otler.
IV. FINANCING: (a) II the purchasa pllce or any PN\ 01 II is to be financed by a third party loan, Ilois Conlract tor Sale and Purchase ("Contract") IS cond.lioned on the B~
oblaintng a wrlllen commilment for Ihe loan wilhln NIA days from Ellectlve Dill.., al an tnlllalll\leresl rale nol to exceed %; term 01 yellS;
and in the principal amount of $ ,Buyer will make appllCBtion within days Irom ElIect.ve Dale, and use reasonable dihgence to oblaln tne loan com-
mitllnl and. thereafter, 10 meel the lerms and condilions of the commiltment and to close the loan, Buyer shall pay all loan expenses. II Buyer lails to obtain lhe loan commitment and,
promptly notities Seller in writing, or aller diligent ellort 'ails 10 meet Ihe lerms and condnlOlls 01 the commllment or 10 wal~e Buyer's riglllS under this subparagraph within the lime
5lated for obtaining the commitment, then either party may cancellhe Contracl and Buyer shall be reluoded the deposlt(s),
(b) Thll exisling mortgage described In Paragraph tUb) above has (CHECK (1) OR (2)): (1) 0 a variable interesl rale OR (2) 0 a fixed interesl rate 01 '4 per annum,
At lime ot \ille transter some fixed interesl rates are subject 10 increase, II Increased, the rale shall nol exceed ... per annum. Seller shall, within
da)'$ 'rom Effective Dale, furnish a slalement Irom all mor1gagee-s staling pllnclPal balances, method 01 payment. II,leresl rate and Sldlus 01 morlgages. /I Buyer haS agreed to assume
a mortgage which requires approval ot Buyer by lhe mortgagee lor assumpllon, Ihen Buyer srlllll promplly oblalll "II reQu"ed appllcallons and will dlllgenlly complete and relurn them
10 the mortgagee. Any mortgagee charge(s) 00110 exceed $ shall be paid by (if not filled in, equally dlvidedl, It the Buyer is nol accepted
by mortgagee or the requirements tor assumption are not in accordance wilh lhe terms 01 the Contract or mOrlgagee mdkeS a cllargc In excess of the slaled amount. Seller or
Buyer may rescind this Contract by. ~rompl wrillen notice to lhe other party unless eilher elects to pay lhe Increase ill Interest rate or excess mortgagee charges. '
V. TITLE EVIDENCE: At least ~ days before closing dale, Seller shall, at Seller's expense, delrver to Buyer or Buyer's allorney, in accordance wllh Standard A, ICheck' (1)
or(2)):(1) Dabstractof.illeOR(2l~lilleinsurancecommitment. or bt2fore Mat-ch 29 1991 .
VI. CLOSING DATE: This transaction shall be closed and the deed and other closing papers dehvered on , unle~s extended by Olher provisions of Contract.
VII. RESTRICTIONS; EASEMENTS: LIMITATIONS: Buyer shall take tille sub/ect 10: zoning, restriclions, prohrbiloons and olher requirements imposed by governmental authOrily; reslrictions
and maller5 appearing on the pial or otherwise common 10 the subdiviSIon; publIC uWny easements 0' record lea~emenls are to be localed conltguous to Huai Property lines and
not more than 10 feet in width as to the rear or lront hnes and 7 If, leet In widlh as to It,., skle lines, unless oltlerwlse speCified Mrein); taxes lor year 01 ClOSing and subl8Qvent
years; assumed mortgal,les and purchase mOlley mortoagas, it any; other:
provided, lhat thera exists at closing no violation 01 the loregoing and none 01 them prevenls use 01 Real Property lor CCll1ll:'rC 13 1 purpose(sl.
VIII. OCCUPANCY: Seller warrants thai thare are no panics in occupancy olher than Seller, but if Property is Inlended to be rented or occupied beyond Clos,ng, the tact and terms
thereof Shall be atated herllin, and the tenanlls) or occupants dIsclOsed pursuant 10 Standard F, Seller agrees 10 deliver OCCUp.lllCY 01 Property at tIme 01 clOSing unless otherwise
Silled herein, II occupancy is to be delivered before CIQliing, Buyer assumes all IIsk 01 loss 10 Property trom date 01 occupancy, stlall be fes~onslble and liable tor malnlenance Irom
thai date, and ahall be deemed 10 have acc~tad PrOPlilI't!"in \tIIl1I ex.Stlng C.ondltlon as 01 time 01 laking occupa"cy unless otl)erwlse Slaled herern or In a separate writing,
IX. TYPEWRITTEN OR HANDWRITTEN PROVISIONS: Typewrillen or hanclwllllen prol/lSlOns shall control all printod prOVisions 01 Contract in conflict with lI,cm,
X. INSULATION RIDER: If Contract is utilized tor the ~Ie of a new residence, lhe Insulahon Rider or eQuivaJanl may be allaclled,
XI. COASTAL CONSTRUCTION CONTROL LINE ("CCCL") RIDER: If Contract IS uhllzed lor the sale 01 Property allecled by the CCCL, Chapler 161, F,S.. (1985), as amendad,
shall apply and the CCCL Rider or .qul~lIlent may be auached 10 this Contracl,
XII. FOR ~IGNINVESTMENT IN REAL PROPERTY TAX ACT ("FIRPTA"' RIDER: The parties shall compl,' w'lh the pro~ISlons of FIRPTA and applICable regulatIOns which could
reQuira Seller to provide additional cash al clOSIng to meel wlthholQlng reCiu,reinenls, and the FIRPTA R.der or eQul~"lenl may be attached to thIS Conlr,act.
, The Seller agrees not to Wl.thdraw this offer to sell
XIII. ASSIQNABIUTY: (CHECK (1) or (2)): Buyer (1) 0 may aSSIgn OR (2) rn may not aSSign Contract. prim: t<? it appearing before the City of Clearwater,
XIV. SPECIAL CLAUSES: (CHECK (1) or (2)): Addendum (1 )&'is allached OR (2) gg is nol appltcatJle, W11IllSSlOl1 [or apprOViJ] on Febn.aary 21, 1991.
THIS IS INTENDED TO BE A LEGALLY BINDING CONTRACT.
IF NOT FULLY UNDERSTOOD, SEEK THE ADVICE OF AN ATTORNEY PHIOR TO SIGNING.
THIS FORM HAS BEEN APPROVED BY Hk FLORIDA ASSOCIATION OF REALTORS AND Till. FLORIDA BAR
Approval does not constitute Jill" O(Jllllon thai an)' at Inti. 'erms and condltlOflS III /filS Contract should /)(! accepwd by /l1e panies m a pQrticular lIansaction,
and ConrJitlonS SIlou/d be (Iego"alecl-J)~d &JPOIl /he respec/,ve ",wresls, olJjecllVes and bar9ainmg pOSit lOllS 01 all ,nterested persO(l5.
COPYRIGHT 1966 BY TI'IE FLORIDA BAR AND THE FLOHID/, ASSOCIATION OF FiEALTOfl$, IIJC .
- - - - - - - - - - -
Terms
_~?;_Dale
.3jr/'l/ Date
-1E/fL !.Jale
3!~/71 Date
I r
DePosit(s) under Paragraph II rec 'ived: F OTJ..;eA THAN CASH, THEN SUbJECT TO CLEARANCE. ___" (Escrow Agent)
BROKER'S FEE: (CHECK & COMPLETE THE ONE APPLICABLE) B\' '
)( IF A LISTING AGREEMENT IS CURRENTlY IN EFFECT:
OR Saller agrees to pay theBiOker named belo,;ziilciudlng cooperalinll sub.agen's named, accordlllg 10 the lerms 01 1\n c,,"lrng "cparate IrSllng agreemcnt
o IF NO LISTING AGREEMENT fS CURRENTLY IN EFFECT:
/ /J!>eller shall pay the Broker named O8low, al tllne OICIOSII\ij, frorll lh~ dlstJursernenls 01 I"" plUcecd~ 01 Ille s"le, Wrrll,en""llon In the amount 01 (COMPLETE ONLY ONE)
~ .... of gross purchase price OR S ,10/ brok"r s servl(.es In ellecl,n>! "'" salc llY 111"11119 IlIe buy", r",,(Jy, wdi"'IJ ami able 10 purchase pursuanllo the foregoll'l\l
Conlract. If Buyer fails to perlorm and deposlt(s) is relaor,ed, 50... thereof, but not exceeding Ihe Broker's lee atlOve provIlI.,d, shall be pilld Broker, as tull con"Oerallon for Broker s
serv'ces including costs expended by Broker, llnd It,e [,,,ldllCe Slldll ~ paid 10 $(,11", II the II"IIs,,~llon shall nol clo~e l)ecau~e 01 refusal or la,'ur... of Seller 1(1 perlorm Seller shall
;lay the lull lee to Broker on demand. In dny \rlll'dlr('" ""''''9 Oul 01 Iht' COlllr"cl (.("'CI'II""9 Ilk' brc,he,s r"e, Ih" plH~'orlrng pdrly 511,,11 'eGover rCilsollalJle allo.rle\' tces and COStS
_ /J ~__lr2, /J/U. J!JlA
W:Jt~~"::: (5"""r) I~
,"ocial Secunly or Td" W." 26')-4o-C)L~j 3
~o..
._.__Oale
7u'C1liJrHin(.T;T~~~.-;---
$OCldl Sccunly or Tax I,D. /1
P1FlN ..~ E OW R f! D S
!llrm ndnw 01 Ej,u",\.>r I
E~RLTf
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ADDENDUM TO CONTRACT FOR SALE AND PURCHASE
rI ..:..
This addendum made and entered into this
day
of
1991, is attached and/or made a
part of the Offer to Purchase and Contract for SAle
dated
1991 between CITY OF CLEARWATER,
FLORIDA Buyer, and ALICE M. RAY, RUTH M. MILLS, ARTHUR
MILLER, JR., GERTRUDE M. CLARK, ANDREW MIl.LER AND
PRANCES L. DOBY, SELLERS, for that certain property
described as Lots 8 and 9 of original Lot 2 of the R. H.
Padgett Subdivision as recroded in Plat Book 5, Page 27
of the Public Records of Hillsborough County, Florida of
which Pinellas County was formerly a part and revised
Plat as recorded' in Plat Book 4, Page 32 of the Public
.
Records of Pinellas County, Florida less a triangle in
the Southwest corner of Lot 8 contining 1035 square feet
.:.
which is dedicated
Date oo/~1(
Date ~ /:5 / r/ '
I ,.
..-..... ~.
right-of-way for Washington Avenue.
~~~1L'/~
AJZLtRa~1 ~
Ruth M. Mills
Date
Date .2/ r /1/
, ~
Arthur Miller, Jr.
It-;f;~ ~ ~~I ~6Ar
Gertrude~M. Clar
Date
Andrew Miller
Dat~<
;
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Frances L. Doby
~
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MIS (RfG)
OMB No 2502-0265
A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT B, TYPE OF LOAN:
1. o FHA 2. o FMHA 3, o CONV, UNINS.
4, OVA 5. o CONV. INS.
6, FILE NUMBER 17. LOAN NUMBER
91030091
8. MORTG, INS, CASE NO,
SETTLEMENT STATEMENT
C, NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p,o,c,)" were paid outside the closing: they are shown here for informational purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER E, NAME AND ADDRESS OF SELLU F. NAME AND ADDRESS OF LENDER
GERTRUDE M. CLARK ,
CITY OF CLEARWATER RUTH M. MILLS
ARTHUR MILLER, JR. '
ALICE MAY RAY CASH TRANSACTION
ANDREW MILLER
FRANCES DOBY
G, PROPERTY lOCATION H, SETTLEMENT AGENT I. SETTLEMENT DATE:
LOTS 8 & 9 OF RE-SUB OF LOT STEWART TITLE COMPANY OF CLEARWATER, INC.
2 OF THE REVISED MAP OF R.H. MARCH 28, 1991
PADGETT"S SUBDIVISION PLACE OF SETTLEMENT
1290 COURT STREET, CLEARWATER, FL 34616 87th DAY OF YEAR
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
1'01 Contract sales price 75 000.00 401. Contract sales price 75 000.00
102. Personal property 402 Personal property
103. Settlement charges to borrow (line '400) q,OO 403
104, 404.
-
105. 405.
Adjustments for items paid by seller in advance: Adjustments for items paid by seller in advance:
106. City /lown taxes 10 406. City/town laxes 10
,.,
107. County taxes to 407. Counly taxes to
108. Assessments to 408 Assessments to
109, 409
110. 410.
111 411
-
112 412
120. GROSS AMOUNT DUE FROM BORROWER: 75,009.00 420. GROSS AMOUNT DUE TO SELLER: 75,000.00
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500, REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money -(). 501 Excess depOSit (see instructIOns)
202, Principal amount of new loan(s) 502 Settlement charges 10 seller (line '400) 8 651. 50
203. Existing loan(s) taken subject to 503. Existing loan(sltaken sublectlo
204, 504. Payoff of lirst mortgage loan -0-
205 505 Payoff 01 second mortgage loan
206. 506
207 507
208. 508
209. 509,
Adjustments for items unpaid by seller: Adjustments for items unpaid by seller:
210, City /lown taxes to 510, City /town taxes to
211, County taxes to 511. County taxes 10
212, Assessments to 512. Assessments to
213. 513 LOT 8 TAX 1/1/91 - 3/28/91 83.88
214. 514 LOT 9 TAX 1/1/91 - 3/28/91 110.39
215. 515
216. 516.
217 517.
218, 518.
219, 519.
220. TOTAL PAID BY/FOR BORROWER: -0- 520. TOTAL REDUCTION AMOUNT DUE SELLER: 8,845.77
300, CASH AT SETTLMENT FROM/TO BORROWER: 600, CASH AT SETTLEMENT TO/FROM SELLER:
301 Gross amount due from borrower (line 120) 75,009.00 601, Gross amount due to seller (line 420) 75,000.00
302. Less amounts paid by Ifor borrower (line 220) -0- 602, Less total reductions in amount due seller (line 520) 8,845.77
303. CASH I~ FROM) ~J{BORROWER: 75,009.00 603. CASH nrO)lrnDD61l SELLER: 66,154.23
CASHIERS CHECK TO STEWART TITLE COMPANY
HUD-l
RESPA, HB 4305.2
nRTV~R'S TTrFNS~ ~ snrT~T
('r'....'Tf' Trr'T lTf1"',oTlr"n('I ......'r'i-"T'.'.
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M /5 LOI Pag&~2
PAGE 2 OF OMB No, 2502.0265
PAID FROM PAID FROM
L. SETTLEMENT CHARGES BORROWER'S SELLER'S
FUNDS FUNDS
7ill! TO>>AL SALES/BROKER'S COMMISSION Based on price $ 75.000.00 @ HI %= 7 ')00 00 AT SETTLEMENT AT SETTLEMENT
Oivision ot commissIon (line 700) as follows:
701$ 7,500.00 to BLAN EDWARDS RF.AT, F.STATF.
702. $ to
703. Commission paid at seUlement 7 500.00
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN.
801. Loan Origination fee %
802. Loan Discount %
803. Appraisal Fee to
804. Credit Report to
805. Lende(s inspection lee
806. Mortgage Insurance application lee to
807. Assumption Fee
808.
809
810
811.
900. ITEMS REQUIRED BY LENDER TO BE PAlO IN ADVANCE,
901. Interest from to @$ /dav
902. Mortgage insurance premium for mo, to
903. Hazard insurance premium for Vrs. to
904. Vrs, to
905.
1000. RESERVES DEPOSITED WITH LENDER
1001 Haza,d insurance mo,@$ per mo '.
1002. MOJlgage insurance mO.@$ per mo. "
1003. City properly taxes mO,@$ per mo
1004. County property taxes mO.@$ per mo.
1005. Annual assessments (Maint.) mO.@$ per mo
1006. mo,@$ per mo,
1007. mo @$ peL mo.
1008. mo @$ per mo.
1100. TITLE CHARGES:
1101. SeUlement or closing fee to
1102. Abslract or title search to STC 100.00
1103 Title examination to
1104. T,Ue insurance binder to
1105. Document preparation to
1106, NOlarv fees to
f--,
1107. Allornev's fees to to
(includes above ilems No.. ~S- .~~~)'~"'~'~~"
1108. Title insurance (1101) to STEWART TITLE COMPANY OF CLEARWATER INC. 532.00
(includes above items No.:
1109. Lende(s coverage $
1110. Owne(s coverage $ 75.000.00
1111
1112
1113
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording lees: Oeed $ 9.00 Mortgage $ Releases $ g.OO
1202. Citv/countv tax/stamps: Oeed $ Mortgage $
1203 State tax/stamps: Deed $ 412.50 Morlgage $ 412.50
1204 RECORD AFFIDAVIT ARTHUR M. MILLER. JR. 6.00
1205 RECORD AFFIDAVIT ANDREW MILLER 6.00
1300 ADDITIONAL SETTlEMENT CHARGES
1301 Survey to POC
1302. Pest inspection to NONE
1303 FEDERAL EXPRESS CLOSING DOCUMENTS & PROCEEDS 90.00
1304 CITY OF CLEARWATER-LIEN SEARCH 5.00
1305
1400. TOTAL SETTlEMENT CHARGES (entered on lines 103, Sect/on J and 502, Section K) gOO A f,C;1 C;O
CERTIFICATION: I ha~1;t.mt7t~ ~~ent Statement and to the best 01 mv knowledge and belief, it is a true and accurate statement of all receipts and disb~em~ade omccount or bV me in this transaction, I further certilv
that I have received a c __, '/;,oUI tatem n, ~ /Yk}"" ~/A
'/\01 /)., RUTH M. MILLS ./
I or: 'LllTI U1' ARTHlTR MTT.T,F.R ,TR I ~ '"'"1'7 J '1-1 "-''V V.... ( .J"./'
Sellers A~! ~f~r V RAY
a true and accurate account of Ihe funds Wl\lfff)~fft.Ye h or will htols6ursud )
MARCH 28,
1991
Selllement Ajjent Date
SelLER'S AND/OR PURCHASER' ATEMENT Seller's and Purchaser's signature hereon acknowledges hisllheir appro',al ollax prorations and signifies their underslanding that prorations were based ontaxes for the preceding vear, or estimates
lor the current year, and in the event 01 any change lor the current year, all necessary adjustments musl be made between Seller and Purchaser; likewise any default in delinquent taxes will be reimbursed to Title Company bV the Seller.
Title Company, in its capacity as Escrow Agent, is and has been authorized 10 deposit alllunds it receives in this transaction in any financial institution, whether affiliated or not. Such tinancial institution may provide Title Company computer
."ounling and audit services drrectlv or through a separateentilV which, if affiliated WIth Title Company, may charge the "nancial.nst.tut.on reasonable and proper compensat'on therefore and retain any prolits therefrom, AnV escrow lees paid bV any
p.,ty ,nvulved '" this transaction shall onlv be lor checkwriting and input to the computers. but not for aforesaid accounting and aud,t services. Title Company shall not be liable for any interest or other charges on the earnest money and shall be under no
Juty' (ll i:w~st or reinvest funds held by it at any time. Sellers and Purchasers here~y acknow,ledgeand consent _to the deposltoflhe escrow mOOdY in financlal,institutlons with which Title Compal~Y has, or,may have other banking relalionshipsand further
LJ11;il,:fll to IIltl rtltliollon by Title COrTlpany and/or its iSffiliattis of any and all benel :i (in ludlOlJ a vantageous Interest rales on loans) Tille Cllmp.wy andlor Its aftilldtes may receive from such hnanclallOstltutions by reasonot their maintenance of said
(;;:.;..J ()W dCCOUllls iJ!t
'I_lId, ~.i:HtjeS ha'oJll ',tdiJ the above ~IHltenct:s, recognize thill .' liO. s r -n r8 m' l j a . and recognize HUe compa"tjtiJ\~~~e 51St BY .
PIJ'd'PMB~JlueriY-lJFet;EARW0'. .,..., ".- ' ~.~eRTRrTDEM-:-r.T-^RK7~~:/~L~l-7-:rt-~- Li~'~
MIS LDt Page 2
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PAGE 2 OF OMB No, 2502-0265
"
PAID FROM PAID FROM
. L. SETTLEMENT CHARGES BORROWER'S SELLER'S
FUNDS FUNDS
700. TDT~ SALES/BROKER'S COMMISSION Based on prica I 75 ()('In nn @ 1() %= 7 '\()() ()() AT SETTLEMENT AT SETTLEMENT
DIvision of commission (line 700j as follows:
701$ 7 c:nn nn to RT.AN 1)J;'AT
702. $ to
703. Commission paid at seltlement 7 500.00
704.
800.ITEMS PAYABLE IN CONNECTION WITH LOAN.
801. Loan Origination fee %
802. Loan Discount %
803. Appraisal Fee to
804, Credit Report to
805. Lender's inspection fee -
806. Mortgage Insurance application fee to
807. Assumption Fee -
808,
809.
810.
811
9OO.ITEMS REQUIREO BY LENDER TO BE PAID IN ADVANCE.
901. Interest Irom to @$ Iday
902. Mortgage insurance premium for mo. 10
903, Hazard insurance premium for yrs, 10
904 yrs. to
905
1000 RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance mO.@$ per mo
1002 Mortgage insurance mO,@$ per mo
1003. Cily property taxes mO,@$ per mo,
1004. County property taxes mO.@$ per mo.
1005. Annual assessments (Maint,) mo,@$ per mo.
1006. mo,@$ per mo,
1007. 1110@$ per.mo.
1008. mO.@$ per mo.
1100 TITlE CHARGES:
1101. Settlement or closing lee 10
1102. Abslract or tille search to STC 100.00
1103. Tille examination to
1104. Tille insurance binder to
1105. Documenl preparation to
1106. Notary fees to
1107. Attorney's fees 10 10
(includes above items No.. ."<'
1108. Tille insurance (1101) to STEWART TITLE COMPANY OF CLEARWATER INC. 532.00
1--,
(includes above items No.: "
1109. Lender's coverage $
1110. Owner's coverage $ 75.000.00
1111
1112
1113,
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed $ 9.00 Mortgage $ Releases $ q,OO
1202. Citylcounty lax/stamps: Deed $ Mortgage $
1203, Slate tax/stamps: Deed $ 412.50 Mortgage $ 412.50
1204. RECORD AFFIDAVIT ARTHUR M. MILLER JR. 6.00
1205 RECORD AFFIDAVIT ANDREW MILLER 0- .A?A t7d", ~'YJ?-,"/hA ~ 6.00
1300. ADDITIONAL SETTlEMENT CHARGES
1301. Survey to POC
1302. Pest inspection to NONE
1303. FEDERAL EXPRESS CLOSING DOCUMENTS & PROCEEDS 90.00
1304 CITY OF CLEARWATER-LIEN SEARCH 5.00
1305.
1400 TOTAL SETTLEMENT CHARGES (entered on lines 103, SectIon J and 502, SectIOn K) Q ()() A /';t:;1 t:;n
CERTIFICATION: I hav~ CllrefUlIuevie~~ .I'e HUDJ1.Sett18lllenl Slatement and 10 the best ot my knowledge and belief, it is a Irue and accurate slalement of all receipts and disbursemenls made on my accounl or by me in this transaction, I further certify
Ihatl have received a -1 Selll e~~te~
III j/ A . I, 11.--1 l><> RUTH M. MILLS
Ior: It ;n:'I "( Jl'V ARTHUR MILLER, JR.
t.
Borrowers. '. . Sellers A1J C E MA,X",Jlf Y
~~~~~~ besl uf my knowledge, the HUO-l Settlement S1alement which I have prepared IS a true and accurate account 01 the funds 1~ffiiNe'N't.?JY'~~ o~~6tJrStld by the undersigned a5 par1 ollhe settlement of this lransaction
MARCH 28, lqCJl
Seutemenl A.llent Dale
SelLER'S ANu/OR PURCHASER'S STATEMENT Seller's and Purchaser's signature hereon acknowledges hisltheir approval of tax prorations and signi'ies their underslanding thai prorations were based on taxes for !he preceding year, or eslimates
'or the curren' year, and in the event 0' any change lor 'he current year, all necessary adjuslments must be made between Seller and Purchaser: likewise any default in delinquent taxes will be reimbursed to Title Company by the Seller.
Title Company, in its capacity as Escrow Agen!. is and has been authorized to depOSit all funds it receives in this transaction in any 'inancial institution, whether aNiliated or not. Such financial institution may provide Title Company compuler
.ccountlng and. audit services directly or through a separate entity which, i' aNiliated with Title Company, may charge the financial Inslttulton reasonable and proper compensation there'ore and retain any profits therefrom, Any escrow fees paid by any
party involved In this transaction shall only be for checkwriting and inpul to Ihe computers. but not 'or aforesaid accounti~ and audit services. Title Company shall not be liable for any interest or other charges on the earnest money and shall be under no
duly 10 inv.st or reinvest funds held by it a any time. Sellers and Purchasers hereby aCknowledge and consent.to the deposlI of the escrow money in financial institutions with which Tille Company has or may have other bankin~ relationships and further
~~~I('~~Ht~~;'f~~::J~...n.p r:tbY.. :. il..I..: c:::::ny ::/0:;~~~:1;~1 of a:y ana~:~:;:~:I::~:~i:~vaag::g~oo~::~~~:: ::::::~,~:~~~ :::::;;~;;~:l~;~;~ receive from such finanCial inst.lutions by reason 0 Iheir maintenance 01 said
i'urcnf'5'f3~rrolff1. A~] --"~ Sellers -
GERTRUDE M. r.T.^RK
MiS LDI P~gP 2
.
.
. ---------
~ PAID FROM PAlO FROM
, L. SETTLEMENT CHARGES BORROWER'S SElLER'S
. FUNOS FUNOS
70ll UitAl SALES/BROKER'S COMMISSION Based on price S 75 nnn nn @ 1 () %= 7 ')()(),()() AT SETTlEMENT A T SETTlEMENT
Division of commission (line 7oo) as follows: ~---,---
701$ 7 500. Q!L....~-__!~____BLAK_EDWARDS-REAL.__ESTAT.E....____,______ -.-.---- ---
702, S 10 .-
---~~----- ----_._-_.~-
703. Commission paid at settlement 7.500.00
704.
800.ITEMS PAYABLE IN CONNECTION WITH LOAN.
801, Loan Origination fee %
802. Loan Discount %
803. Appraisal Fee to
804, Credil Report to
805, Lender's inspection fee
806, Mortgage Insurance application fee to
807, Assumption Fee
808,
809,
810,
81l.
9OO,lTEMS REQUIRED BY LENDER TO BE PAlO IN ADVANCE,
901, Interest from to @S /day
902, Mortgage insurance premium for mo, to
903, Hazard insurance premium for yrs, to
904, yrs. 10
905,
1000, RESERVES DEPOSITED WITH LENDER
1001, Hazard insurance mo @S per mo.
1002, Mortgage insurance mo @S per mo, ~ .
,:,.lj; , '
1003, City property taxes mo @S per mo.
"
1004. Counly property taxes mo,@S per mo.
1005, Annual assessments (Main!.) mo @S per mo. .t
mo,@S 'j'"
1006, per mo,
1007. mO.@$ per.mo. :
1008, mo,@S per mo, c'
, . ~
1100, TITlE CHARGES:
1101, Settlement or closing fee 10
1102. Abstract or tille search to STC 100.00
1103, Tille examination 10
1104, Tille insurance binder to
1105. Document preparation to
1106. Nolary tees to
1107. AlIorney's fees to to
(inc/udes above items No..
1108. Title insurance (1101) to STEWART TITLE COMPANY OF CLEARWATER INC. 532.00
(includes above items No.:
1109, Lender's coverage S
1110, Owner's coverage S 75.000.00 ' ./
. ,
111l.
1112.
1113,
1200 GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed S 9.00 Mortgage S Releases S Q.OO
1202. City/county tax/stamps: Deed S Mortgage S
1203. Stale tax/stamps: Deed S 412.50 Mortgage S 412.50
1204, RECORD AFFIDAVIT ARTHUR M. MILLER JR. 6.00
1205. RECORD AFFIDAVIT ANDREW MILLER 6.00
1300,ADDITIONAL SETTlEMENT CHARGES -
130l. Survey to POC:
1302, Pest inspection to NONE
1303. FEDERAL EXPRESS CLOSING DOCUMENTS & PROCEEDS 90.00
1304. CITY OF CLEARWATER-LIEN SEARCH 5.00
1305.
1400. TOTAL SETTLEMENT CHARGES (entered on lines 103, Sectton J and 502, SectIon K) Q()() R f,'il 'i()
CERTIFICATION: Iha~~'/)l:;?a. ~rrement Statement and to the bestol my knowledoeand belief, Ills a true and acaJrate statement of all receipts and disbursements made on my account or by me In this transacllon,llurthercertlfy
that I have received a c r / m State :WM ~
RUTH M. MILLS
1: OT: . ij I'JT t:7r ARTIDJR MILLER, JR.
PAGE 2 OF OMB No 2502-02E
Borrowers
To the best of my knowledge, the HUQ,I Settlement Slatement which I have prepared is a true and accurate account 01 the funds 1~
Mt\X, be~l~;rsed by the undersigned as part of the settlement of this Iransaclion
MARCH 28, lqq]
-~~ ~
SElLEll'1I AND/OR PURCHASER'S STATEMENT Seller's and Purchaser's signature hereon acknowledges his/their approval of tax prorations and signllles their understanding that prorations were based on taxes for the preceding year, or estimates
lor the current year, and In the event of any change for the current year, all necessary adjustments must be made between Seller and Purchaser; likewise any delault in delinquent taxes will be reimbursed to TiUe Company by, the Seller,
TItle Company, In its capacity, as Escrow Agenl. Is and has been authorized to deposit alllunds II receives In this transac:tion In any financial Institution, whether alllllated or not. Such financial Institution may provide TIt e Company computer
accounting and audll services d rectly or through a separate entity which, II alllllated with Title Company, may charge the financial institution reasonable and proper compensation therelore and r.taln any profits therefrom. Any escrow lees paid by any
party Involved In this transacUon shall only be lor checkwrltlng and input to the computers, but not for aforesaid accounUng and audit services, ntleCompany shall not be liable for any Interest or other charges on the earnest money and shall be under no
duty to Invest or reinvest funds held by it al any time, Sellers and Purchasers hereby acknowledge and consent to the deposit of the escrow money In IInanciallnstitutions with which Title Company has or may' have other bankln relationships and lurther
consent to the retention by Title Company and/or its alllllat of any and all benefits (Including advantageous Interest rates on loans) TiUe Company and/or its affiliates may receive from such flnanclallnslttutions by reason eir maintenance of said
escrow accounts. ~ ~ ~
The parties have read th . her.ln are material, agrll8 to same, and recognize Title Compa~R'Jl~~ ~ stl'b B ~) .
Purchr6sra~rroe"t' ' Sellers Y ~_~ -' -< _ ___
WARIIIS: U Is a rl
AL T A O;'Nner's Policy - Form B - Amended 10.
.
POLICY OF TITLE INSURANCE ISSUED BY
91030019
STEWART TITLE
GUARANTY COMPANY
SUBJECT TO THE EXCLUSIONS FROM COV
THE PROVISIONS OF THE CONDITIONS
COMPANY, a corporation of Galveston, Texas,
Schedu Ie A, against loss or damage, not exceedil10
fees and expenses which the Company may beco~
reason of:
1, Title to the estate or interest desc'
2, Any defect in or lien or encumbra
3, Lack of a right of access to and fro
4. Unmarketability of such title
IN WITNESS WHEREOF, Stewart Ti
duly authorized officers as of Date of Polic~
IONS CONTAINED IN SCHEDULE BAND
HEREOF, STEWART TITLE GUARANTY
in called the any, insures, as of Date of Policy shown in
amount otiNurance stated in Schedule A, and costs, attorneys'
ted to pay hereunder, sustained or incurred by the insured by
than as stated therein;
is policy to be signed and sealed by its
~~~~
W~/$~
Chairman of the Board
C'"~d~
Aut~orized Signatory
President
Company
City, State
SanO/I)' (II ((miran
The following matters are expreSSly excluded from the coverage of this policy:
1. Any law, ordinance or governmental regulation (including but not limited to building and zoning ordinances) ~estricting or regulating or
prohibiting the occupancy, use or enjoyment of the land, or regulating the character, dimensions or location of any improvement now or
hereafter erected on the land, or prohibiting a separation in ownership or a reduction in the dimensions or area of the land, or the effect
of any violation of any such law, ordinance or governmental regulation.
2, Rights of eminent domain or governmental rights of police power unless notice of the exercise of such rights appears in the public
records at Date of Policy.
3. Defects, liens, encumbrances, adverse claims, or other matters (a) created, suffered, assumed or agreed to by the insured claimant; (b) not
known to the Company and not shown by the public records but known to the insured claimant either at Date of Policy or at the date
such claimant acquired an estate or interest insured by this policy and not disclosed in writing by the insured claimant to the Company
prior to the date such insured claimant became an insured hereunder; (c) resulting in no loss or damage to the insured claimant; (d)
attaching or created subsequent to Date of Policy; or (e) resulting in loss or damage which would not have been sustained if the insured
claimant had paid value for the estate or interest insured by this policy,
~~
-+------"""+'-.......,..-
Page 1 of 0 9902
Policy _ .
Serial No,
~~~~-----~~--
583038
001B
f
f
t
t
f,
t
t
f
1.
DEFINITION OF TERMS
COND1TIONS AND STIPULATIONS
The following terms when used in this policy mean:
(a) "insured": the insured named in Schedule A, and,
subje~t to any rights or defenses the Company may have
against the named insured, those who succeed to the
interest of such insured by operation of law as distinguished
from purchase including, but not limited to, heirs, dis.
tributees, devisees, survivors, personal representatives, next
of kin, or corporate or fiduciary successors.
(b) "insured claimant": an insured claiming loss or
damage hereunder.
(c) "knowledge": actual knowledge, not constructive
knowledge or notice which may be imputed to an insured
by reason of any public records,
(d) "land": the land described, specifically or by
reference in Schedule A, and improvements affixed thereto
which by law constitute real property; provided, however,
" the term "tand"does nohnctudeany property beyond the-
lines of the area specifically described or referred to in
Schedule A, nor any right, title, interest, estate or easement
in abutting streets, roads, avenues, alleys, lanes, ways or
waterways, but nothing herein shall modify or limit the
extent to which a right of access to and from the land is
insured by this policy.
(e) "mortgage": mortgage, deed of trust, trust deed, or
other security instrument.
(f) "public records": those records which by law
impart constructive notice of matters relating to said land,
2.
CONTINUATION OF INSURANCE AFTER CON-
VEYANCE OF TITLE
The coverage of this policy shall continue in force as of
Date of Policy in favor of an insured so long as such insured
retains an estate or interest in the land, or holds an
indebtedness secured by a purchase money mortgage given
by a purchaser from such insured, or so long as such insured
shall have liability by reason of covenants of warranty made
by such insured in any transfer or conveyance of such
estate or interest; provided, however, this policy shall not
continue in force in favor of any purchaser from such
insu red of either said estate or interest or the indebtedness
secured -I:iV aUpLJrCnase money mortgage given to sucfi~
insured.
3.
DEFENSE AND PROSECUTtON OF ACTIONS-
NOTICE OF CLAIM TO BE GIVEN BY AN INSURED
CLAIMANT
(a) The Company, at its own cost and without undue
delay, shall provide for the defense of an insured in all
litigation consisting of actions or proceedings commenced
against such insured, or a defense interposed against an
insured in an action to enforce a contract for a sale of its
estate or interest in said land, to the extent that such
litigation is founded upon an alleged defect, lien,
encumbrance, or other matter insured against by this
policy.
or interest as insured, and which might cause loss or damage
for which the Company may be liable by virtue of this
policy or, (iii) if title to the estate or interest, as insured, is
rejected as unmarketable. If such prompt notice shall not
be given to the Company, then as to such insured all
liability of the Company shall cease and terminate in regard
to the matter or matters for which such prompt notice is
required; provided, however, that failure to notify shall in
no case prejudice the rights of any such insured under this
pol icy unless the Company shall be prejudiced by such
failure and then only to the extent of such prejudice.
(c) The Company shall have the right at its own cost tc
institute and without undue delay prosecute any action 01
proceeding or to do any other act which in its opinion may
be necessary or desirable to establish the title to the estate
or interest as insured, and the Company may take any
appropriate action under the terms of this policy, whether
or not it shall be liable thereunder, and shall not thereby
concede liability or waiveaflyproviwn of-thisjJVli"y,----~-
(d) Whenever the Company shall have brought any
action or interposed a defense as requ ired or perm itted by
the provisions of this policy, the Company may pursue any
such I itigation to final determination by a court of
competent jurisdiction and expressly reserves the right, in
its sole discretion, to appeal from any adverse judgment or
order,
(e) In all cases where this policy permits or requires
the Company to prosecute or provide for the defense of
any action or proceeding, the insu red hereunder shall secure
to the Company the right to so prosecute or provide
defense in such action or proceeding, and all appeals
therein, and permit the Company to use, at its option, the
name of such insured for such purpose, Whenever requested
by the Company, such insured shall give the Company all
reasonable aid in any such action or proceeding, in effecting
settlement, securing evidence, obtaining witnesses, or pros-
ecuting or defending such action or proceeding, and the
Company shall reimburse such insured for any expense so
incurred,
4.
NOTICE OF LOSS - LIMITATION OF ACTION
I n add ition to the notices requ ired under paragraph
3Tb) of tnese Conditions and Stipulations, a statement in
writing of any loss or damage for which it is claimed the
Company is liable under this policy shall be furnished to
the Company within 90 days after such loss or damage shall
have been determined and no right of action shall accrue to
an insured claimant until 30 days after such statement shall
have been furnished, Failure to furnish such statement of
loss or damage shall terminate any liability of the Company
under this policy as to such loss or damage,
5.
OPTIONS TO
CLAIMS
PAY OR
OTHERWISE
SETTLE
The Company shall have the option to payor otherwise
settle for or in the name of an insured claimant any claim
insured against or to terminate all liability and obligations
(b) The insured shall notify the Company promptly in of the Company hereunder by paying or tendering payment
writing (i) in case any action or proceeding is begun or of the amount of insurance under this policy together with
defense is interposed as set forth in (a) above, (ii) in case any costs, attorneys' fees and expenses incurred up to the
koow!..e.dge ~hall cOf!1e to an insured hereunder of any claim time of such payment or tender of Qayment, by the il'isured )
of title or interest which is adverse to the title to the estate claimant and authorized by 'the Co';pany.
entinued and concluded on last page of this P.)
.'
ALTA OWNER'S POLICY -Amended 101171.
.
mls
583038
SCHEDULE A
Order No,: 91030019
Policy No.: 0 - 9902 - 583038
Date of Policy: April 01, 1991
1. Name of Insured CITY OF CLEARWATER, FLORIDA
Amount of Insurance: $ 75, 000 . 00
2. The estate or interest in the land described herein and which is covered by this policy is:
Fee Simple
3. The estate or interest referred to herein is at Date of Policy vested in:
CITY OF CLEARWATER, FLORIDA
4. The land referred to in this policy is described as follows:
Lot 8 in Lot 2 of R.H. PADGETT'S SUBDIVISION of the Southeast
quarter of the Northwest quarter of Section 15, Township 29
South, Range 15 East, according to plat therof recorded in Plat
Book 2, Page 63, Public Records of Hillsborough County, Florida
of which Pinellas County was formerly a part, also according to
map or plat thereof, recorded in Plat Book 4, Page 32 of the
Public Records of Pinellas County, Florida.
Lot 9 of a re-subdivision of Lot 2 of THE REVISED MAP OF R.H.
PADGETT'S SUBDIVISION, of the Southeast quarter of the Northwest
quarter of Section 15, Township 29 South, Range 15 East,
according to the map or plat thereof as the same is recorded in
Plat Book 4, Page 32, Public Records of Pinellas County,
Florida. ALSO DESCRIBED AS:
Lots 8 and 9 of original Lot 2 of R.H. PADGETT SUBDIVISION as
recorded in Plat Book 5, Page 27 of the Public Records of
Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page 32 of the Public Records of Pinellas County, Florida LESS
the following described parcel.
Begin at Southeast corner of Lot 8 of original Lot 2 of R.H.
PADGETT SUBDIVISION Section 15, Township 29 South, RAnge 15
East, as recorded in Plat Book 5, Page 27 of the Public Records
of Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page 32 of the Public Records of Pinellas County, Florida, for
a point of beginning; go thence West along South lot line 45.5
feet to Westerly lot line of said lot, also being Easterly right
of way line of Washington Street; thence Northerly along said
right of way line 45.5 feet to a point; thence Southeasterly 65
feet to the point of beginning.
Page 2
STEWART TITLE
GUARANTY COMPANY
0012 - 70
AL TA OWNER'S POLICY
.
Order No.
.
~lUjUU1~
r ,..-
SCHEDULE B
.
9902
Policy No.: O-~-583038
This policy does not insure against loss or damage (and the company will not pay costs,attorneys'
fees or expenses) which arise by reason of:
delete Righ
2, Easements, or claims of easements, not shown by the public records,
3, Encroachments, overlaps, boundary line disputes, or other matters which would be disclosed by
an accurate survey and inspection of the premises,
delete4,
hed,
rds.
5. Community property, dower, curtesy, survivorship, or homestead rights, if any, of any spouse of
the insured,
6. Any titles or rights asserted by anyone including but not limited to persons, corporations,
governments or other entities, to tide lands, or lands comprising the shores or bottoms of
navigable rivers, lakes, bays, ocean or gulf, or lands beyond the line of the harbor or bulkhead
lines as established or changed by the United States Government or water rights, if any,
7. Taxes for the year 19 91 and thereafter.
2113 (Rev, 6-87)
Page 3
S~r:F~WAR~r ~I'I~rl..]~~
GUARANTY COMPANY
.ONDITIONS AND STIPULATIONS Contin.
(continued and concluded from reverse side of Policy Face) .~
. .
6. DETERMINATION AND PAYMENT OF LOSS
(a) The liability of the Company under this policy
shall in no case exceed the least of:
(j) the actual loss of the insured claimant; or
(ii) the amount of insurance stated in Schedule A.
(b) The Company will pay, in addition to any loss
insured against by this policy, all costs imposed upon an
insured in litigation carried on by the Company for such
insured, and all costs, attorneys' fees and expenses in
litigation carried on by such insured with the written
authorization of the Company,
(c) When liability has been definitely fixed in accord-
ance with the conditions of this policy, the loss or damage
shall be payable within 30 days thereafter.
7. LIMITATION OF LIABILITY
No claim shall arise or be maintainable under this
policy (a) if the Company, after having received notice of
an alleged defect, lien or encumbrance insured against
hereunder, by litigation or otherwise, removes such defect,
lien or encumbrance or establishes the title, as insured,
within a reasonable time after receipt of such notice; (b) in
the event of litigation until there has been a final
determination by a court of competent jurisdiction, and
disposition of all appeals therefrom, adverse to the title, as
insured, as provided in paragraph 3 hereof; or (c) for
liability voluntarily assumed by an insured in settling any
claim or suit without prior written consent of the Com-
pany.
8. REDUCTION OF LIABILITY
All payments under this policy, except payments made
for costs, attorneys' fees and expenses, shall reduce the
amount of the insurance pro tanto. No payment shall be
made without producing this policy for endorsement of
such payment unless the policy be lost or destroyed, in
which case proof of such loss or destruction shall be
.furnished to the satisfaction of the Company.
9. LIABILITY NONCUMULATIVE
It is expressly understood that the amount of insurance
under this policy shall be reduced by any amount the
Company may pay under any policy insuring either (a) a
mortgage shown or referred to in Schedule B hereof which
is a lien on the estate or interest covered by this policy, or
(b) a mortgage hereafter executed by an insured which is a
charge or lien on the estate or interest described or referred
to in Schedule A, and the amount so paid shall be deemed a
payment under this policy, The Company shall have the
option to apply to the payment of any such mortgages any
amount that otherwise would be payable hereunder to the
insured owner of the estate or interest covered by this
policy and the amount so paid shall be deemed a payment
under this policy to said insured owner,
10. APPORTIONMENT
If the land described in Schedule A consists of two or
more parcels which are not used as a single site, and a loss is
established affecting one or more of said parcels but not all,
the loss shall be computed and settled on a pro rata basis as
Valid Only If Schedules A and B are Attached.
'" .~
if the amount of insurance under this policy was divided
pro rata as to the value on Date of Policy of each separate
parcel to the whole, exclusive of any improvements made
subsequent to Date of Policy, unless a liability or value has
otherwise been agreed upon as to each such parcel by the
Company and the insured at the time of the issuance of this
policy and shown by an express statement herein or by an
endorsement attached hereto.
11. SUBROGATION UPON PAYMENT OR SETTLE-
MENT
Whenever the Company shall have settled a claim under
this policy, all right of subrogation shall vest in the
Company unaffected by any act of the insured claimant.
The Company shall be subrogated to and be entitled to all
rights and remedies which such insured claimant would
have had against any person or property in respect to such
claim had this policy not been issued, and if requested by
the Company, such insured claimant shall transfer to the
Company all rights and remedies against any person or
property necessary in order to perfect such right of
subrogation and shall permit the Company to use the name
of such insured claimant in any transaction or litigation
involving such rights or remedies. If the payment does not
cover the loss of such insu red claimant, the Company shall
be subrogated to such rights and remedies in the proportion
which said payment bears to the amount of said loss. If loss
should result from any act of such insured claimant, such
act shall not void this policy, but the Company, in that
event, shall be required to pay only that part of any losses
insured against hereunder which shall exceed the amount if
any, lost to the Company by reason of the impairment' of
the right of subrogation.
12. LIABILITY LIMITED TO THIS POLICY
This instrument together with all endorsements and
other instruments, if any, attached hereto by the Company
is the entire policy and contract between the insured and
the Company.
Any claim of loss or damage, whether or not based on
negligence, and which arises out of the status of the title to
the estate or interest covered hereby or any action asserting
such claim, shall be restricted to the provisions and
conditions and stipulations of this policy,
No amendment of or endorsement to this policy can be
made except by writing endorsed hereon or attached hereto
signed by either the President, a' Vice President, the
Secretary, an Assistant Secretary, or validating officer or
authorized signatory of the Company,
13. NOTICES, WHERE SENT
All notices required to be given the Company and any
statement in writing required to be furnished the Company
shall be addressed to it at its main office, P. 0, Box 2029,
Houston, Texas 77252.
14. The premium specified in Schedule A is the entire,
charge for acceptance of risk. It includes charges for
title search and exam ination if same is customary or
requ ired to be shown in the state in which the policy is
issued,
STEWART TITLE
GUARANTY COMPANY
f
A_~,~~i:an,-:~an'd ,!itle A~Sociati:n",com.=~t~ 19:_~,_==,===~=========..~~ac, ~
COMMITMENT FOR TITLE INSURANCE
ISSUED BY
91030019
"'1
jl
STEWART TITLE
GUARANTY COMPANY
STEWART TITLE GUARANTY COMPANY, A Texas Corporation, herein called the Company,
for a valuable consideration, hereby commits to issue its policy or policies of title insurance, as
identified in Schedule A, in favor of the proposed Insured named in Schedule A, as owner or mortgagee
of the estate or interest covered hereby in the land described or referred to in Schedule A, upon pay-
ment of the premiums and charges therefor; all subject to the provisions of Schedules A and B and to
the Conditions and Stipulations hereof.
This Commitment shall be effective onlY,^,~~~\~~~/identity of the proposed Insured and the
amount of the policy or policies committedf()ri~~\(~been inserted in Schedule A hereof by the
Company, either at the time of the issuance of this Commitment or by subsequent endorsement.
This Commitment is preliminary to the issuance of such policy or policies of title insurance and all
liability and obligations hereunder shall cease and terminate six months after the effective date hereof
or when the policy or policies committed for shall issue, whichever first occurs, provided that the
failure to issue such policy or policies is not the fault of the Company.
Signed under seal for the Company, but this Commitment shall not be valid or binding until it
bears an authorized Countersignature,
IN WITNESS WHEREOF, StewartTitl.e Guarjinty Company has caused its corporate name and
seal to be hereunto affixed by its duly authorized officers on the date shown in Schedule A.
STEWART TITLE
",~j/I!{U~
l'.~ '\\..........."f.~..
'!o.........oo;
~.... if~(.o.POIt.f;,.\
: ....... -*- '<iI.
: ';i.\ 1 9 0 8 il1
" }.. .*. .-.
X. . ~ .;:r...~...~.-;;-:., ,.i>
'~,
elAad$~
~~ ht~
Chairman of the Board
Co~~4~
Authorized Signatory
GUARANTY CUMPANY
President
Company
City, State
Serial No. C. 9912.71 7 7 6 2
"
~~======::-.::::::=..-::::===-.....::==.-=--=::::::::::::-..:::::-~:=:_:::-:::=::::::=~=:~:::..:- -=
."'==c,.,,.=."-=,,=c-=.=.c===.=.=.=""==--===.=,===...=..=~=.=======.:1
005N Rev, 3/78
,
.
.
rnls
SCHEDULE A
C-9912-717762
Your No,:
~ff"t;ve D.te of Comm;tmoo'
==r= March 12, 1991 at 5:00 P.M.
Commitment No.
Prepared For:
Inquiries Should be Directed to:
MIKELL L. ST.GERMAIN
Stewart Title Company of Clearwater
1290 Court Street
Clearwater, Florida 34616
(813) 441-2689
, , Policy or Policies to be issued:
Amount
(a) 0 ~L TA Owners Policy
$
75,000.00
Proposed Insured:
CITY OF CLEARWATER, FLORIDA
(b) 0 AL TA Loan Policy
$
Proposed Insured:
2. The estate or interest in the land described or referred to in this Commitment and covered herein is a Fee Simple.
3, Title to said estate or interest in said land is at the effective date hereof vested in:
RUTH M. MILLS; ARTHUR MILLER JR.; ALICE MAY RAY; ANDREW MILLER; FRANCES
DOBY and GERTRUDE M. CLARK
4 The land referred to in this Commitment is located in the County of PI NELLAS
State of FLORIDA and described as follows:
Lot 8 in Lot 2 of R.H. PADGETT'S SUBDIVISION of the Southeast
quarter of the Northwest quarter of Section 15, Township 29
South, Range 15 East, according to plat therof recorded in Plat
Book 2, Page 63, Public Records of Hillsborough County, Florida
of which Pinellas County was formerly a part, also according to
map or plat thereof, recorded in Plat Book 4, Page 32 of the
Public Records of Pinellas County, Florida.
Lot 9 of a re-subdivision of Lot 2 of THE REVISED MAP OF R.H.
PADGETT'S SUBDIVISION, of the Southeast quarter of the Northwest
quarter of Section 15, Township 29 South, Range 15 East,
according to the map or plat thereof as the same is recorded in
Plat Book 4, Page 32, Public Records of Pinellas County,
Continued on next page
Page 2 of 5 STEWART TITI--4E
GUARANTY COMPANY
2552
.
.
CONTINUATION SHEET
SCHEDULE_
A
Order Number:
Commitment Number:
91030019
C-9912-717762
PROPERTY DESCRIPTION CONTINUED:
Florida. ALSO DESCRIBED AS:
Lots 8 and 9 of original Lot 2 of R.H. PADGETT SUBDIVISION as
recorded in Plat Book 5, Page 27 of the Public Records of
Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page 32 of the Public Records of Pinellas County, Florida LESS
the following described parcel.
Begin at Southeast corner of Lot 8 of original Lot 2 of R.H.
PADGETT SUBDIVISION Section 15, Township 29 South, RAnge 15
East, as recorded in Plat Book 5, Page 27 of the Public Records
of Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page 32 of the Public Records of Pinellas County, Florida, for
a point of beginning; go thence West along South lot line 45.5.
feet to Westerly lot line of said lot, also being Easterly right
of way line of Washington Street; thence Northerly along said
right of way line 45.5 feet to a point; thence Southeasterly 65
feet to the Point of Beginning.
Page ---3. of 5
0055
STEWART TITI..E
GUARANTY COMPANY
.
.
CONTINUATION SHEET
SCHEDULE _
A
Order Number:
Commitment Number:
91030019
C-9912-717762
PROPERTY DESCRIPTION CONTINUED:
Florida. ALSO DESCRIBED AS:
Lots 8 and 9 of original Lot 2 of R.H. PADGETT SUBDIVISION as
recorded in Plat Book 5, Page 27 of the Public Records of
Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page 32 of the Public Records of Pinellas County, Florida LESS
the following described parcel.
Begin at Southeast corner of Lot 8 of original Lot 2 of R.H.
PADGETT SUBDIVISION Section 15, Township 29 South, RAnge 15
East, as recorded in Plat Book 5, Page 27 of the Public Records
of Hillsborough County, Florida, of which Pinellas County was
formerly a part, and revised plat as recorded in Plat Book 4,
Page\332-bf the Public Records of Pinellas County, Florida, for
a poitrt---6f beginning; go thence West along South lot line 45.5
feet to Westerly lot line of said lot, also being Easterly right
of way line of Washington Street; thence Northerly along said
right of way line 45.5 feet to a point; thence Southeasterly 65
feet to the Point of Beginning.
Page_ 3 of 5
STEWART Trl"'LE
0055
GUARANTY COMPANY
.
SCHEDULE B
.
ORDER NO:
91030019
Commitment Number:
C-9912-7177
I. The following are the requirements to be complied with:
1. Instruments necessary to create the estate or interest to be insured must be properly executed, delivered and duly filed for
record.
Valid photo identification (ie:
social security numbers required
transaction by the Insuror.
Driver's License, Passport) and
of all parties to the
Proper disposition of certified judgment from DORIS CAVANAG~,
for the use and benefit of NATIONWIDE INSURANCE COMPANY agalnst
ARTHUR MILLER, JR., filed June 25, 1976 in O.R. Book 4430, Page
2059 of the Public Records of Pinellas County, Florida.
Schedule B of tlie policy or policies to be issued will contain exceptions to the fo~~@/"~ U~fJf>sthB~ctJnepel~ciisposed
of to the satisfaction of the Company:
II.
1, Defects, liens, encumbrances, adverse claims or other matters, if any, created, first appearing in the pUblic records or
attaching subsequent to the effective date hereof but prior to the date the proposed Insured acquires for value of record the
estate or interest or mortgage thereon covered by this Commitment.
2, Standard Exceptions:
(a) Rights or claims of parties in possession not shown by the public records,
(b) Easements, or claims of easements, not shown by the public records,
(c) Encroachments, overlaps, boundary line disputes, or other matters which would be disclosed by an accurate survey
and inspection of the premises.
(d) Any lien, or right to a lien, for services, labor, or material hereto or hereafter furnished, imposed by law and not shown by
the public records.
(e) Rights of dower, homestead or other marital rights of the spouse, if any, of any individual insured,
(f) Any titles or rights asserted by anyone including but not limited to persons, corporations, governments or other entities,
to tide lands, or lands comprising the shores or bottoms of navigable rivers, lakes, bays, ocean or gulf, or lands beyond
the line of the harbor or bulkhead lines as established or changed by the United States Government or water rights, if any.
3, Special Exceptions:
(a) Taxes,
Subject to Taxes for the year 1991 and subsequent years, which
are not yet due and payable. Parcel No. 15/29/15/65214/002/0080
Gross Tax for the year 1990, $371.08.
Subject to Taxes for the year 1991 and subsequent years, which
are not yet due and payable. Parcel No. 15/29/15/65214/002/0090
Gross Tax for the year 1990, $487.58.
21 S3 (Rev, 3/80)
Page XX 4 of 5
S'I'E'VAU,T TI'I'LE
GU A RA NTY COMPA NY
.
.
,
. ,
CONTINUATION SHEET
Order Number:
SCHEDULE_
B
Commitment Number:
91030019
C-9912-717762
SCHEDULE B - PART I CONTINUED
Proper disposition of certified judgment from NATIONAL OPERATING
L.P., vs. ARTHUR M. MILLER, INC., a Florida corp. and ARTHUR M.
MILLER, jointly and severally, filed March 27, 1990 in O.R.
Book 7234, Page 872 of the Public Records of Pinellas County,
Florida.
Proper disposition of Federal Tax Lien against ARTHUR MILLER,
filed in O.R. Book 6248, Page 2019 of the Public Records of
Pinellas County, Florida.
Proper disposition of Welfare Lien against ANDY MILLER AND LEE
ANN ~ILLER, filed in O.R. Book 4315, page 1948 of the Public
Records of Pinellas County, Florida.
Warranty Deed to be executed from RUTH M. MILLS; ARTHUR MILLER,
JR.; ALICE MAY RAY; ANDREW MILLER; FRANCES DOBY and GERTRUDE M.
CLARK (showing marital status) to CITY OF CLEARWATER, FLORIDA~
Page -5 of 5
0055
STEWART TITI",E
GUARANTY COMPANY
----...-.- ..-",---;",,".~.-~--,-
.
.
CONDITIONS AND STIPULATIONS
1. The term mortgage, when used herein, shall include deed of trust, trust deed, or
other security instrument.
2. If the proposed Insured has or acquires actual knowledge of any defect, lien,
encumbrance, adverse claim or other matter affecting the estate or interest or
mortgage thereon covered by this Commitment other than those shown in
Schedule B hereof, and shall fail to disclose such knowledge to the Company in
writing, the Company shall be relieved from liability for any loss or damage
resulting from any act of reliance hereon to the extent the Company is prejudiced
by failure to so disclose such knowledge. If the proposed I nsured shall disclose such
knowledge to the Company, or if the Company otherwise acquires actual
knowledge of any such defect, lien, encumbrance, adverse claim or other matter,
the Company at its option may amend Schedule B of this Commitment
accordingly, but such amendment shall not relieve the Company from liability
previously incurred pursuant to paragraph 3 of these Conditions and Stipulations.
3. Liability of the Company under this Commitment shall be only to the named
proposed Insured and such parties included under the definition of Insured in the
form of policy or policies committed for and only for actual loss incurred in
reliance hereon in undertaking in good faith (a) to comply with the requirements
hereof, or (b) to eliminate exceptions shown in Schedule B, or (c) to acquire or
create the estate or interest or mortgage thereon covered by this Commitment. In
no event shall such liability exceed the amount stated in Schedule A for the policy
or policies committed for and such liability is subject to the insuring provisions and
the Conditions and Stipulations and the exclusions from coverage of the form of
policy or policies committed for in favor of the proposed Insured which are hereby
incorporated by reference and are made a part of this Commitment except as
expressly modified herein.
4. Any action or actions or rights of action that the proposed I nsured may have or
may bring against the Company arising out of the status of the title to the estate or
interest or the status of the mortgage thereon covered by this Commitment must
be based on and are subject to the provisions of this Commitment.
STE"W'ART TITLE
GU ARANTY COMPANY
All notices required to be given the Company and any statement in writing required to
be furnished the Company shall be addressed to it at P.O, Box 2029, Houston, Texas
77252, and identify this commitment by its printed COMMITMENT SERIAL NUM-
BE R which appears on the bottom of the front of the first page of this commitment.
COMMITMENT
FOR
TITLE INSURANCE
')
. ,
.
Sunctit, of Contract
'.
Issued by
STEWART TITLE
GUARANTY COMPANY
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I HEREBY CERTIFY THAT THE SURVEY REPRESENTED HEREON MEETS THE MINIMUM
REQUIREMENTS OF CHAPTER 21 HH-6, OF THE FLORIDA ADMINISTRATM CODE.
DATE: f-/5-- ~/
1fWf4"P "(~6" /.;"~ --?/
EVANS LAND SURVEYING
OWN. BY: JC$
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DUNEDIN, FLORIDA 34698 PH: 734 - 3821
6'c;1~/V'L?~~Y fc;:/~YcY
~d",.R/7~/EL7 Td
~ PREPARED FOR: .:::~/ )")/' a--=- ,;..':' E..4~""/t~/~?"?' SEC. /5 TWP. ~ RGE. ~
.::>/"C/(;::..p.r?T ,7.";-:::: a,~ .:"'LEA-<'/l~:;::.c~ ~~
..?:-=~<<A-:::r /7?E 6~A""4h7)// ,:;.1:;!-W~.-4'A/y/
A SURVEY OF: lDt 8 in lDt 2 of R.H. PADGE'IT'S SUBDIVISICN of the Southeast
quarter of the Northwest quarter of Section 15, Township 29 South, Range 15
East, according to plat therof recorded in Plat Book 2,. page 63, Public
Records of Hillslx>rough County, Florida, also according to map or plat thereof
~corded in Plat Book 4, page 32 of the Public Records of Pinellas County,
Florida;
AND
lDt 9 of a re-subdivisicn oflbt 2 of THE REVISED HAP OF R.H. PADGE'IT'S SUB-
DIVISICN, of the Southeast quarter of the Northwest quarter of Section 15,
Township 29 South, Range 15 East, according to the map or plat therof as the
sane is recorded in Plat Book 4, page 32, Public Records Of Pine lIas County,
Florida;
AISO KNavN AS
~,
lDts 8 & 9 of original lot 2 of R. H. Padgett Subdivision as recorded
in plat Book 5, page 27 of the Public Records of lI~llsborougll CoWlty, Florida, of
which Pinellas Connty was fonrerly a part, and revised plat as recorded in Plat Book
4, page 32 of the Public Records of Pinellas Connty, Florida LESS the following
described parcel.
,.
Begin at Southeast comer of lDt 8 of original lDt 2 of R. II. Padgett subdivision
Section 15, Township 29 South, Range 15 East,as recorded in Plat Book 5 page 27 of
the Public IEcords of Hillsbbrough Connty, Florida, of which Pinellas Connty was
formerly a part, and revised plat as recorded in Plat Book 4, page 32 of the Public
Records of Pinellas Connty, Florida, for a point of beginning: go thence West along
South lot line 45.5 feet to Westerly lot line of said lot, also being Easterly right
of way line of Washington Street; thence Northerly along said right of way line 45.5
feet to a point; thence Southeasterly 65 feet to the point of begirming; containing
1035 square feet, nore or less.
-.?~::.:.T .:;.-7 CJ/," Z
I HEREBY CERTIFY THAT THE SURVEY REPRESENTED HEREON MEETS THE MINIMUM
REQUIREMENTS OF CHAPTER 21 HH-6, OF THE FLORIDA ADMINISTRATIVE CODE.
DWN. BY: ./,::'5
INV. NO.7'/-/3't:?
EVANS LAND SURVEYING
?fdt? MAIN STREET - UNIT R
DUNEDIN, FLORIDA 34698 PH: 734 - 3821
8~~::~{/v~"qy .::7.;:/'~/,~y
DATE: 5-/.5- ~/
/"P'4'"V"<!<'".FP 4''''''''''' .5-?V'~ /
A"'/" 1::4'':&7 H'~"<'7,r L<,....,g<'!.....::....6::? .:::J'/-","'"
.
.
SlIlloily o{ CIIIlIf(/(:L
RONALD(RON)E.SOMERS
President
S'l"E"\V AR'r 'rI'I'LE
OF CLEARWATER
P.O. Box 2756
Clearwater. Florida 34617
(813) 441-2689
1290 Court Street
Clearwater. Florida 34616
.....',
Aill'HORIZATION AND ACKNOWl.EDGEl'1ENT FORM
Reference:
FILE NO.
91030091
LEGAL LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF
R.H. PADGETT"S SUBDIVISION
SELLER GERTRUDE M. CLARK; RUTH M. MILLS; ARTHUR MILLER, JR.;
ALlCE MAY RAY
BUYER
/
We hereby approve and acknowledge receipt of a copy of the Statement and actual
cost (DISCLOSURE/SE'ITLEMENT STATEMENT - BUD FORM 1) and authorized disbursement
of funds as shown therein this 28 day of MARCH , 19-2]. We further
acknowledge that we understand utility bills are not included in this statement
and that the proration of taxes as shown in the statement of actual cost is
based on the latest information available. If any changes are to be made in this
proration when the tax bill is received, it will be handled between the parties of
this transaction. Stewart Title Con~y of Cleanvater, Inc., will not be held
responsible. It is further understcxxl that Stewart Title Company of Clearwater,
Inc., cannot, at this time, assertain if there will be personal property tax on
subject property or an amount on which to base a proration. Any proration necessary
when tax bills become available will be handled between the parties to this
transaction, outside of Stewart Title Company Company of Clearwater, Inc.
Stewart Title Company of Clearwater, Inc., will be not held responsible.
ht1 VI ~J1 ~ f(Q
for: ITY OF CLEARWATER -
~,!i~'L~/Lz lpJl.[laeL
GE~DE~. CLARK ~~
~ t4. In J /flJ.de.#
RUTH M. MILLS
/CA~~~<1 ~~
ARTHUR ILLER, JR. v
./ aL':~ 7}U:Jr/~/'-
~ ,
ALICE MAY RAY /
~~iX~xFORWARDING ADDRESS:
BUYERS
HOME PHONE#
K1XKJKL.1{Kz: FORWARDING ADDRESS:
SELLERS "
/tC:Y-h.l!~~.)7'
~~ ~() m. "
(:4Q~~,~, 351G/S-
. ,
HOME PHONE# y~~ - 78 75
WORK PHONE#
THIS IS TO FURTHER Aill'HORIZE A'/ //;
CHANGES NECESSARY TO THE CLOSING STA~
WORK PHONE#
TO APPROVE" ANY
~z=;~~ me.
r....
.
.
.';'lIlClil,t ,,{ COt//f"ct
RONALD (RON) E. SOMERS
President
STEWAR'r TITLE
OF CLEARWATER
P.O. Box 2756
Clearwatar, Florida 34617
(813) 441-2689
1290 Court Street
Clearwater, Florida 34616
D I S C LOS U R E
We, the Owners of that certain real property located at
LOTS 8 & 9 OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
Pinellas County, Florida, do hereby disclose the following facts
known to me which may materially 'affect the value or desirability
of said property.
I HEREBY CERTIFY that I have no knowledge of any facts or
defects in said property which may materially effect the value or
desirability of said property, except as set forth above. I
acknowledge that this disclosure will be given to the listing
broker, the selling broker? and any prospective buyer.
(. 'p
\ Sj. /
,--/~~ ~. \~~~
Witness
(j' ~ 1Jl'
;,,---- d1 p-ur ' 7J~
ANDREW MILLER
~b~~
\ht s .
STATE OF VIRGINIA
(3,
~\1TY ofp~J
\<
---
SWORN TO AND SUBSCRIBED BEFORE ME THIS %. <=t
DAY OF
MARCH
, 19 91 .
.:
~
My Commission
i i;
'- \.~"
Expires: t.-~
~~~ at>, Iqq1
Notary Public
\, r I
~---- ' (,
\) ( (!
.
.
.\1I11(:(il,l' {II Clll/lft/et
RONALD (RON) E. SOMERS
President
1290 Court Straet
Clearwatar, Florida 34616
STEWAR"l" TI"l"LE
OF CLEARWATER
P.O. Box 2756
Clearwater, Florida 34617
(813) 441-2689
D I S C LOS U R E
We, the Owners of that certain real property located at
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
Pinellas County, Florida, do hereby disclose the following facts
known to me which may materially 'affect the value or desirability
of said property.
I HEREBY CERTIFY that I have no knowledge of any facts or
defects in said property which may materially effect the value or
desirability of said property, except as set forth above. I
acknowledge that this disclosure will be given to the listing
broker, the selling broker~ and any
prospective buyer.
/~u.J, ~ / (' /drL~
}2') MlhLAan{ It
/~~~MILL?1 ~flA Gh
a. A tea ,~. '9' #
'71j, .. Alii -
Y- (l, W;tX-, . " ~!fl/O/~
w: tness
---:-t-
W1tness
~
/ ' ,'" ,< 7JL4!;)
r" ALICE MAY RAY
/~/
STATE OF
COUNTY OF
FLORIDA
PINELLAS
SWORN TO AND SUBSCRIBED BEFORE ME THIS
MARCH 19 91 .
28
DAY OF'
My Commission Expires:
IJ -'1- LJo/
Notary Public
.
.
,'\u"'_'I;/)' 01 (~ollllllt:t.
RONALD (RON) E. SOMERS
President
STEWART TITLE
OF CLEARWATER
P.O. Box 2756
Claarwatar, Florida 34617
18131441-2689
1290 Court Street
Clearwater, Florida 34616
D I S C LOS U R E
We, the Owners of that certain real property located at
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
Pinellas County, Florida, do hereby disclose the following facts
known to me which may materially 'affect the value or desirability
of said property.
I HEREBY CERTIFY that I have no knowledge of any facts or
defects in said property which may materially effect the value or
desirability of said property, except as set forth above. I
acknowledge that this disclosure will be given to the listing
broker, the selling broker? and any prospective buyer.
@/j)d~{u fJ- lfILt~~
Witness
Q v"v?/~~ #~
FRANCES DOBY
. ~{i1;Q ~.~dlJ?rrJJ0
It ess .
STATE OF~ ltLORlDA
COUNTY iiff.. ./
SWORN TO ANu SUBSCRIBED BEFORE ME THIlf...- ..::J? tl
DAY OF
MARCH
, 19-21.
G
My Commission Expires: ~
Notary Public, State of Florida
My Commission Expires Feb. 3. 1993
~...dc~51J?;/A~.
Notary Public
, \
1(\'
\ Ii
.-/ .
'-.,. /I,.' (,.., I
'jt-_., ,1\
.
.
NON l;'OmUGN CE.H'l'U'ICJ\'l'lON UY INIJIVIDUI\.L 'l'Rl\NSFEHOR
1.
Section l44S of the Internol He venue Code provides that a transferee (If a United
States real pl:OrlCt-Ly :lnlet'esl must withhold lax if the transferor is (j foreign person.
In order to infotlll the transferee that withholding of tax is not required upon the
tUs[XJs.i. t.i.on by FRANCES DOBY
2.
... ~ \ \"
of the United States real property described as follows:
LOTS 8 & 9, OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
the unoorsigned transferor certifies and declares by means of this certification, the
following:
(a) I (We) am (are) not non-resident alien(s) for p.1rposes of United States incane
laxation and,
(b) Ny lIlIil r.d States
Nl\MI~
-
FRANCES DOBY
taypatJer identifying nUlllber(s) (Social Security Number) is/are:
SOCIl\lJ SI!:CUIU'.l'Y. NUMDEH
CD -
Uv J.(f)~ - (P Ip- 7~B7
II
It
11
(c) ~1y hOllle il(1(lrem'l is
(nUuched addJUollo.1. page .i.f necessary)
(d) There nJ:e no oLher persons who have nn ownershJp .interest in the atnve-descr.tbed
pruperLy oUl0.r thon Lhose persons set forth aoove in subparagraph (b).
3. 'l1\e 1I11(1ersi~Jlled hereby further cerL.tries and declares:
(a) I (We) undersLand that the l~rchaser of the above described properLy intends
to rely 011 the [oJ:e9()in~J representaLJons ill connection wJth the tlnJ.ted Stutes
li'omj,911 InvesLrllclIl ill Heal ProperLy TuX Act. (94 Statute 2G02 as amended).
(IJ) .I (we) ullderstalld LItis cm,-ULicaUun lIay be disclosed to the Internal Hevenue
Service by Lransferee and that any false statement conta.i.neu ill this cerUf.i.cation
IIlilY Ix~ IllII1Jnh(!d by flne, illlprJsonlllcmt ur I.x)lh.
lInde r penD 1. L.i.es 0 [
f lea lion and it is
\ ~-
'-v
Date MARCH 1991
perjury I (we) declare I (we) have examined carefully this certi-
Lrue, correct and complete.
( '1,')
~'V
County,
FLORIDA
~ --, ~j1iv5d../ a_:.!iJJ ct!Lt->>M'L-/
Witness
v:ii!:.iufft fj,. ~oi1 ff/rx/tJ
(111i8 dOClUnent must be retained WItH the end of the fifth taxable year following the
taxable year In wld.cll Lhe transfer: takes place).
CONSlIV!' YOlln ^,1'mHNI~ ANIJ/on '1'1\){ ^,JVISOH - NO lU!:PHESE.'N'l'A'1'ION OH HEC()l\1MI!.'NIJA'J'JON IS Ml\DE BY
STI~WAH'r 'r.I.TLI~ INSUIu\NCg C()\1PANY ANU/OH CONCERNING TIII~
LEGAL SUL"F'lCHNCV ANn/Olt TAX CONSQUI~'NCES 01;' 'HilS l.XJCUMI~N'l'. YOll MJ\Y DE HEQllIHI!D 1'0 FLU!;
^ COpy Oli' TilLS rXX:lIMI':N'l' Wl'J.1I 'l'IJ1i: IN'l'EHNAfJ 1U!:VI~lll~ SI~l{vlq~. 'J1W:SI!: J\HF, QUI~Sl'.lONS Fan youn
J\'1'l'OHNIW OH TJ\X J\rNlson.
\ l/ .
"J ....-.(0-, -;?c4~~ ~~
FRANCES DOBY
S'l'J\'l'E 01'\ \. FLORIDA
COUNTY OF' 'v'
I IIEHlmv ClmTIl;'Y that 011 LIds day, before me, an officer duly authorized J.n the state
aforesa:l.d and in the County aforesaid Lo take aclmowledgments, personally oppeared
FRANCES DOBY
to me knO\",. Lo be Lite persol1s described in and who executed the foregoing instrument
and they acknowledyed IJefore me that they executed the same. i ,'.
.1-
Wl'1'NI~SS illY halld illlu offJ.cinJ. Geol ill the County onu Stilte lost aforesaid this 21 . day
of____MARCH , 19 ,91.) ()
. /' Jf5e-,l.,jc..i y;?cr:;tifaq,~_<i
NOl'J\RY PUBLIC --'Notary Public, State of Florida
.- t I ~~l 'I ' ;
MY CO''JlIITSSlON EXPHmS' .~, ' " .
.
.
NON-FOmnGN CI!.H'l'U'lCJ\'l'lON UY INDIVIDUl\.L 'l'R1\NSli'EHOO
1.
Sectioll 1445 of the Internal Hevellue Cooe provides that a transferee (If a United
States real pt:operty .Interest must withhold tax if the transferor is (j foreign person.
In ordet: to in [Otlll the transferee that withholclin~ of tax is not required upon the
d.isposi.UolI by GERTRUDE M. CLARK and RUTH M. ILLS
2.
\' 'I,. \'
of the UnJlL't1 Slales real properly described as follows:
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
the undersigned transferor certifies and declares by means of this certification, the
following:
(a) I (We) am (are) not non-resident alien(s) for purposes of United states means
taxation und,
(b) Hy Unil r..u States
NI\MI~
-
GERTRUDE M. CLARK
RUTH M. MILLS
taypatJer identifying nlllllber{s) (Social Security NLUnber) is/are:
SOCJJ\T.I SI!X:UIU'.l'Y NUMDEH
# ~"1it;/~ ~~"ff:ilt~- ~. 7'1 ,
It ;" , -.yt> 91'~...
"
11
(c) ~1y hOllle mklreB9 :is
(t1Lt.aclled addJUOlla.1. paUe Jf Ilecessary)
(d) There are 110 other persons who have nn ownership interest in the alJove-descr.tbed
property othr:n' than those persons set forth ilbove .1.n subparagraph (b).
J. 'J1te 11lJdersi~llled hel-eby further certifies and declat'es:
fa) I (We) understand that the plrchaser of the above described property intends
to rely on t.he [otegoill9 representali.ons .1.n connection with the l1n.i.ted Stotes
FlH"ej~ln Investment in Heal Property 'lux Act. (94 StHtuLe 2G02 as iJIllended).
(b) I (we) 11IKlersLiJlld LIds cerl:i.ficaUon lIBY be llisclosed to the Int.ernal Hevenlle
Service by transferee and that any false statement contai.ned in this cerUf.i.cation
lIIay lJo 11IIIJiGIt(~d by finn, :i.lllpr.l.sOllllll~nl: ur I.ul:h.
Under penalties of perjury I (we) declare I (we) have exandned carefully this certi-
fication and it is LnJe, correct and complete.
Date
MARCH 28, 1991
at
PINELLAS
:Uo"L~J: ~, cf..~d7(~
GERT~DE1 )1. CLARK., " A /J
"/-iAZiv II], /)}Upw
RUTH M. MILLS
(l11is dOClUllent nlUst be retained until the end of the fifth taxable year following the.
taxable year 1n which the tr.ansfer takes place).
CONSUl:l' YOllH l\'J'IUIlNIW l\NI>/OH '1'l\X A/)VlSOH - NO HEPIU!:SE.'N'l'Nl'ION OH HECOI"r1ENDNl'lON IS MJ\JJE DY
STI~Wl\H'J' 'r.l'I'LP; INSlJHANCg Gl-1Pl\NY ANIJ/OH CONCgRNING 'l1IE
LEGAL SUrrICJE;NCY ANn/OH TAX CONSQUI!.'NCES Of' 'nus I.JOCUMI~N'l'. YOU MAY BE HEQUIHI!D lD FIJ.JE
A COpy OF' '1'111 S J)(XJJMliNl' WI'l1! '1'1 m IN'l'E.HNl\J, IUWI.!-:NlJl~ SI~HV.l.q~. 'J1 m:SI!: l\HF. QU&l:J'l'IONS liDH youn
l\'1TOHNIW OH 'l'l\X l\DVlson.
County,
FLORIDA
S'l'l\'l'F. OJ.i'
COUNTY OF'
FLORIDA
PINELLAS
I IIEnEIJY Cl!:lrl'U'Y that on LIds day, before me, an officer duly authorized 1n the Slale
aforesaid and in lhe County aforesaid to lake acknowledgments, personally lIppeared
GERTRUDE M. CLARK and RUTH M. MILLS
to me knO\oJIJ Lo be the persons described in and who executed the foregoing .instrument
and they uclmowledyed lJe[ore me that they execuled the same.
Wl'l'NI~SS my halld and ofUcioJ. seal In the
of MARCH , 19 .91.
County emu State last aforesaid tlds
~ 61'-m~
Nal'l\RY PUBLIC
1/- ') ,- o/c/
MY C(XIlI'ITSSJON I':Xr1Tnr~s ~
28 ' day
_/
.
.
NON-fOmUGN CE.H'l'lJ.o~lCNl'10N UY INIJIVIDUI\.L '1'Rl\NSFEnOR
1.
Section 1445 of tile Intenlul Hevenue Code provides that a transferee (,f a United
Stales 1"eu1 property interest IIIUSt withhold tax if the transferor is (j foreign person.
In onlet' Lo 1n[01111 the transferee that withholding of tax is not required upon the
dis[x>sJli.on by ANDREW MILLER
2.
" '" \.
of the Un.Lteu Stales real properly described as follows:
MAP OF R.H. PADGETT'S SUBDIVISION
OF A RE-SUB OF LOT 2, OF THE REVISED
LOTS 8,9,
the undersigned lransferor certifies and declares by means of this certification, the
following:
(a) I (We) am (are) not non-resident alien(s) for ~qx>ses of United States incans
taxation and,
(b) ~1y Unil r.o SlaLes laypalJer identifying munber(s) (Social Security NLUnber) is/are:
Nl\MI~ SOCImJ SI!:CUIU'.lY. NUMlJEn
ANDREW MILLER 01, .,- :< ~ 2. - "T 6 8" Z '13
"
/J
11
(c) Ny home ml<1n.ms is
(aLttlched (JddJUolla.l (xJge if necessary)
(d) There ("lI:e 110 oLher. persons who have nn ownership .interest in the alx>ve-descr.tood
property olh8r than lhose persons set fOl-th nbove .in subparagraph (b).
J. '1118 llndersJ911ed hereby furlher certifies and declares:
(a) I (We) Illluerstand thal lhe l~rchaser of the above described property intends
to rely 011 the forego1.nU representations in connection with the United Stales
P'omJ911 InveslrllclIl in Heal Property Tax l\ct. (94 Statute 2602 as amellded).
(I>) I (we) 1IIId(~l:Sti.llld Lids cerLi[icaUull lIny be disclosed lo the Internal Hevellue
Service by It-allsferee and that allY false stalemenl contai.ned ill this certification
flll.IY IJe l>lflliGhed by f.l.lJ(~, .i.lllpr.l.solllllelll: ur I.uth.
Under pcnnlU.es of perjury I (we) declare I (we) have examined carefully this cerl:.i-
ficalion [Ind it is lrue, correct and complete.
l. ?) __
Date 1..9 MARCH 1991
"v' ~\~ ~. ~\u~~
Witness
\ .~~;
a~--- R~~t4.(lNj
(!~N
-€Ottnt y ,
VIRGINIA
1--.........-
\y~/' ~~~.u~r-- ?Y~
AND EW MILLER ", .
Wilness
(lhis u retained wltil the end of the fifth taxable year following the
laxable ye -.in wldch the transfer lakes place).
CONSlJUl' VOllH l\'J'l'OHNI~'Y l\NIl/on 'l'l\X l\DVlSOH - NO HEPIU~E.1fl'l\'l'lON on nECOMMENDl\'l'ION IS Nl\IJE DY
S'mWl\H'J' 'l'.lTLI~ J.NsUnl\NCI~ CCt-1Pl\NY l\NIJ/OH CONCgRNING '11/E
LEGl\L SUI;'FJCIE:NCY l\ND/on 'J'l\X CONSOlJI!:NCES 0J.0~ '11/15 I.X:JQ.JMI~'N'l'. YOU Ml\Y DE HEQUIHl!JJ 1'0 FILE
l\ COpy ()li' 'I'IIIS l)eXJ1M/iNJ' W.I'l1I 'I'm: IN'l'EIlNMJ HE:VI!:NlJl~ SI~HV.lq~. 'n "!:Sl~: l\HE QUESJ'.LONS {;UH YOUH
l\'l'lOHNI~Y OH 'l'l\X l\IJVISOH. '
-
S'l'l\'l'I~ OJ.i' (,,~? VIRGINIA
~i~W 01;1" "e.\U\.~",d
I IIErmOY CI!:H'l'lF'Y lhat 011 Lids day, before me, an officer duly authorized .:l.n the State
aforesa:l.d and ill the County aforesaid to take acknowledgments, personally nppeared
ANDREW MILLER
to l1Ie known to be lite persolls described in and who execuled lhe foregoing illstnunent
emu lhey acknowlcdyed before me thal they executed lhe same.
Wl'1'NI~SS my hand and offic.itll seal in
of MARCH , 19 91.
, (' I
..
~
the COUllty r\SLate lust aforesaid this Zq
.~,~
Nal'l\IlY ruDLIC .
MY C<l'l'IISSTON P;XPTnE,S: <;"[>~""Il\>! r ~F)
, day
(c,q (/
.
.
NON-FOlUUGN CE.H'l'U'lCJ\'l'lON BY INIJIVIDUl\.L 'l1U\NSFEHOR
1. Section 1445 of the Internal Hevenue Code pruvides that a transferee ...E a United
States reill pt:uperty :interest "lUst w.lthhold tax if the transferor is (j foreign person.
2. In orde!: to in[ol1l1 Lhe transferee that withholding of tax is not required upon the
d.isposJUon hy ARTHUR MILLER, JR. and ALICE MAY RAY
" , , of the United States real property described as follows:
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
the undersigned trallsferor certifies and declares by means of this certification, the
following:
(a) I (We) am (are) not non-resident alien(s) for IXJrposes of United States incane
taxation and,
(b) Ny Unit r.d States
NI\NI~
ARTHUR MILLER, JR.
ALICE MAY RAY
taypaper ic1entifyirKJ nUlllber(s) (Social Security Nlullber) is/are:
SOCIl\TJ s~:cunl'.l'Y. ~ '<'
U!J Q C S'- 3 C/ - 7':;l:$ 9
(]J) 2~ 7- 3C:; -c,'f? 77
II
11
(c) Ny hOllle (Id<1reBfI is
(nltached addJ U.ollal lXJUe .i.f lIeceSsaty)
(d) There (lJ:e no oLhe!: persons who have an ownershlp .interest in the above-descr.tted
prupel-ty oth0r than those persons set forth ubove in subparagraph (b).
). '111e 1I11dersiUlled hereby further certifies alld declares:
(a) I (We) understand that the purchaset- of the above described property intends
to t:(~ly 011 t.he foregoin9 representalions in connection with the United Slates
[i'lne.i.911 Jnvesltllcnt in Heal Property 'lux ^ct. (94 Statute 2602 as amended).
(b) 1. (we) U1Klemti.llld tills certification "flY be disclosed to the Intemal Hevenue
Service by transferee and that any false statement conla:i.neu in this cerULi.cation
IIlilY Ix! Pludshed by f.l.lle, JUlprJ.SOI1ll1l111l: 01: !.lOLh.
Under pcnalUes of perjury I (we) declare I (we) have examined carefully this certi-
fication and it is true, correct and complete.
Date
at
PINELLAS
FLORIDA
County,
\/JAit,. . ift7Qd~'
Wit",,\, . ~ '{. Il Il ARHTUR Mlf~ JR.
LLu.., /n r ( J&.II ~ \ t7,'{<0Z- /~-j A".~
Witness . ALICE MAY RAY rf/ ~
(111is doclunent "ust be retained wltil the end of the fifth taxable year following the
taxable year In wllich tile tr.ansfer takes pluce).
CONSULT YOl/H l\'J'I'OHNI!:Y l\NI >/OH 'l'l\X l\IJVlSOH - NO HEPHJ!:SENTl\'l'lON on HOC()ll'l\1ENDl\'J.'ION IS t-WJE BY
S'l'EWl\RI' 'J'1'J'L1~ INSlJIW~CI~ CCNPMY ^NIJ/OH CONCgUNING '1'1I1~
LEGl\L SlJIi'FICJ.ENCY ^ND/On '1'l\X CONSQUI!:NCI!:S Or' '11/18 OOCUMt~N'l'. YOU Ml\Y BE REQUIRI!JJ 'to FIlJE
1\ COpy Of 'I'll I S rXX:IJMtiNl' W]'nr 'n iii: IN'l'EHNI\T~ 1U!:Vm-JtJI~ SI~nV.lq~. 'n 1I!:S1~: I\HF. QUES']'.lONS Fon youn
Nl'IDHNIW on 'l'I\X I\INlSOH.
5'1 'l\'1'I~ Of.i'
COUNTY OF'
FLORIDA
PINELLAS
I "Em~OY CI~H'l'lF'Y that on LIds day, before me, an officer duly authorized J.n the Slal:.e
a[oresaJ.d and in the County aforesaid lo take aclmowledgments, personally nppeared
ARTHUR MILLER, JR. and ALICE MAY RAY
to l1Ie knowll to be tile persons described in and who executed the foregoing instrument
and they acknowledged before hie that they executed the same.
WI'1'NI~SS Illy hilno ilnd official seal in lhe
of MARCH , 19 91
County ano State last aforesaid this 28
,~ d-~<_~
NaI7\RY PlJBLIC
MY CCJlIl'lISSION F:XPlnr~S! / / .. "), ..",..,} " -
day
t BE FILLED IN PERSONA!
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
Seller or Owner-Borrower
LOT 8 IN LOT 1 OF R.H. PADGETT'S SUBDIVISION
Contractor (if new construction)
CITY OF CLEARWATER
Purchaser
personally known to me to be the person whose name is subscribed hereto, and upon his oith"deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
l. No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any personal property or fixtures that are located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there are no security
interests on such property secured by a financing statement, security agreement or otherwise except the
following: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY Approximate Amount
.
2. No loans of any kind on said property except the following: (If none, so state.)
NAME AND ADDRESS OF CREDITOR Approximate Amount
3. All labor and material used in the construction of improvements or repairs on the above described property
have been paid for and there are now no unpaid labor or material claims against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If none, so state.)
NAME AND ADDRESS OF SUPPLIER OF LABOR, SERVICES OR MA TERIALS Approximate Amount
4. I, the purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS J L
111(-
f'\O h)/~
Approximate Amount
S. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state.)
SUPPLIER OR LABOR, SERVICES OR MA T~~S ADDRESS
.{)C' fur
6. I, the undersigned owner, further certify thi'.t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession. actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PAY ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND AITORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HAVE AN INCEPTION DATE PRIOR TO THE CONSUMMATION OF THIS TRANSACTION.
I realize that the purchaser and/or lender in this transaction are relying on the representation contained herein in purchasing
same or lending money thereon and would not purchase same r lend mo?ty th reon unless said representations were made.
V. V. / " (J ,}
SWORN TO AND SUBSCRIBED BEFORE ME ~HJS
.C2~-/1/'~i/~ -
Notary Public in and for PINELLAS County,
1
day of
APRIL
91
,19_.
M Co JaQ,UBI 1W~J.lc..s.TATE OF FlORID~.
Y mltW~MM~N"EXt'IHl:.:;: I\IAR. 2. 1993.
FLORIDA IONPI;;D THRU NOTARY PUBLIC UNDERWRITER'"
Rev. 1/88
NOTE: This form is '0 be oi",ed by seller in case of sale. If no sale, i, is '0 be liJMd by ,he o....r..bom..'''r. If lhe... is ..y new co"'Nelio.. lhe conlr.e1or mUll .110 join I. Ihis fOnD
or lian I Kparate one.
. .
TO BE FILLED IN PERSONALLY
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
GERTRUDE M. CLARK; RUTH M. MILLS; ARTHUR MILLER, JR.; ALICE MAY RAY
Seller or Owner-Borrower
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
Contractor (if new construction)
Purchaser
penonaUy known to me to be the person whose name is subscribed hereto, and upon his oath deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
1. No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any penonal property or fixtures that are located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there are no security
interests on such property secured by a fmancing statement, security agreement or otherwise except the
following: (If none, so state.)
E AND ADDRESS OF SECURED PARTY Approximate Amount
Approximate Amount
AU labor and material used in the construction of improvements or airs on e above described property
have been paid for and there are now no unpaid labor or material claims against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If. ne, so state.)
ADDRESS OF SUPPLIER OF LABOR, SERVICES 0 eMA TERIA Approximate Amount
'Y,t,'
kind other than those listed
, the purchaser, represent that I have no knowledge of any debts or
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS
Approximate Amount
5. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state.)
SUPPLIER OR LABOR, SERVICES OR MATERIALS ADDRESS
6. I, the undersigned owner, further certify th~.t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PAY ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND AITORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HAVE AN INCEPTION DATE PRIOR TO THE CONSUMMATION OF THIS TRANSACTION.
I realize that the purchaser and/or lender in this transaction are relying on the representation contained herein in purchasing
same or lending money thereon and would not purf ,ayme o~ lend money thereon unless said representations were made.
J/ V\..'"
~
c{'4.~e-/!ld
ALICE MAY RA
MARr.H
~
PINELLAS County,
My Commission Expires:
FLORIDA
!/-? .. e;;r
Rev. 1/88
NOTE: This form i. to be silned by Klier in calC of ule. If no sale. it is to be .iped by the owner~bo"owcr. If there la any new construction, the contractor mUI' also join in thia form
or lian . sepaU.IC onc.
. .
TO BE FILLED IN PERSONALLY
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
FRANCES DOBY
Seller or Owner-Borrower
LOTS 8 & 9 OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
Contractor (if new construction)
Purchaser
personally known to me to be the person whose name is subscribed hereto, and upon his oath deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
I. No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any personal property or fixtures that arc located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there arc no security
interests on such property secured by a fmancing statement, security agreement or otherwise except the
following: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY
CD Approximate Amount
I {./ /ValVe:
.
2. No loans of any kind on said property except the following: (If none, so state.)
NAME AND ADDRESS OF CREDITOR (~) Approximate Amount
..: V' N(JNL::
3. AU labor and material used in the construction of improvements or repairs on the above described property
have been paid for and there arc now no unpaid labor or material claims against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If none, so state.)
NAME AND ADDRESS OF SUPPLIER OF LABOR, SERVICES OR MA TERIALS {,:":;:-, APprox',mate Amount
'-..:.J,./ A/(J/Je
4. I, the purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS Approximate Amount
S. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state.)
SUPPLIER OR LABOR, SERVICES OR MATERIALS ADDRESS
6. I, the undersigned owner, further certify th...t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PA Y ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND AITORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HAVE AN INCEPTION DATE PRIOR TO THE CONSUMMA nON OF THIS TRANSACTION.
I realize that the purchaser and/or lender in this transaction arc relying on the representation contained herein in purchasing
same or lending money thereon and would not purchase same or lend money thereon unless said representations were made.
'l/' I ~~
1,.,J/,77~
FRANCES DOBY
SWORN TO AND SUBSCRIBED BEFORE ME TH~S - .;;;:J'7~ay of
ti2ctu(rf>>?t &~J .
No ary Public in and for" /~ (IJUJOA. County,
MARCH
91
,19_.
Rev. 1/88
Notary Public, State of Florida
My Commission Expires: t.-1iiY Commission Expires Feb. 3, 1993
FLORIDA _
".1;; L;,J/l c. L"
NOTE: Thil (onn is to be lilned hy Klier in CAse of u.k. If no laic. it ia to be Ilped by the oWDet-borrower. If there it any new conatruction. the conlractor mUI' allO join in thit form
or lian a sep8rate one.
. .
TO BE FILLED IN PERSONALLY
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVI'r AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
ANDREW MILLER
SeDer or Owner-Borrower
LOTS 8 & 9 OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
Contractor (if new construction)
Purchaser
penonally known to me to be the person whose name is subscribed hereto, and upon his oath deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
I. No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any personal property or fixtures that are located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there are no security
interests on such property secured by a fmancing statement, security agreement or otherwise except the
following: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY G Approximate Amount
~ Uc?U?
.
2. No loans of any kind on said property except the following: (If none, so state.)
NAME AND ADDRESS OF CREDITOR . (ji Approximate Amount
--- /t..g~
3. All labor and material used in the construction of improvements or repairs on the above described property
have been paid for and there are now no unpaid labor or material claims against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If none, so state.)
NAME AND ADDRESS OF SUPPLIER OF LABOR, SERVICES OR MATERIALS I '), Approximate Amount
,.~ ~ -;;z,bYC..1
4. I, the purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS Approximate Amount
5. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state.)
SUPPLIER OR LABOR, SERVICES OR MATERIALS ADDRESS
6. I, the undersigned owner, further certify th2.t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PAY ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND ATTORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HAVE AN INCEPTION DATE PRIOR TO THE CONSUMMATION OF THIS TRANSACTION.
I realize that the purchaser and/or lender in this transaction are relying on the representation contained herein in purchasing
.. same or lending money there n and would not purchase same or lend money thereon unless said representations were made.
(l!)// ..
ANDREW MILLER
TO AND SUBSCRIBED BEFORE ME T~liSv - '2- q
day of
MARCH
,19~.
,/
",/
Q~~~~r4d
&ttmty,
Cl+--f
NOTE: This (orm is 10 be si.ned by sellcr in calC of laic. If no sale. it illo be .ipcd by the owner.bonower. II there i.a any new conllruclion. the contractor mUll al.o join in Ihis fonn
or sian I separuc one.
? c ".L.._ I ~", ,e;c./
My Commission Expires: ~ . _ -,
VIRGINIA
I'
Rev. 1{88
.
.
A F F I D A V I T
STATE OF ~ VIRGINIA
~OF ~
~rr'l
BEFORE ME, THE UNDERSIGNED AUTHORITY, personally appeared
ANDREW MILLER
who being by me first duly sworn deposes and says:
That
he is not one and the same person as
Andy Miller
who is named in Wp-lf&re -Lief1..
as recorded in O.R. Book 4315
Page
1948
Public Records of Pinellas County, Florida.
Affiant further states that his Social Security Number is as
fo 11 ows: /ra&,- '10 g" 9:3
~ Signed, sealed and delivered
~ . h f
: 'c. !) 1 n t e pre s e n ceo :
1"'- ---f 'I. '- {
-'~~-l /~~ 5&):\\OoM~
(" ?i
.~ F m:>
---
C\$3J
1;9)~ Rl/7 '////
/..'.j/ l./Z<,(./' 7 ./ /.~tJ
ANDREW MILLER
Sworn to and subscribed before me
(1)/
t his 2.Cl day 0 f March,
,j)~e~
NotarY,Public, State of ~
,
M C ,.. . s ~rgin~",..rUl
y omml ss 1 on expl re~). MW Of/f1"'r
I
, 1961
This instrument prepared by:
MIKELL L. ST. GERMAIN
for: Stewart Title Co. of Clearwater
1290 Court Street
Clearwater, Florida 346rEi
)ct
.
.
91030019
A F F I D A V I T
STATE OF FLORIDA
COUNTY OF Pinellas
BEFORE ME, THE UNDERSIGNED AUTHORITY, personally appeared
ARTHUR MILLER, JR.
who being by me first duly sworn deposes and says:
That
he
i s not 0 n e and the sam e per son a s ARTffiJR MILLER, JR.
who i s n a m e din CERTIFIED JUDGMENT
as r e cor d e din O. R. Boo k 4430
Page
2059 ***
Public Records of Pinellas County, Florida.
Affiant further states that ~sSocial Security Number is as
follows: a6's-- 3 0-9~.3 ~
*** FEDERAL TAX LIEN FILED IN O.R. BOOK 6248,
PAGE 2019 AGAINST ARTffiJR MILLER AND
CERTIFIED JUDGMENT FILED IN O.R. Book 7234,
PAGE 872 AGAINST ARTffiJR M. MILLER, INC., a
Florida corporation and ARTHUR M. MILLER,
jointly and severally
Signed, sealed and delivered
in the presence of:
/~A~
..
f,
Sworn to and subscribed before me
t his ~ day 0 f . March, 1 9 91
'..~d~
Notary public, State of Florida
My Commission expires: ///-7-97'
This instrument prepared by:
MIKELL L. ST. GERMAIN
Stewart Title Co. of
1290 Court Street
Clearwater, Florida
Clearwater
,_A~~':' ~ (.:':~,~:~r,: ";/
.,.- , . '.' . I. , I,. <:> /',
::: ":'J'\(~..r""""~":-,"'..'-' /....
........f. ... ~..
for:
.3461~ .
"/ .:
.', ""'....... ') .','
.
.
91030019
^ F FlU ^ V I T
STATE OF FLORIDA
COUNTY OF Pine11as
BEFORE ME, THE UNDERSIGNED AUTHORITY, personally appeared
ARTIRJR MILLER, JR.
who being by me first duly sworn deposes and says:
That
he
i s not 0 n e and the sam e per son a s ARTIillR MILLER, JR.
who is named in CERTIFIED JUDGMENT
as r e cor d e din O. R. Boo k 4430
Page
2059 ***
Public Records of Pine11as County, Florida.
Affiant further states that ~sSocia1 Security Number is as
fo 11 ows: L~8'S-- 30-9.:<.3 t:)
*** FEDERAL TAX LIEN FILED IN O.R. BOOK 6248,
PAGE 2019 AGAINST ARTIillR MILLER AND
CERTIFIED JUDGMENT FILED IN O.R. Book 7234,
PAGE 872 AGAINST ARTIillR M. MILLER, INC., a
Florida corporation and ARTIillR M. MILLER,
jointly and severally
Signed, sealed and delivered
in the presence of:
dL~. kp~AA7J'
~ 7f;{J; ~~
l-
~ ~~-
/I . 'A~~ ? v:-
ARTHUR L ,J. '
~
Sworn to and subscribed before me
~n' 91
t~h ~ ~d~19
Notary public, State of Florida
My Commission expires: ///~7-97'
This instrument prepared by:
MIKELL L. ST. GERMAIN
for: Stewart Title Co. of Clearwater
1290 Court Street
Clearwater, Florida .34616.
-"... ......:.;"""'.
,..., _ ': ' . r: ! I r . '/ ,
'-, ~~....._". _.". ...t:'> -:,...
-f -.
....J ....
, . A_
-..
, "
,\ .
.
.
A F F IDA V I T
S TAT E 0 F :KIXJaIJmOOO{ VIRGINIA
c.o~OF ~ ~
c., 11'1
BEFORE ME, THE UNDERSIGNED AUTHORITY, personally appeared
ANDREW MILLER
who being by me first duly sworn deposes and says:
That
he is not one and the same person as
Andy Miller
who is named in Welfare Liet1..
as recorded in O.R. Book 4315
Page
1948
Public Records of Pine11as County, Florida.
Affiant further states that his Social Security Number is as
(f)
fo 11 ows: / "c,'J- 4(') g~ 9:3
) Signed, sealed and delivered
1::"~ ) i nth e pre s e n ceo f :
1- .
'J ~
. ~~,~ / ~ ~ ~:\\o... >^A-\
!~ {CJ> '
'---c5 3 v' '-
c~ ~~(,(/ m~u
ANDREW MILLER
Sworn to and subscribed before me
vl/
t his 2q day 0 f March,
,>~~~
NotarY,Pub1ic, State of ~
M C ,'.. . 5 ~rgin:la~~1.
yom m 1 s s 1 0 n e x p 1 r e~) .....w 00'1'"f....,..
I
. I
, 1 991
This instrument prepared by:
),U;
MIKELL L. ST. GERMAIN
for: Stewart Title Co. of Clearwater
1290 Court Street
Clearwater, Florida 34616
T~E FILLED IN PERSONALL!'
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
ANDREW MILLER
Seller or Owner-Borrower
LOTS 8 & 9 OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
Contractor (if new construction)
Purchaser
personally known to me to be the person whose name is subscribed hereto, and upon his oath deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
I. No unpaid debts for plumbing fixtures, water heaters, noor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any personal property or fixtures that are located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there are no security
interests on such property secured by a financing statement, security agreement or otherwise except the
following: (If none, so state,)
NAME AND ADDRESS OF SECURED PARTY
f\' Approximate Amount
\..) ~. ~
.
2. No loans of any kind on said property except the following: (If none, so state.)
NAME AND ADDRESS OF CREDITOR . (,), ~~~.:'ount
3. All labor and material used in the construction of improvements or repairs on the above described property
have been paid for and there are now no unpaid labor or material claims against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If none, so state.)
NAME AND ADDRESS OF SUPPLIER OF LABOR, SERVICES OR MA TERIALS I '.~ Approximate Amount
k"--- -nt,~
4. I, the purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS Approximate Amount
S. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state,)
SUPPLIER OR LABOR, SERVICES OR MATERIALS ADDRESS
6. I, the undersigned owner, further certify th....t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PA Y ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND A ITORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HA VE AN INCEPTION DATE PRIOR TO THE CONSUMMATION OF THIS TRANSACTION.
I realize that the purchaser and/or lender in this transaction are relying on the representation contained herein in purchasing
same or lending money there n and would not purchase same or lend money thereon unless said representations were made.
1,1/1;/,/' . ...
ANDREW MILLER
;..,
TO AND SUBSCRIBED BEFORE ME THIS"
"2..'\
da y of
MARCH
,19~.
I',
Q~~'n~rld
Eottftty,
Cl~
NOTE: This form is '0 be li.ned by Kiter in calC of ule. If no laic, i. i. 10 be li,Md by the owner.bono....". If there i.J Iny new consuuction. the contractor mull 1110 join in Ihli form
or sil" I UplrllC one.
i-
My Commission Expires:
VIRGINIA
~5C>,f~C,1
.
,,/
Rev.I{88
. .
TO BE FILLED IN PERSONALLY
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
FRANCES DO BY
Seller or Owner-Borrower
LOTS 8 & 9 OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
Contractor (if new construction)
Purchaser
personally known to me to be the person whose name is subscribed hereto, and upon his oath deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
I. No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any personal property or fixtures that are located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there are no security
interests on such property secured by a financing statement, security agreement or otherwise except the
following: (If none, so state,)
NAME AND ADDRESS OF SECURED PARTY
CD Approximate Amount
I I./" NoA/e.::
.
2. No loans of any kind on said property except the following: (If none, so state,)
NAME AND ADDRESS OF CREDITOR (,',?I Approximate Amount
. v' N()N(~-
3. All labor and material used in the construction of improvements or repairs on the above described property
have been paid for and there are now no unpaid labor or material claims against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If none, so state,)
NAME AND ADDRESS OF SUPPLIER OF LABOR., SERVICES OR MA TERIALS ('-:l~ Approximate Amount
_..1 / A/(JIJE
4. I, the purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS Approximate Amount
S. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state,)
SUPPLIER OR LABOR, SERVICES OR MATERIALS ADDRESS
6. I, the undersigned owner, further certify th...t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract,lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PA Y ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND ATTORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HA VE AN INCEPTION DATE PRIOR TO THE CONSUMMA TION OF THIS TRANSACTION.
I realize that the purchaser and/or lender in this transaction are relying on the representation contained herein in purchasing
same or lending money thereon and would not purchase same or lend money thereon unless said representations were made.
i l/' ' -I i?, y
, 1../,774"'<:.~ AJ/p-Y
FRANCES DOBY
SWORN TO AND SUBSCRIBED BEFORE ME T'H~S -.;;.JI)t~ay of
. ~'9.2;,~~,(r;! 51~;'://kj .
No ary Public In and for ~ ,:) (/~Clj(/~ County,
MARCH
91
,19_.
Rev. 1/88
Notary Public, State of Florida
I- --,
My Commission Expires: My Commission Expires Feb. 3, 1993
FLORIDA _
/J ? t. / JIl c. ( -
NOTE: Thil form is to be li.ned by Klier in cate of ulc. rr no ..Ie, it is to be ,ilntd by lhe owncr-borro..er. U there i. Iny new conl.ruelion, the contractor must .1.0 join in thli rorm
or lian . Itplrale one
. .
TO BE FILLED IN PERSONALLY
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
GERTRUDE M. CLARK; RUTH M. MILLS; ARTHUR MILLER, JR.; ALICE MAY RAY
Seller or Owner-Borrower
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
Contractor (if new construction)
Purchaser
penonally known to me to be the person whose name is subscribed hereto, and upon his oath deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
I. No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any personal property or fixtures that are located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there are no security
interests on such property secured by a financing statement, security agreement or otherwise except the
following: (If none, so state.) r
E AND ADDRESS OF SECURED PARTY , ..-.. J!.
Approximate Amount
Approximate Amount
All labor and material used in the construction of improvements or airs on e above described property
have been paid for and there are now no unpaid labor or material claIms against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If _ ne, so state.)
ADDRESS OF SUPPLIER OF LABOR, SERVICES 0 MATERIA Approximate Amount
~)&
kind other than those listed
, the purchaser, represent that I have no knowledge of any debts or
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS
Approximate Amount
5. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state.)
SUPPLIER QR LABOR, SERVICES OR MATERIALS ADDRESS
6. I, the undersigned owner, further certify thl.>t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PA Y ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND ATTORNEY'S FEES THAT SAID PARTIES MA Y INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HA VE AN INCEPTION DATE PRIOR TO THE CONSUMMATION OF THIS TRANSACTION.
/
I realize that the purchaser and / or lender in this transaction are relying on the representation contained herein in purchasing
same or lending money thereon and would not puZ ,ase, same ~,~ len~ mone~ t~:reon unless said representations were made.
. ,L ,,",---, J _ '
ltJ
/ C:4~;.7't~
ALICE HAY RA
MAR!.H
~4-0
PINELLAS County,
My Commission Expires:
/;-7 "~r
FLORIDA
Rev. 1/88
NOTE: Thi. form i. 10 be si.ned by Kiter in UK of uk. If no IDle. iI is Co be lipcd' by the owner-borrower If there is any new conltruclion. the contractor mUllllso join in Ihis form
or Ii." I s('p.rllC one.
TfoE FILLED IN PERSONALL'
BY SELLER OR BORROWER IN HIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEBTS, LIENS, AND POSSESSION
USE SEPARATE FORM FOR EACH PARTY
Seller or Owner-Borrower
LOT 8 IN LOT 1 OF R.H. PADGETT'S SUBDIVISION
Contractor (if new construction)
CITY OF CLEARWATER
Purchaser
personally known to me to be the person whose name is subscribed hereto, and upon his oath"deposes and says:
I, the seller, owner-borrower, and/or contractor, represent to the purchaser and/or lender in this transaction
that to my knowledge there are:
1. No unpaid debts for plumbing fixtures, water heaters, floor furnaces, air conditioners, radio or television an-
tennae, carpeting, rugs, lawn sprinkling systems, venetian blinds, window shades, draperies, electric appliances,
fences, street paving, or any personal property or fixtures that are located on the subject property described
above, and that no such items have been purchased on time payment contracts, and there are no security
interests on such property secured by a financing statement, security agreement or otherwise except the
following: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY Approximate Amount
.
2. No loans of any kind on said property except the following: (If none, so state.)
NAME AND ADDRESS OF CREDITOR Approximate Amount
3. All labor and material used in the construction of improvements or repairs on the above described property
have been paid for and there are now no unpaid labor or material claims against the improvements or the
property upon which same are situated, and I hereby declare that all sums of money due for the erection of
improvements or repairs have been fully paid and satisfied, except: (If none, so state,)
NAME AND ADDRESS OF SUPPLIER OF LABOR, SERVICES OR MA TERIALS Approximate Amount
4. I, the purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed
above, except: (If none, so state.)
NAME AND ADDRESS OF SECURED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MATERIALS
111 (J L
k\ tl 11 II ~
. --
Approximate Amount
S. I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state.)
SUPPLIER OR LABOR, SERVICES OR MA.!~'~S ADDRESS
. l..J (, /up
6. I, the undersigned owner, further certify th~.t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property are now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER. OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PAY ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND ATTORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTL Y APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HAVE AN INCEPTION DATE PRIOR TO THE CONSUMMATION OF THIS TRANSACTION.
I realize that the purchaser and / or lender in this transaction are relying on the representation contained herein in purchasing
same or lending money thereon and would not purchase same r lend mAt, y, th reon u,n, less said representations were made.
/1 I .
j/ . 1(.) . ..
or:
SWORN2~o, AND SUBS~RIBED ~EF;E ~.~ ~HIS
/ -,I, r ( ./' //
L ~.....-,,~ - -' . 1/"., ~ 1. L J.<' -r"C' ---
Notary Public in and for PINELLAS County,
1
day of
APRIL
91
,19_.
M C .Ml.BI11 ~'~J.I'~ST^TE OF FLORID~
Y om.,~:t!8~IM~Utthl'lHl~5: IIIAH. 2. 19'93.
FLORIDA IQIiP"DrHRU NOTARY puaLlc UNDERWRITE"lIf
Rev, 1/88
NOTE: ThiJ rorm i. 10 ... .i.nod b, "'''r in .... or ..... If no ...., it iJ 10 ... .iped b, I'" ow...r-borrow... If theN Is on, ...01 cOnltru<tioft. tho conlro<tor mull 01.0 join In IhiJ rorm
or .in I Kparate one.
.
.
NON-F'OHlUGN Cl!.H'l'lLPICl\'l'lON UY INIJIVIDU^L 'l1U\NSF'EHOH
1.
Secl.l.ulI ],115 of tho lllLenml He venue Code 1>t'Uvldes that n trallsferee (If a Ullited
Stales J:ea.L pl:upet"Ly .IIILer.'esL IIIUSt w.ltllho.Ld tax If Lhe trallsferor J.s lJ foreign persoll.
111 order Lo .LllfUllll Lhe Ln:llJsferee that wlthho1cllllg of tnx is not required llpon the
d.ls(xJS.l.L.i.oll hy ARTHUR MILLER, JR. and ALICE MAY RAY
2.
" ~ " \.
of LileUllIteu SLaLes I:enl pnJ(>erly uescdbeu as follows:
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
the lIlIdersigned lnllls[erol~ certifies and ueclares by means of this cerlification, the
followlllg:
(a) I (We) mil (are) IIOt 1I0n-resiuenl alien(s) for purposes of lhlited Slates incalle
taxalJun and,
(b) Ny Unll r.u States laYl'ilper
NI\I'1I~
ARTHUR MILLER, JR.
ALICE MAY RAY
identifylng IlI.lIllber(s) (Social Security NlUllber) is/are:
SOC.J.J\rJ SI!:CUHl'.l'Y NUNl3mt
(jo Q as- 30 -7:;13 9
(]i) 2~ 7- 3(;; . rry 77
It
11
.('.
(c) ~Iy home ml(1r(!fJn .iH
(HUnched mldJUolln.1. pay€! .i.f lIecessaty)
(d) II'hl!te flro no other (x~rsolls who huve 011 oWllorsh.l.p .lllter"esl .ill the (Jlx.Jve-descr.u~d
pruperLy oLhr,!t~ Lhon lhose persolls Set [orLh nbove .1n subparagraph (b).
J. 'llle 1Il1dersj~/lIed heleby hn:ther cerUfles alld tleclat:es:
(a) 1 (We) underslDlld thDt the (:urchaser of the nbove described prol~rLy int.ends
Lo ll?ly 011 the [ore9oJIIU repr.eselltaLJolls .ill COll1l8CLioll wJth the 1I11.I.ted Slflles
1;'oreJ911 ]lIvesLlllclIL ill Heal ProperLy '1l.1X l\cl. (94 StaLute 2G02 flS Clmended).
(IJ) 1 (we) lllldcrstilnd Lllis cl.nU[.i.caUulI IIny be disclosed La the Inlet"l1al Hevenue
Service by tl:"alluh~ree Dud that allY false statement cOlllalnetl ill this cerUf.f.cation
IlIilY I)(~ 11I1IlifJh(!<! by r .1.110, .l.lllpr.i.Bolllllt111l: ur I.):) l.1I .
Under lJ(~nil.1.U.es of perjury I (we) declam I (we) have exallulleu carefully this certi-
flcal:ioll alld it is Lrue, correct alld complete.
Date
nl
PINELLAS
FLORIDA
County,
\ i:Lit, 9 "7r1{{t?,.",~
Witll~ .' --. () ARHTUR MltL'iR: JR.
L4~ .J'-i" lG ~.<l^---' \ t7 /,' <!-L .'7:/(""'1 A<':4
WHness ' . ALICE MAY RAY (/ c;:r-
('111is docllment IInJSt be retained wltH the enu of the fifth taxable year following the
taxable yenl- JII whlch the trallsfer.- Lakes place).
CONSUl :l' YOlll~ l\TIUIlNI;;Y l\NI1/On 'J'l\X l\IJVISOH - NO Iml'LU!:SE.NTl\'1'lON on HECU'l'mNIJNI'lON IS NNJE DY
S'1'I~Wl\Il'l' '1'111'J ,p; JNSUnl\HCI~ O1'1Pl\NY l\NIJ/OH CONCgHNING '1111~
LEGl\L SUFFICJ/;:NCY l\NIJ/OH 'J'l\X CONSQlJI!.NCJ!S OI!' '.l1JlS IXx..1JME:tfl'. YOll r-1l\Y m: 1U~'QUlfUiJ) '1'0 FILE
l\ COpy or 'I'lli ~j f)(XJJNU'fl' WI'1l1 'filii: IN'l'EHNl\IJ 1U!:VI!:NlJl~ 51~HV.Lq:. 'J1I E:5 Ii: I\IU~ QUI~J'.LONS FOH YOUn
l\'1'lDHNI~Y on 'l'I\X I\IJV lson.
S'l'NJ'I~ OJ.i'
COUNTY 01"
FLORIDA
PINELLAS
I IIEHEIJY CI':H'J'H'V Lhat 011 tlds day, before me, an officer duly authorized J.n the Slale
a[oresa.l.d and ill Lhe COUllLy o[oresoid to take adUlowledgllle/1ts, persollal1.y nppeared
ARTHUR MILLER, JR. and ALICE MAY RAY
to llIe Imol.....l Lo be the l>et"flOllS descd"bed i/1 allu who execuLed LIIe foregoing instnullellt
fllltl Lhey ackllowledged before l1Ie Lhat limy executed the same.
Wl'1'NI~SS Illy hand onll offlc.inl seal 111 the COllnly cllld State last aforesaid tltls
of MARCH , 19 91
28
day
~~
- ......"..
. -- ? ?-'l.--c-_,
c::-- , ~
!/. ..:) .. ~,
.
.
NON-I!'OHlUGN Clm'l'U'lCI\'l'lON UY INIJIVllJUI\L 'l1U\NSIPEHOH
1.
SecU_UIl .1'l1!:; of thn llltenml Hevellue Code pruv.ldes that 0 tr.allsferee (IE a lJnIted
States I.-eal pL'u(let"Ly Jllterest Illust w.lthhold Lax Jf the trallsferor is (J foreign persall.
]11 aideI:' to 111[Ullll the lnllls[et-ee lhnl wilhhold.i.IIU of lnx is flat required lIpon lhe
d.lslxm.l. UOll hy ANDREW MILLER
2.
~ ~ \. "
OfU,e UIiTletl Stale~l properly tlescdl.Jetl as follows:
MAP OF R.H. PADGETT'S SUBDIVISION
OF A RE-SUB OF LOT 2, OF THE REVISED
LOTS 8,9,
the 1I11demlYlIed lrallsferor certifies alld declares by mealls of lids certification, the
following:
(a) I (We) alii (are) 1I0t 1I01l-resitlellt a11en(s) [or P..lL-poses of lhlited States wcane
taxaU.oll OIlc.1,
(IJ) Ny UIIII r.d Slules lnYP(Jper
NI\NI~
ANDREW MILLER
identifyJJl<j IIl.lIllber{s) (Social Security Nlunber)
SOCJJ\fJ SI!:CUIU'.l'Y NtJr.~
~i, ~ :<~:2. - "To gZ'13
"
II
11
is/are:
(c) Ny hOllle nd<1nmH :In
(nlt:iJched addJUollnI l"JUG Jr necessary)
(d) Thore ill-e 110 olhe!" lxnsol\s who hove 01' oWllen3hJp tllterest ill Lhe nwve-tlesctlbed
ptol){n.ty olhr:n' tholl Lhose persolls set forth nbove .ill sllblXJI~ayraph (b).
J. 'Jl,o tlIlllersJ~Jlled hetchy fUtther cerL.tries Gild declares:
(a) :r. (\"r~) IlIKlerslulld that lhe Ix.lrchaser of lhe aoove described property intends
to roly Oll tho roro~l(Jl."U repl:esenLaUOIIS .in COllllecUon wlLh lhe HlIl.ted SLotes
li'oreJ~11I Jllvcstrll(~lIt ill Heal Property 'fux Act. (94 Stalute 2GB2 os Wllcllde(1).
(I)) 1 (we) 1I11t!ewl.i1l1d LIds ccrU.Li.caLJulI Jlny IJe disclosed to lhe Interllal Hevellue
Service by trilllU[IHee and that uny false slutell1enl contalned ill this cetu.f.i.cation
HlilY I)(! 1""11nhl!d hy f.l.llo, .I.1II1'....I.S011l11(?IIl: 0... luLh.
UIKh~L- 1)(~llillUes of pel~jl\'~Y 1 (we) dec.1m:e 1 (we) have exumJned carefully lids certi-
ficatiulI illld it Is true, correct alld cumplete.
\.).1.-
Dale 1..,9 MARCH 1991
t.,' ~.~ ~.~\u~~
Wilness
I '-','
R ~~t-toNcf
~~N
-futmt y ,
VIRGINIA
n~
\. ~ ~ ,~
\ J . ~
.,,-' ~~RA.Aj~ 22;:~
. .
AND EW MILLER
I-~
Witness
(111ls d Ilelllt IlnJst be t-etalned until lhe entl of, lhe fifth taxable year following the
taxable ye UJn \"IIIcll the It:alls[ee lakes place).
CONSULT YOllH A'I'I'OIINli;Y MIIl/OH '1'AX AIJVlSOH - NO HEPIU!:SI~N'l'^,L'10N OH HECCXlII'W:NJJA'1'I0N IS NN)I!; UY
S'J'I~WAH'J' '1'.lTJ ,p; IN~;lJIW~CI~ lX1'11'I\NY ANIJ/OH CONCEHNING '1'1"~
LEGAl.. SUF'F.I CJ(i;NCY ANIJ/OI{ TAX CONSQlJI~NCI!;S OF '11 IlS 1JCJC.,1JMli:N'l'. YOU r-1l\Y IJI!; HEQULHliJ) '1'0 FILE
A COpy OF' '1'III}j IXXJIMli:N'J' W/'l1l '1'IIJi: IN'l'EIlNl\JJ lU~:VI!NIW: SI~lWI.CI!~. 'I1W:Sli: I\HE QUI~S'J'.lONS lcOIl YOUH
l\'1'lDnNI!~i on TAX I\IJV 1SOlL .'
STATE: OJ.i' (I.. . _A VIRGINIA
'W~~ OF' t\~~~<'Jd
I JlEHEIJY Cf.i:H'I'H'Y tllat 011 LhJs day, before lIIe, an officer tllJly auLhorized J.n llle Slale
a[oresaJd nlld ill lhe Counly aforesnJd to take acknowledglllents, personally .lppeared
---.-----AtIDREWJ1IL.1ER _. __.
to IIle kllOI'" , to be tile 1}(~n;IJIIS desed.bed in and who executed the foregolng Jnstnullellt
nntl lhey acknow.l.ed~ed IN:~fore hle that they executed the sallie.
Wl'l'NI~SS illY hand illltl ofOcJaJ. seal 111
of MARCH , 19 91.
,~
Lhe COUII~: CI::~ald LIlis Zq
NOl'l\llY PUBLJ.C I
C ~ I l \ ~ F' fl.,n I
NY Ol'l'lfSSrOl1 Ji:XP1PJ~,r;:' ,-r.~ND't'\" J 'f
day
.
.
NON-FOHKLGN CE.H'l'U'lCJ\'l'lON UY INIJIVIDU^L 'l1V\NSFEHOlt
1.
Secl.l_on l'11S o[ lhe Illteuml Hevellue Code provides lhat a tnllls[eree uf a United
Slales n~al 1'1:operLy .llIletest Illust w.llhhold lax If the transferor J.s IJ foreign person.
.1n oLder. lo lllrUlIll Ule tnll/sferee Lltnt wiLhhOl<lltl~ of Lax is not requit-ed upon the
d.lslxmJUolt by GERTRUDE M. CLARK and RUTH M. ILLS
2.
~ .. .. \'
of lite UII.i.tetl StntefJ I:enl pl'Operty descr.U.Jed ns follows:
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF TIlE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
the llIKletsJyltetl lWlIsfet-or eertifies ana declares by "'eons of litis cerUfication, the
following:
(a) 1 (We) 01\1 (at'e) not lIoll-resident ol1en(s) for purposes of thlited States incalle
laxatloll ond,
(1)) ~1y Unll r:d SLntes LoypnlJet
NNm
GERTRUDE M. CLARK
RUTH M. MILLS
idelltifyJny 1lI.1II1ber{s) (Soeial Security Nlul1oor) is/are:
SOCJl\r.l SI!;CUIU'.l'y' NUNlJIm
U /W<-'~ ' ~ii'z-i~, P" 7'f
,,;.' I 7J. I',' '-Ifo-91'1-3
"
11
(c) ~ly hOlllC tld<1lum .Ill
(nUnched (J(ldJUollo.1. pa~Je Jr Ilecemmty)
(d) Thele nto 110 other l~lSOIlS wlto have nn ownersltJp .lntet-est in tIlQ nlnve-descdood
property olll0.r lhnlt those persons set forlh above ill sullparagraph (b).
]. 'I1JC 1Il1dend~llled heleby hll:theL' cerl.tries olld declal:es:
(a) I (\,,(~) ulluerstCllld tltnt lite purehasm- of the alJove described pl-operty illLends
to U!Jy Oil tile rot:e~I().l.IIU repl:esentaU.olts 111 c0l1ltectlo11 willt tlte 1I111ted stutes
Vond~11/ IltveGLIlI(~l/t :ilt Ueill Property Tux l\ct. (94 StCltlll.e 2G02 os HllIelldad).
(IJ) J (we) IlIldl.!rst.tltd this COl-U.r.i.caUoll IIny Ix.~ lIi.sclosed lo Lite Internal HevenLle
Serv.ice by tralls[{nee alld that {lilY [a.l.se statemenl colt tallied ill Lhis cerUf.i.catiolt
IIli,ty I>(~ ,III1!.i.r;It(!(I by r.I.II(~, .I.l\Il't.l.sollllll.ml ot I.XJtlt.
1I11der llClti1H.l.es of perjury 1 (we) declare I (we) Itave examined carefully this certi-
fJcaUun ulld .it is true, correct alld cOlllplete.
Date
MARCH 28, 1991
nl
PINELLAS
~Yv" /-C:J: ~/, (f.. ~ . >'1(Z
GERTJDEL )1. ~LARK / '" 'J
/ /' I-~(Ziu lJ), / )Ju/fv
Wltlless . RUTH M. HILLS
('1his dOClUllellt IInJSt be retalned until the elld of tlte fifth taxable year following the
taxable yei1l- .1.11 \...ltlclt the tr.alts[et: lakes pInce).
CONSUI:l' YOllH l\'I'I'OHNI':V l\NI l/ou 'l'l\X l\J)V I SOH - NO HEPIH!:SI~'N'1'l\'J'lON on HEC0I'1I'1I!.'NJ.ll\'1'JON IS ~tl\.I)E ny
STI~WMn' '1'101'/ ,p; JN~;UH^NCI~ C(X'lPl\NY l\NI.l/OH CONCE/UUNG 'l1l1~
Ui;Gl\IJ SUli'rJCJliNCY l\NI>/on Tl\X CONSQUI~'NCES 01" 'nlls LXJCUMI!:~Ol~1l\ Y BE HEQ\J1H1iJJ '1'0 FILE
1\ COpy Ol~ 'l'IIIS J)(X:UI\WNl' WJ'11I 'I'm: INTEHNl\J. IHWI!:NlJl~ slmVJq~. 'I1W:Sli; ^Im QUI~SJ'.lONS ron Youn
l\'1TOnNIW on 'mx 1\IN iSOIt.
County,
FLORIDA
S'1'1\'l'I~ 0J.i'
FLORIDA
PINELLAS
COUNTY Ol"
I IIEUEIJY n:rrl'H'Y tllat Oil tills day, before llIe, all offLcer duly alltllodzed ill lhe Slale
aforesa.ld nlld .ill Lhe COllllty o[otesold lo lake ackllowlec1glllenls, persollally lIppeared
GERTRUDE M. CLARK and RUTH H. MILLS
to lIIe -j~II0\ll11 to lJC tile .>enJolIs c1escd_bed1i1 mul who executed tile foregolltg -JJIslnUllellt
find they ad~n()wlcdved l.x~[orc llIe lhat they executed tlte Sullie.
Wl'l'NI;;S;; illY It,JItd emu u[fJdnJ. neal 111 Lite Coullty nnd StnLe lust aforesaid tlds 28' day
or MARCH , 19 .91 . ____--7 =~ /
- /~/ 6J ~-"<'?
Nal'l\HY PUBJJIC
~lY nl'1'HSSJnN l;:XI'''!I~~~ J/. ').- <,,/'c/
.
.
NON-FOHEIGN Cl!.H'l'H'ICl\'l'lON UY INIJIVI/JUI\.L 'l1U\NSIPEHOH
1.
Sect.i.ulI 1'14~ of the ]IJLenlOl Hevenlle Code pt'uvldes lhat n tr.allsferee ...f a UlJited
Slales n~(Jl pt'upet.l.y JlJl(H'esl IIIUSt w.Lthhold lax J[ the tralJsferor is (j foreign person.
111 order Lo infotm Lhe tnlllsfet'ce that wiLhhohUlJg of tax is not required upon the
l1.is[XJsJ L.l.olI hy FRANCES DOBY
2.
~ ' .. ..
of lile UlIlLed Slales I:eol pmperty descdbed as follows:
LOTS 8 & 9, OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
lhe lllldet'sJYlled tronsferor certifies and declares 1.Jy means of lhis cerlificotion, the
following:
(a) I (We) am (are) not lion-resident alien(s) for purposes of lhlited states incane
laxa lion ond,
(I>) Ny Unll r.u Slules lOYPllper
N 1\1'11 ~
FRANCES DOBY
idel1tify.l.ng nUlIlber(s) (Social Security NLunber) ia/are:
SOCIMJ SI!:CUIU'.l'Y. NUNlJl!.1t
c.DUV J.(o"j-l-;I; - 7'(~7
If
"
11
(c) ~ly hOlllo ndd leml JIl
((lUnched mldJUollil.l. pauo Jr 'Il~cemmty)
(d) 'I'h(!re '11-0 110 olhm,- lX!l'solls who have 011 oWlle/:sh.lp .Il1le/'enl :1.1\ lhe iJI.xJve-desct.H.~d
lJ/.qxH'ty oLlllJr thun those persulJs set [orth obove .1.n subpatayt-ilph (b).
]. 'J1111 t111denJi~llled hetehy [u/.-lhe/: cerl.tries olJd declares:
(0) .I. (\-.Jf~) understand lhal lhe purchaser of the above descril.Jed properly inlends
lo u!ly on lhn fore9oJIIU relwesenlilUOIlS ill connccUolI wJlh the llnl.tcd Sloles
I"olei~lll Jnvestlllcnt ill Heal l'J:olx~J:ly 'I'llX l\ct. (94 SLl:lluLe 2GB2 as ClIu81lded).
(11) J (we) IIII(ltnntillllJ LlI.1s cerU.f.l.caU.oll Il\JY IJe discloscd to lIm lnlemol Hevellue
Service by ll:illltl[(~t'ee and tllflt OilY false statemenl conlolneu in lids cetU.f.l.calioll
lIIilY I)(~ Illu1.i.nlll!d by 1'.1110, Jlllpl.'JnolllllulIl: or hJl:h.
Ullder penlll.U.es of
ficatIulI ond J t is
~ !)'-
'.v
/Jule MARCH 1991
l>at'jury 1 (w(~) declnre I (we) have examIned carefully this cerli-
lnle, correct and complete.
~. t/AA~(lV5d--/ fl_: l/ll cthJJal\.-.'
WIlness
...~~~/<iAfifr [j,. C!dwlJrr!/
W~~
(lhis docllment IIIl1st be relained unU.1. the end of lhe fifth laxable year following the
laxaule yea/: .In \",Id.ch L110 Lnlllsfee Lakes plnce).
CONSUI:1' YOllH l\TI'OllNIW l\NI l/on 'mx l\'WISOH - NO HEl'IU!:SI!.N'1'A'J'JON OH HOCO!\1I\lI!:NtJl\TJON IS Nl\Dl~ Uy
S'l'I~Wl\H'J' 'J'ITI,I;; JN~;Unl\HC'~ LU\ll'l\NY l\NU/OH CONCEHNlNG 'l'Il1~
LEGl\L SUF'FJc:U;:NCY l\NI>/OH 'J'l\X CONSUI1I~'NO;S Of 'n Il~l txx:UME:N'l'. YOlJi,/\y BE HEQUIHliJJ 'ID FILE
l\ COpy Ol~ 'I'IIIS IJ(X:IJr.WNJ' WI'I1I 'l'IIP; INTEHNM, 1U~:VUlJtJl~ Sp:nvlq~. '1111i:~)Ji: l\lU~ QUI;;"c;'I'.lONS nm YOUH
^'l'lDHNI~Y OH 'l'I\X ^IJV 1 SOU .
( ~,
u lv---
Counly,
FLORIDA
\ l( .
. ~ {/~
.....--C'. Cl:#t!.~/' A.-, 'c.--c;
FRANCES DOBY
S'l'^,,"~ 0Ji\ \, FLORIDA
COUNTY OF"~
1 IIEm:IJY CI;;H'J'H'Y that 011 UJ.l.s day, before me, an officer duly aulhorized JI1 the Slate
aforesaJd iJlld ill the COUllly aforesold lo lake ackllowledYlllellts, persollally llppeored
FRANCES DOBY
to me knU\1/l1 Lo be Ule I>eJ'f;OIlS descrJ.1Jed in a1K] who execuLed Lhe foregoing JllslrWllellt
and Liley ilcJ;l:owledved lx~[ore me lhat they executed the same. I ' i
-
Wl'l'NE:SS illY hilllCl illlU offJdnl nenl ill Lhe County nuu SLille InsL n[oresaid lids ::P} . day
of_____~ARCH , 19 ,91.) , ')
, /' 1(.//'/1 1/
. ./" '--(~1')(('~ti'L(/(~:;; ;1 l(/'t.ftlat'{f~'_C 1
NOl'l\HY PlTBJJIC '-Nolary Public, S\J\~ of Flwillil
~1Y Gli'HSS'ON I;;Xl'rrws. "I'" . . , i' 11,)
.
.
.\I/II"lil,t ,,{ CflI/III":t
RONALD (RONI E. SOMERS
President
S'I"EW AIl'r 'I"rrl~E
OF CLEARWATER
P.O. Box 2756
Clearwater, Florida 34617
(8131441-2689
1290 Court Street
Clearwater, Florida 34616
D I S C LOS U R E
We, the Owners of that certain real property located at
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT'S SUBDIVISION
Pinellas County, Florida, do hereby disclose the following facts
known to me which may materially 'affect the value or desirability
of said property.
I HEREBY CERTIFY that I have no knowledge of any facts or
defects in said property which may materially effect the value or
desirability of said property, except as set forth above. I
acknowledge that this disclosure will be given to the listing
broker, the selling broker~ and any prospective buyer.
l?J/f)liLja/ ti. l/lt~Wlv.'I'--'
Witness
Q) /'~--'-~ fi~
FRANCES DOBY
. '/>!1/~ &,r?dmrrJ}G
~ ess .
STATE OF_ ~LuRlDA
\~
COUNTY OF ./
L<{)
SWORN TO AND SUBSCRIBED BEFORE ME THIS...- ~'l tl
DAY OF
MARCH
19-.2.!.
C0
My Commission Expires: ~
Notary Public, State of FlorIda
My Commission Expires Feb. 3, 1993
;Z;~c~)1Jr:fi'L(~~,
Notary Public
t' ,.-, )
. \
.-:..
'...., /'..-1
")(" c;(
-
.
.
.",'lIurt;,y ,,1 ('(llIllIll't
RONALD (RONI E. SOMERS
President
s'rEW All'r 'rl"rLE
OF CLEARWATER
P.O. Box 2756
Clearwater, Florida 34617
(8131441-2689
1290 Court Street
Clearwatar, Florida 34616
D I S C LOS U R E
We, the Owners of that certain real property located at
LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
Pinellas County, Florida, do hereby disclose the following facts
known to me which may materially 'affect the value or desirability
of said property.
I HEREBY CERTIFY that I have no knowledge of any facts or
defects in said property which may materially effect the value or
desirability of said property, except as set forth above. I
acknowledge that this disclosure will be given to the listing
broker, the selling broker, and any
prospective buyer.
~fi;t_( "i, 1''7{ , f'./d'l.C
GA~U,DE M/?CLARK /1 l~
/ t// 7 /}JI_(
/~~&~MILL~ L(/j2 ~
· A ill , :Jif. '-l? #
~71/iU;( xiflf/!!/JIO/:-
W tness '
--.--t---
Witness
/ t[~ /7t ~ L~-
r'" ALICE MAY RAY
STATE OF
COUNTY OF
FLORIDA
PINELLAS
SWORN TO AND SUBSCRIBED BEFORE ME THIS
MARCH 19 91 .
28
DAY OF'
;
"
My Commission Expires:
II -"l - cio/
Notary Public
.
.
s""uil.t ,,/ ('t>rIlT",.t
RONALD (RONI E. SOMERS
President
S'l'EW AIl'l" 'rrl'IjE
OF CLEARWATER
P.O. Box 2756
Clearwater, Florida 34617
18131441-2689
1290 Court Street
Clearwater, Florida 34616
D I S C LOS U R E
We, the Owners of that certain real property located at
LOTS 8 & 9 OF A RE-SUB OF LOT 2 OF THE REVISED MAP OF R.H. PADGETT"S SUBDIVISION
Pinellas County, Florida, do hereby disclose the following facts
known to me which may materially 'affect the value or desirability
of said property.
I HEREBY CERTIFY that I have no knowledge of any facts or
defects in said property which may materially effect the value or
desirability of said property, except as set forth above. I
acknowledge that this disclosure will be given to the listing
broker, the selling broker, and any prospective buyer.
(~ 'p\
\ c1 ) "
'/<~ ~. ~ M.~
Witness
u1 4:e m .
v/'"' d1 ,i"~{1"~ L--e~
ANDREW MILLER
1~~
Wt t s
STATE OF VIRGINIA
(3i
0OUN'fY OFn""'L-...n..l. - - oj
Q.~~ '-"~
l .
-
SWORN TO AND SUBSCRIBED BEFORE ME THIS ~ c:;
DAY OF
MARCH
19 91 .
~
My Commission
ll)
Expires: v'-
~~~ Ot1,qqf
Notary Public
( , I
~-- (
) i {I (
.
.
RONALD (nON) E. SOMERS
President
\o"t";/l HI (:01111(1(:(
S'rE'VAI{'r'rrrLE
OF CLEAH,WATER
P.O. Box 2756
Clenrwater, Florida 34617
(813) 441-2689
. 1290 Court Street
Clearwater, Florida 34616
AU'l'HORIZA'rION AND ACKNOWLEDGEMENT FORM
Reference:
FILE NO.
91030091
LEGAL LOTS 8 & 9 OF RE-SUB OF LOT 2 OF THE REVISED MAP OF
R.H. PADGETT"S SUBDIVISION
SEllER GERTRUDE M. CLARK; RUTH M. MILLS; ARTHUR MILLER, JR.;
ALICE MAY RAY
BUYER
We hereby approve and acknowledge receipt of a copy of the Statement and actual
cost (DISCLOSURE/SET1~EMENr STA1~r - HUD FORM 1) and authorized disbursement
of funds as shown t.herein this 28 day of MARCH , 19-1..L We further
acknowledge that we understand utility bills are not included in this statement
and that the proration of taxes as shown in the statement of actual cost is
based on the latest information available. If any changes are to be made in this
proration when the tax bill is received, it will be handled between the parties of
this transaction. Stewart Title Comp3.ny of Cleanvater, Inc., will not be held
responsible. It is further wlderslcxx] that Stewart Title Company of Clean-later,
Inc., cannot, at this time, assertain if thore will be personal property tax on
subject property or an aJl10Wlt on which to base a proration. l\ny proration necessary
when tax bills become available will be handled between the p:1rties to this
transaction, outside of Stewart Title Company Company of Clearwater, Inc.
Stewart Title Comp:my of Clearwater, Inc., will be not held responsible.
hlq kI ttr CLl., iUi
for: ITY OF CLEARWATER -
/ /1 ..../ I L.,'~1 j) I L
v~./l..L-- ?L<..u:-L<. j). C{'fl~ "
GE~DE~. CLARK ~/7
~ t III J /h'7.d t:.<f/
RUTH M. MILLS
/CA~~~<1 4fd~ ~
ARTHUR ILLER, JR. v
~/ d" (;.'6v 7J[ay /(~7/'
ALICE MAY RAY'
~~~lj{RX~xFORWARDING l\DDRESS:
BUYERS
~X$. FORWARDING l\DDRESS:
SELLERS ',\
~~L;;'~,~r ST':;"
(:4t1~~,~, 3_G/S-
, ,
HCX'1E PHONE# Y ~ ~ - 78 75
HCX'1E PIIONEtt
WORK PI 10NE#
WORK PIIONE#
'TIllS IS TO FURTHER AU'l'HORIZE R /;9
GlANGES NECESSARY TO 1HE CLOSING S1'ATEl'1EN"r.
TO APPROVE ANY
STEWART TITLE COI.\1PANY OF CLEl\RWA'l'm,
~<<~/~
L.
INC.
BY: