GEORGE W STONE TRUSTEE OF J O STONE GRANDCHILDRENS TRUST
, .'~""'" ;0' (",,10'" 'flf-.dd"'''' ,to,",' '","op,)
" ~ame: ~TEWARTT1TLE OF CLE;A~ATER, INC.
Address: 1290 Court Street
Clearwater, Florida 33756 .
,...,...... This Instrument Prepared by: MARIANNE, SCHAFFER
of STEWART TITLE OF CLEARWATER, INC.
as a necessary incident to the fulfillment of conditions
contained in a title insurance commitment issued by it.
Property Appraisers Parcel Identification (Folio) Number(s):
15-29-15-00000-210-0700
Grantee(s) 5,5,#(s):
FILE NO:
I 999 a: 18PM
N- 8- 1 c; 188
99-188793 ~u eK 10545 p
PIN r: I...I...I~~\ I\~ 1\1\1 11\\1 1\1\1 1\111 1\\1\ 1\1\\ IIII 1\\1
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99010086
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WAR~Y D1i~
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e'w:-
nOhe terms -gralllor- and -granlee- herein shall be cOl1Slrued 10 Include.1I Renders and sinlUI., or plural as the cornut indicales.)
This Warranty Deed Made this aday of May A,D,19 99 , by
) GEORGE W. STONE, TRUSTEE of the J. O. STONE GRANDCHILDREN'S
~A~:~,~~';:1'RUST under Trust Agreement dated December 29th., 1976 , f/b/o MAX FORESTER
A""" '~r~V D
DE?'I (}J~ j'WIiose marital status is: ,
'fY'-! \:It hereinafter called the grantor, whose post office address IS:
F t!ICITY OF CLEARWATER, FLORIDA, a Florida Municipal Corporation
I". "
.. C;:('
whose post office address is: P. O. Box 4748, Clearwater, Florida 33758-4748
,. "3 I der~nafter called the grantee,
WITNESSETH: That said grantor, for and in consideration of the sum of $10,00 Dollars, and other valuable considerations.
~. receipt whereof is hereby acknowledged, h,ereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the
grantee, all that certain land situate in Plnellas County. Florida. viz:
C~+~,
l(GAL DtSCRIPTION:
A PARCEL OF LAND BEING A PORTION OF THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL RECORDS
BOOK 9956. PAGE 1415 OF THE PUBLIC RECORDS or PINELlAS COUNTY. FLORIDA. lYING WITHIN THE WEST 1/2 OF
THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION I~, TOWNSHIP 29 SOUTH. RANGE I~ EAST, CITY OF
,ClEARwATER, PINElLAS COUNTY, FLORIDA, BEING MORE PARTICULARLY DESCRIBED AS FOlLOWS:
CCM.ENCE AT THE SOUTmt'(ST CORNER OF THE NORTHEAST 1/4 OF THE NORTI{NEST 1/4 Of SECTION 15, TOWNSHIP
29 SOUTH, RANGE 15 EAST. CITY OF CLEARWATER, PINELLAS COUNTY. FLORIDA: THENCE S 89-'2'05. E. ALONG
THE SOUTH BOUNDARY LINE OF SAID NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 15 (BEING THE BASIS OF
BEARINGS FOR THIS DESCRIPTION). FOR 665.46 FEET TO THE SOUTHEAST CORNER OF THE WEST 1/2 OF SAID
NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 15. SAME ALSO BEING THE SOUTHEAST BOUNDARY CORNER OF
THAT CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415 OF THE PUBLIC
RECORDS OF PINELLAS COUNTY. FLORIDA, SAME ALSO BEING THE SOUTHEAST BOUNDARY CORNER OF THAT CERTAIN
PROPERTY AS DESCRIBED IN OFFICIAL RECORDS BOOK 3219, PAGE 346 OF THE PUBLIC RECORDS OF PINElLAS
COUNTY. FLORIDA; THENCE lEAVING SAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4
OF SECTION IS, N 00-00'08- W, ALONG THE EAST BOUNDARY LINE OF. SAID WEST 1/2 Of THE NORTHEAST 1/4 OF
THE NORTHWEST 1/4 OF SECTION 15, SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS
DESCRIBED IN OFFICIAL RECORDS BOOK 32'19. PAGE 346. S~ ALSO BEING THE EAST BOUNDARY LINE OF SAID
CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 99~6. PAGE 1415. FOR 52.68 FEET TO
THE NORTHERN MOST BOUNDARY CORNER OF SAID CERTAIN PROPERTY AS DESCRIBED IN OfFICIAL RECORDS BOOK
3219, PAGE 346, SAME ALSO BEING THE POINT or BEGINNING; THENCE CONTINUE N 00-00'08" W, ALONG SAID
EAST BOUNDARY LINE Of THE WEST 1/2 OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 15, SAME
ALSO BEING SAID EAST BOUNDARY LINE OF THAT CERTAIN PROPERTY DESCRIBED AS PARctL II IN OFFICIAL
RECORDS BOOK 9956, PAGE 1415. FOR I II .84 FEET TO THE NORTHEAST BOUNDARY CORNER OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL RECORDS BOOK 9956, PAGE 1415, SAME ALSO BEING THE
SOUTHEAST BOUNDARY CORNER OF THAT CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915, PAGE 103 Of THE
PV8L1C RECORDS OF PINELLAS COUNTY, FLORIDA: THENCE lEAVING SAID EAST BOUNDARY LINE Of THE WEST 1/2
OF THE NORTHEAST 1/4 OF TK: NORTmt[ST 1/4 OF SECTION 15. N 89-'2'05" W. ALONG THE NORTH BOUNDARY
LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956, PAGE 1415, SAME
ALSO BEING THE SOUTH BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915, PAGE 103,
FOR ~,70 FEET TO THE SOUTHWtST BOUNDARY CORNER OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK
9J~. PAGE 103: THENCE LEAVING SAID NORTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL
I I IN OFFICIAL RECORDS BOOK 9956, PAGE 1415. S 03-08'~6" W. FOR 164.64 FEET TO THE NORTHEAST
BOUNDARY CORNER OF LOT I, REVISED MAP OF R.H, PADGETT'S SUBDIVISION. AS RECORDED IN PLAT BOOK 4.
PAGE 32 Of THE PUBLIC RECOROSOF PINELLAS COUNTY, FLORIDA, SAME ALSO BEING THE POINT Of INTERSECTION
WITH THE SOUTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL" IN OFFICIAL RECORDS
BOOK 9956, PAGE 1415. SAME ALSO BEING AFORESAID SOUTH BOUNDARY LINE Of THE NORTHEAST 1/4 Of THE
NORTHWEST 1/4 Of SECTION I~: THENCE S 89- IZ'05. E. ALONG SAID SOUTH BOUNDARY LINE OF THE NORTHEAST
I/~ OF THE NORTHWfST I/~ or SECTION IS, SAM( ALSO BEING SAID SOUTH BOUNDARY lINE OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415. FOR ~,05 rEET TO THE
SOUTHWEST BOUNDARY CORNER OF AFORESAID CERTAIN PROPERTY AS DESCRIBED IN OFFICIAL REyORDS BOOK 3219,
PAGE 346: THENCE LEAVING SAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 or
SECTION 15. N 09-23'45" E. ALONG THE WEST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN
OFFICIAL RECORDS BOOK 3219. PAGE 346. FOR 53,27 FEET TO THE POINT OF BEGINNING AND CONTAINING 1.2B9
SOUARE FEET OR 0,0296 ACRES, MORE OR lESS.
See attached Exhibit "A" hereto
Page 1 of 2
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IINELLAS COUNTY rLA,
Orr,REC,8K 10545 PG 189
This property [PO [is not] the homestead of the Grantor(s),
TOGETHER with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining,
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor
has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will
defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes
accruing subsequent to December 31, 19 99, reservations, restrictions and easements of record, if any,
IN WITNESS WHEREOF, Grantor has hereunto set grantor's hand and seal the day and year first above written,
< ttjJ~
(Seal)
TRUSTEE
(Seal)
Witness Signature:
Witness Printed Name:
(Seal)
Witness Signature:
Witness Printed Name:
(Seal)
STATE OF FLORIDA
COUNTY OF Pinellas
The foregoing instrument was acknowledged before me this N~ day of Uay , 19 99
by GEORGE W. STONE, TRUSTEE of the J. O. STONE GRANDCHILDREN'S
TRUST under Trust Agree~ent dated December 29th., 1976, f/bla MAX FORESTER
who is/are personally known to me or who has/have produced driver license(s) as identification,
Printed Name:
Notary Public
Serial Number:
~
, My Commission expires:
~O--
~~A,"
... .,
o '=
z: n
DEBRA A. BORGH
Notary Public, State of Florida
My COIIlIIlission Expire. Jan. 30.2001
Commlllion , CC691511
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me this
by
day of
, 19
who is/are personally known to me or who has/have produced driver license(s) as identification,
My Commission expires:
Printed Name:
Notary Public
Serial Number:
8C080941 06-08-1999
01 0000000000
DED-CLIIR
RECORDING 003 PAGES
DOC STA"P - DR219
14: 18: 11
J"F
1
3
TOTAL:
P CHECK A"T.TENDERED:
CHANGE:
$15.00
$16.10
--------
$31.10
$31.10
$.00
Page 2 of2
I, - 1
,I -iHl~ls t<<2i A SUR~ 'EXHI~IT "Au - Paoe 2 of 2
I THERE MAY BE ADDITIONAL RESTRICTIONS AFFECTING THIS PROPERTY THAT
MA Y BE fOUND IN THE PUBLIC RECORDS OF 'tHIS COUNTY.
I
THIS LEGAL DESCRIPTION AND SKETCH WAS PREPAREb WITHOUT THE BENEFIT
OF" A TITLE POLICY. ,
BEARINGS ARE BASEO UPON, SEE SKETCH AND LEGAL DESCRIPTION
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PINELLAS COUNTY FLA, --,
OFF,REC,8K 10545 PG 190
POC
SW COR
OF THE NE 1/4
or THE NW 1/4
OF SEC 15-29S-15E
~
z
(BEARING BASIS)
S BNOY UNE OF TH NE 1/4
OF THE NW 1/4 Of' SECTION 15-29S-15E
LEGOjQ
BNOY . Boundcwy
COR · Com.
POC · Point of Convnen<:6-nent
P08 · Point of 8~ilnhv
SF . Squore f.
At; . Acn(e)
t: - "'ore ItI lea
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OR . ~ ~ Boalt
PO · Pate
De . Deed Soak
NOT PLA TIED
PARCEL "
OR 9956, PG 1415
10
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589'2'OS-E
5.05'
1,289 SF OR 0.0296 AC :f:
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Q:ID
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01
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o
r AREA =
503'08'S6.W
53.27'
52.68'
_J_
/W PER OS 91~. PO 10J
---t-
N89' 2'OS.W
4.70'
N09'2J'45-
\ R/W t
Oft 3219. PG ~_ _
NOO'OO'oa.W
164.64'
_~OO'OO'08-W _ __
111.84'
---
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20' R/W
PB H4 PG 99
MADISON AVENUE
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101
N 0
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SE COR Of THE W 1/2 E UNE OF Tl-lE W 1/2 Of THE
OF THE NE 1/4 OF 'THE NE 1/4 or THE NW 1/" Of
NW 1/4 Of SEe 15-29S-15E SECTION 15-29S-15E :
CLEARWA TER HEIGHTS
PLA T BOOK H4, PAGE 99
n-tS lLGAl AND Sl((TC>4 ....IS PRD'ARED NTH n.E BENOlT r:F A RlCHT-r:F-WAY ~ TOPOGRAPHIC SJIl't'tY PR(J)AAal BY FlORIOA O(.gQj CCfofSUl'!ANTS. INC..
nTUJ) "'AOISON A'<{NUE/COUlD STREIT", JOe No. 191-02. LAST OAlI r:F FlEl.O WORK 7/411/'"8 AND OAlI SCNm 8/27 /l~~a.
PRD' AAfl) ... Oft:
SMEl., 0( SCRIPllCtt
SCAU:
r' = 30'
jJOe ~
197 -02
THE CITY OF CLEARWATER. FLORIDA
SKETCH
OA1t: ORA. J I
9/0211998 LCS ~
S( C11ON:
I hereby certlf1 Ihot thl. legal descrlplion and sketch
m..ts Ih. minimum t.chnical standard. a. ..t forth
by Ihe Florido Boord of Profes.lonot Land Surveyors
in Chapter 61G17-6 Florida Administrollve Code,
pur.uant to Section 472.027, Florida Statut..
NOT VALID WITHOUT THE SIGNATURE
AND THE ORIGINA RAISED SEAL OF A FlORIDA
lICENS URVEY R AND MAPPER.
CER D A 0 GAL ESCRIPTION AND SKETCH
CAlC(t); III
LCS ,...,..
TOWlNSHIP:
RCW
IlAHCt:
15 E
15
29 5
R.ORDA DESIGN CONSU..TANT8, we.
ENGINEERS, ENVIRONMENT AllS TS
SURVEYORS 8 PLANNERS
2639 McCo,rnic, D';n
Cleo' "01.'. 1"0"40 337S9
(727) 724.e422
Certlflcate of Authorization: l8 6707
Stotfl! n' F1,.".IA...
C. WRIGHT, JR.
PROFESSIONAL SURVEYOR AND MAPPER
L1CE~S.E_!,U~~~~_lS ~~ $lATE OF FLORIDA
.,
l,
I
I
PURCHASE AGREa?1 FOR R1:':~OF-:::JECT : Ml>J)ISON AVENUE
~e~~ Stone, tiJr
THIS AGREEMENT is made between ~:;=;:=@:;=;:~~~, as Trustee FBO Jody Forester
U/T/A dated December 29, 1976, owner and holder as tenant in common of an
undi vided 25% interest in subj ect real property; and as Trustee FBO Max
Forester U/T/A dated December 29, 1976, owner and holder as tenant in common
of an undivided 25% interest in subject real property, (herein, collectively,
"Seller"), c/o Charles F. Barber, Esquire, 1550 South Highland Avenue, Suite
B, Clearwater, Fl. 33756, and the CITY OF CLEARWATER, FLORIDA, a Florida
Municipal Corporation, 112 South Osceola Avenue, Clearwater, Fl. 33756 herein
("Buyer" or "City").
WITNESSETH
For and in consideration of the mutual covenants and conditions herein
contained, Seller hereby agrees to sell and Buyer agrees to buy the following
property or interest therein, upon the following terms and conditions:
I. DESCRIPTION
Real estate or interest
depicted in EXHIBIT "A",
made a part hereof.
therein, identified as legally described and
Pages 1 and 2 which are attached hereto and
INTEREST BEING ACQUIRED: [X] Fee simple
Personal property to be conveyed: None
[ ] Easement
II. CONSIDERATION
Amount to be paid by Buyer to Seller ln cash at closing. . . .$9,023.00
III. CONDITIONS AND LIMITATIONS
(a) It is mutually understood and agreed that this Agreement is
executed by the Seller subject to final approval and acceptance by
the Clearwater City Commission, which shall occur within forty-five
45) days of receipt of this document by Earl Barrett, Real Estate
Services Manager in the Clearwater Public Works Department,
together with counterpart agreements from all other parties having
fee interest in the property described herein. Date of acceptance
and execution by duly authorized officers of the City shall be the
Effective Date of this agreement, and execution shall serve to
ratify and confirm the purchase price and all terms and conditions
as are contained herein. If this agreement is not timely accepted
and executed by the City, Seller may, at Seller option, withdraw
from this agreement by providing written notice of such intent to
the office of the City Attorney, whereupon this agreement shall
thereafter be null and void in all respects.
(b) No actual or estimated ad valorem taxes shall be prorated to
the City or collected from Seller at time of closing this
transaction. The city shall pay state documentary stamps to record
deed given in this transaction.
;,
1
I
I
Page 2 - Madison Avenue (stone Buick parcel)
(c) The Buyer shall designate a closing agent located in Pinellas
County, Florida, and this transaction shall be closed in the
offices of the designated closing agent. Seller shall deliver
unencumbered title to the City at closing; however, the City shall,
at City's sole cost and expense, have the obligation to obtain any
releases of encumbrances as the City may require, together with
title insurance and certified parcel survey.
(d) The City agrees to restore to the present or equal condition any of
Seller1s remainder property up to but not more than five feet (5')
abutting the parcel being conveyed that may be disturbed or
impacted during construction of contemplated right-of-way
improvements. Such restoration shall be accomplished at City
expense and shall be completed not later than project completion.
IV. CLOSING DATE - POSSESSION
This transaction shall be closed and the Seller shall convey title by
Special Warranty Deed within sixty (60) days of the Effective date of
this agreement.
V. TYPEWRITTEN OR HANDWRITTEN PROVISIONS
Typewritten or handwritten provisions inserted herein or attached
hereto as addenda, and initialed by the parties, shall control
all printed provisions in conflict therewith.
VI. COUNTERPARTS; FACSIMILE COPY
This agreement may be executed in two or more counterparts, each of
which shall be deemed an original and all of which together shall
constitute one instrument. A facsimile copy of this agreement,
including any addenda, attachments and any written modifications hereof,
and any initials or signature thereon shall be deemed an original.
VII. IN WITNESS WHEREOF, the Seller has caused these presents to be
executed this ~ day of -';~I1JJ.a( , 1992:..
SELLER:
(~kH_
'..
I
I
Page 3 - Madison Avenue (stone Buick parcel)
VI. FINAL ACCEPTANCE BY THE CITY OF CLEARWATER, FLORIDA, EFFECTIVE DATE.
IN WITNESS WHEREOF, the City of Clearwater, Florida has caused these
presents to be approved and accepted by its city Commission, and executed in
its name by its officers thereunto duly authorized this ~day of
~ ' 1999.
~~ \
BUYER:
OF CLEARWATER, FLORIDA
CITY
~
.,
By:
Michael J. Roberto, City Manager
Approved as to form
and correctness:
Attest:
~~
John Carassas
Assistant City Attorney
Stone Buick ROW Contr,l198Bewb
..
..
lHlS IS t4.QI A SU~~ . EXHIEfT "An - Paae 1 of 2
THERE MAY BE ADDITIONAL RESTRICTIONS AffECTING THIS PROPERTY THAT
MAY BE fOUND IN THE PUBLIC RECORDS Of THIS COUNTY,
THIS LEGAL DESCRIPTION AND SKETCH WAS PREPARED WITHOUT THE BENEFIT
OF A TITLE POLICY,
BEARINGS ARE BASED UPON. SEE SKETCH AND LEGAL DESCRIPTION
LEGAL DESCRIPTION:
A PARCEL OF LAND BEING A PORTION OF THAT CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS
BOOK 9956, PAGE 1415 OF THE PUBLIC RECORDS OF PINELLAS COUNTY, FLORIDA. LYING WITHIN THE WEST 1/2 OF
THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 15, TOWNSHIP 29 SOUTH, RANGE 15 EAST, CITY OF
CLEARWATER, PINELLAS COUNTY, FLORIDA, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
COMMENCE AT THE SOUTHWEST CORNER OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION IS, TOWNSHIP
29 SOUTH, RANGE 15 EAST. CITY OF CLEARWATER, PINELLAS COUNTY, FLORIDA; THENCE S 89012'05. E. ALONG
THE SOUTH BOUNDARY LINE OF SAID NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 15 (BEING THE BASIS OF
BEARINGS FOR THIS DESCRIPTION), FOR 665,46 FEET TO THE SOUTHEAST CORNER OF THE WEST 1/2 OF SAID
NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION IS, SAME ALSO BEING THE SOUTHEAST BOUNDARY CORNER OF
THAT . CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956, PAGE 1415 OF THE PUBLIC
RECORDS OF PINELLAS COUNTY, FLORIDA, SAME ALSO BEING THE SOUTHEAST BOUNDARY CORNER OF THAT CERTAIN
PROPERTY AS DESCRIBED IN OFFICIAL RECORDS BOOK 3219. PAGE 346 OF THE PUBLIC RECORDS OF PINELLAS
COUNTY, FLORIDA; THENCE LEAVING SAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4
OF SECTION IS, N 00000'08" W, ALONG THE EAST BOUNDARY LINE OF SAID WEST 1/2 OF THE NORTHEAST 1/4 OF
THE NORTHWEST 1/4 OF SECTION 15. SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS
DESCRIBED IN OFFICIAL RECORDS BOOK 3219, PAGE ~46, SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID
CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415. FOR 52,68 FEET TO
THE NORTHERN MOST BOUNDARY CORNER OF SAID CERTAIN PROPERTY AS DESCRIBED IN OFFICIAL RECORDS BOOK
3219, PAGE ~46. SAME ALSO BEING THE POINT OF BEGINNING; THENCE CONTINUE N 00000'08" W, ALONG SAID
EAST BOUNDARY LINE OF THE WEST 1/2 OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION IS, SAME
ALSO BEING SAID EAST BOUNDARY LINE OF THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL
RECORDS BOOK 9956. PAGE 1415, FOR I I I .64 FEET TO THE NORTHEAST BOUNDARY CORNER OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415, SAME ALSO BEING THE
SOUTHEAST BOUNDARY CORNER Of THAT CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915, PAGE 103 OF THE
PUBLIC RECORDS Of PINELLAS COUNTY, FLORIDA; THENCE LEAVING SAID EAST BOUNDARY LINE OF THE WEST 1/2
OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 15. N 89012'05" W. ALONG THE NORTH BOUNDARY
LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956, PAGE 1415, SAME
ALSO BEING THE SOUTH BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915, PAGE 103.
FOR 4.70 FEET TO THE SOUTHWEST BOUNDARY CORNER OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK
91S. PAGE IO~: THENCE LEAVING SAID NORTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL
II IN OFFICIAL RECORDS BOOK 9956. PAGE 1415. S 03008'56" W, FOR 164,64 FEET TO THE NORTHEAST
BOUNDARY CORNER Of LOT I, REVISED MAP OF R,H, PADGETT'S SUBDIVISION, AS RECORDED IN PLAT BOOK 4.
PAGE 32 OF THE PUBLIC RECORDS OF PINELLAS COUNTY. FLORIDA, SANE ALSO BEING THE POINT OF INTERSECTION
WITH THE SOUTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS
BOOK 9956, PAGE 1415. SANE ALSO BEING AFORESAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 OF THE
NORTHWEST 1/4 OF SECTION 15: THENCE S 89012'05. E. ALONG SAID SOUTH BOUNDARY LINE OF THE NORTHEAST
1/4 OF THE NORTHWEST 1/4 OF SECTION 15, SAME ALSO BEING SAID SOUTH BOUNDARY LINE OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL I J IN OFFICIAL RECORDS BOOK 9956. PAGE 1415, FOR 5,05 FEET TO THE
SOUTHWEST BOUNDARY CORNER OF AFORESAID CERTAIN PROPERTY AS DESCRIBED IN OFFICIAL RE~ORDS BOOK ~219.
PAGE 346; THENCE LEAVING SAID SOUTH BOUNDARY LINE Of THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF
SECTION IS, N 0902~'4S" E. ALONG THE WEST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN
OFFICIAL RECORDS BOOK ~219. PAGE 346, FOR 53,27 FEET TO THE POINT Of BEGINNING AND CONTAINING 1,289
SOUARE FEET OR 0,0296 ACRES. MORE OR LESS, CLOSURE: 0,0018'
THIS ILeAL AND SKETOi WAS PREPARED YIfT'- '!HE 3ENE1lT (:F A RlGHT-(:F-WAY ANO TOPOGRAPltC SJR'v[Y PREPARED BY FlORIDA OESlCH CONSJLTANTS. INC..
mUD "'WADlSON AVENUE/GOULD ~. ..oe No. 187-02. LAST DATE (:F fIELD M:)RK '/21/1998 AND DATE SIGNED 11/27/1iia.
PREPARED fOR;
THE
CITY OF CLEARWATER, FLORIDA
LEGAL DESCRIPTION
SHUT DESCRIPTION:
SCAlL:
N/A
DATE: DIU~
9/02/1998 LCS
SEcnON:
CAlcm: u J
LCS ~
TO'lIIC~P:
O€
197 -02
15
29 S
15 E
I h.r.by c:.rllfy Ihai Ihi. legol dnc:ription and .kelc:h
mu" Ih. minimum I.c:hnic:al .tandard. os ..t forth
by the Florida Boord of Professional land Surveyors
In Chapt.r 61G17-6 Florldo Administrative Code,
pursuant to Sec:tion 472.027, Florida Slatutn
NOT VALID WITHOUT THE SIGNATURE
AND THE ORIGIN RAISED SEAL OF A FLORIDA
CENSE URV R AND MAPPER.
AS DESCRIPTI N AND SKETCH
JC8 No.:
FLORIJA DESIGN CONSaTANTS, NO.
ENGINEERS. ENVIRONMENT AlIS TS
SURVEYORS 8 PLANNERS
2639 McCormick Oriv.
Cl.arwal.r. f10rida 33 '~9
(727) '2~-8~22
Certlflcate of Authorization: LB 6707
State of florida
ROBERT C. WRIGHT, JR.
PROFESSIONAL SURVEYOR AND MAPPER
LICENSE NUMBER lS 4 5 S TE OF FLORIDA
DA TE SIGNED,
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'MS IS Mm A SUR~ . EXHI IT "Au - Paae 2 of 2
THERE MAY BE ADDITIONAL RESTRICTIONS AFFECTING THIS PROPERTY THAT
MA Y BE FOUND IN THE PUBLIC RECORDS OF THIS COUNTY.
THIS LEGAL DESCRIPTION AND SKETCH WAS PREPARED WITHOUT THE BENEFIT
OF' A TITLE POLICY.
BEARINGS ARE BASED UPON. SEE SKETCH AND LEGAL DESCRIPTION
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OF THE NW 1/4 OF SECnON 15-295-15E
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SE COR OF THE W 1/2 E LINE OF THE W 1/2 OF THE
OF THE NE 1/4 OF THE NE 1/4 OF THE NW 1/4 OF
NW 1/4 OF SEe 15-29S-1SE SECTION 15-29S-1SE "
CLEARWATER HEIGHTS
PLAT BOOK H4, PAGE 99
lHS LEGAl AND SKETCH 'N"-S PREPARED Yllll4 n.tE BENEflT OF A RIGHT-OF-WAY ANO TOPOGRAPHIC SURVEY PREPARED BY FlORIOA OE:SICN CONSULTANTS. INC.,
nTI.ED "WAOlSON Avt:NUE/GOULO STJlEEr, JOe No. 197-02, LAST DAlE OF FIElD WORK 7/21/1998 AND DATt: SIGNED 8/27/1998.
PR(PARED FOR;
SHELT DESCRIPlION:
THE CITY OF CLEARWATER, FLORIDA
SKETCH
SCALE: DATE: DRAWN: tJ CAlero: '/..t
I" = 30. 9/0211998 LCS LCS RCW
J08 Na.: SECllOH: TOlIlNSHIP: ItAHCE:
197 - 0 2 15 29 S 15 E
I hereby cerflf1 Ihol Ihis legal description and sketch
meets the minImum technical stondords as set forth
by the Florida Boord of Professionol Lond Surveyors
in Chopter 61G17-6 F'lorido Administrotlve Code,
pursuant to Section 472.027, Florida Statut..
NOT VALID WITHOUT THE SIGNATURE
THE ORIGINA RAISED SEAL OF' A FLORIDA
L1CENS URVEY R AND MAPPER.
D A 0 EGAL ESCRIPTION AND SKETCH
FLORDA DESIGN CONSU..TANTS, NO.
ENGINEERS, ENVIRONMENTALISTS
SURVEYORS a PLANNERS
2639 McCo'mic. Drive
Cleo' waler, F'loflda 33 7~9
(7271 72<1-8<122
Certificate of AuthorIzation: L8 6707
State of F1orido
C. WRIGHT, JR.
PROFESSIONAL SURVEYOR AND MAPPER
LICENSE NUMBER LS, ~ ~ SlATE OF FLORIDA
DA TE SIGNED. 7- )-7'(
ALTA OWNER'S POLICY - 10-17-92 WITH FLORIDA MODIFICATIONS
"If you want information about coverage or need assistance to resolve complaints, please call 1-800-729-1902. If you make a claim under your policy,
you must'furnish written notice in accordance with Sjction 3 of the CO~ditions a~d Stipulations."
Visit our World-WIde"Web 3lte at. httO:llwww.stewarlom I
POLICY OF TITLE INSURANCE ISSUED BY
SUBJECT TO THE EXCLUSIONS FROM COVERAGE, THE E~CEPTIONS FROM COVERAGE CONTAINED IN
SCHEDULE B AND THE CONDITIONS AND STIPULATIONS, STEWART TITLE GUARANTY COMPANY, a Texas
corporation, herein called the Company, insures, as of Date of Policy shown in Schedule A, against loss or damage, not
exceeding the Amount of Insurance stated in Schedule A, sustained or incurred by the insured by reason of:
1. Title to the estate or interest described in Schedule A being vested other than as stated therein;
2. Any defect in or lien or encumbrance on the title;
3. Unmarketability of the title;
4. Lackof a right of access to andfromthaJal'ld.
The Company will also pay the costs, alom~S'f_~~rlH.liIcur"" in defense of the title, as insured, but only
to the extent provided in the Conditions and Stipulations. . .
IN WITNESS WHEREOF, Stewart Title Guaranty Company has caused this policy to be signed and sealed by its
duly authorized officers as of the Date of Policy shoVtn ill Schedule A.
~tl
1';
99010086
STEWART TITLE
GU ARANTY COMPANY
STEWART TITLE
GUABANTYCOMP1NY
Company
City, State
EXCLUSIONS FROM. COVERAGE
The following matters are expressly excluded from the coverageotthis pOlicy and the Company will not pay loss or damage, costs, attorneys' fees or
expenses which arise by reason of:
1. (a) Any law, ordinance or governmental regulation (including but not.limited to building and zoning laws, ordinances, or regulations) restricting,
regulating, prohibiting or relating to (i) the occupancy, use, or enjoyment of the land; (ii) the character, dimensions or location of any improvement now or
hereafter erected on the land; (iii) a separation in ownership or a change in the dimensions or area of the land or any parcel of which the land is or was a
part; or (iv) environmental protection, or the effect of any violation of these laws, ordinances or governmental regulations, except to the extent that a notice 0
the enforcement thereof or a notice of a defect, lien or encumbrance resulting from a violation or alleged violation affecting the land has been recorded In th
public records at Date of Policy.
(b) Any governmental police power not excluded by (a) above, except to the extent that a notice of the exercise thereof or a notice of a defect, lien or
encumbrance resulting from a violation or alleged violation affecting the land has been recorded in the public records at Date of Policy.
2. Rights of eminent domain unless notice of the exercise thereof has been recorded in the public records at Date of Policy, but not excluding from coverage
any taking which has occurred prior to Date of Policy which would be binding on the rights of a purchaser for value without knowledge.
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, not recorded in the public records at Date of Policy, but known to the insured claimant and not disclosed in writing to
the Company by the insured claimant prior to the date the insured claimant became an insured under this policy;
(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.
4. Any claim, which arises out of the transaction vesting in the Insured the estate or interest insured by this policy, by reason of the operation of federal
bankruptcy, state insolvency, or similar creditors' rights laws, that is based on:
(a) the transaction creating the estate or interest insured by this policy being deemed a fraudulent conveyance or fraudulent transfer; or
(b) the transaction creating the estate or interest insured by this policy being deemed a preferential transfer except where the preferential transfer results
from the failure:
(i) to timely record the instrument of transfer; or
(iI) of such recordation to impart notice to a purchaser for value or a judgment or lien creditor.
----------
Page 1 of 0 2125
PO'icy - -
Serial No.
234766
, . I I
II I
SCHEDULE A
FILE NO.
POllCY NUMBER
DATE OF POllCY
June 08, 1999
2:17 PM
AMOUNT OF INSURANCE
99010086
0-2125-234766
9 023.00
1. Name of Insured:
CITY OF CLEARWATER, FLORIDA, a Florida Municipal Corporation
2. The estate or interest in the land which is covered by this Policy is:
FEE SIMPLE
3. Title to the estate or interest in the land is vested in the Insured.
4. The land referred to in this policy is described as follows:
For Company reference Purposes Only
According to insured representation or vesting instrument(s), the street address of the property is:
Street Name:
City /State/Zip:
County: pinellas Pin/Tax #: 15-29-15-00000-210-0700
The Company does not represent or insure the above address is accurate
STEWART TITLE
Reg. D 0012 Rev. 11-91
GUARANTY COMPANY
, . 1'1
Policy Number: 0- 2125-234766
File No: 99010086
SCHEDULE B
This policy does not insure against loss or damage by reason of the following:
1. Rights or claims of parties in possession not shown by the public records.
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.
4. Any lien, or right to a lien, for services, labor, or material heretofore or hereafter furnished, imposed by law and
not shown by the public records.
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 1999 and thereafter and assessments, if any, not recorded in the public records.
8. Subject to any lien for municipal improvements or services to
captioned land which has not been filed for record in the office
of the Clerk of the Circuit Court of Pinellas County, Florida,
and any and all outstanding assessments projected or to be
projected, if any.
9. Any lien provided by Chapter 159 of Florida Statutes in favor
of any city, town, village or port authority for unpaid service
charges for service by any water system, sewer system or gas
system servicing the land described herein.
10. Subject to zoning and/or other governmental prohibition or
regulations affecting the use of the property.
11. Title to any furniture, furnishings, fixtures, or chattels or
personal property located in, to or upon the land described in
Schedule "A" hereof.
12. Subject to unrecorded leases and/or options to purchase
affecting subject premises.
13. If subject property has been a rental unit or non-owner occupied
property, it may be subject to Tangible Taxes, which are not
covered by this policy.
Exceptions numbered
1 and 4
are hereby deleted from the Owners Policy.
llGAL O~SCRI~TI~: I I
A PARCEL OF lAND BEING A PORTh.... ~ THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFi<ICI~L 'RECORDS
BOOK 9'956: PAGE 14/5 OF THE PUBLIC RECORDS OF' PINELLAS COUNTY. F'LORIDA. LYING WITHIN THE WEST 1/2 OF'
THE NORTHEAST 1/4 ~ THE NORTHWEST I/~ OF SECTION IS, TOWNSHIP 29 SOUTH. RANGE IS EAST, CITY OF
.ClEARWATER, PINELLAS COUNTY. FLORIDA. BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
COMMENCE AT THE SOUTHWEST CORNER ~ THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 Of SECTION 15. TaNNSHIP
29 SOUTH. RANGE 15 EAST. CITY Of CLEARWATER, PINELLAS COUNTY, FLORIDA; THENCE S 89-'2'05' E. ALONG
THE SOUTH BOUNDARY LINE Of SAID NORTHEAST 1/4 OF THE NORTHWEST 1/4 Of SECTION 15 (BEING THE BASIS OF
BEARINGS FOR THIS DESCRIPTIONI. FOR 665.46 FEET TO THE SOUTHEAST CORNER OF THE WEST 1/2 OF SAID
NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTI ON 15. SAME ALSO BE I NG THE SOUTHEAST BOUNDARY CORNER OF
THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL RECORDS BOOK 9956. PAGE 1~15 OF THE PUBLIC
RECORDS or PINELLAS COUNTY. FLORIDA. SAME ALSO BEING THE SOUTHEAST BOUNDARY CORNER OF THAT CERTAIN
PROPERTY AS DESCRIBED IN OFFICIAL RECORDS BOOK 3219, PAGE 346 OF THE PUBLIC RECORDS OF PINELLAS
COUNTY. FLORIDA; THENCE LEAVING SAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4
OF SECTION IS, N 00-00'08- W. ALONG THE EAST BOUNDARY LINE OF SAID WEST 1/2 Of THE NORTHEAST 1/4 OF
THE NORTHWEST 1/4 Of SECTION 15, SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS
DESCRIBED IN OFFICIAL RECORDS BOOK 3219. PAGE 346. SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID
CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL RECORDS BOOK 9956. PAGE 1~15, FOR 5Z.68 FEET TO
THE NORTHERN MOST BOUNDARY CORNER or SAID CERTAIN PROPERTY AS DESCRIBED IN OfFICIAL RECORDS BOOK
3219. PAGE 346. SAME ALSO BEING THE POINT OF BEGINNING: THENCE CONTINUE N 00.00'08" W. ALONG SAID
EAST BOUNDARY LINE Of THE WEST 1/2 Of THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION IS, SAM(
ALSO BEING SAID EAST BOUNDARY LINE Of THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL
RECORDS BOOK 9956, PAGE 1415. FOR 111.84 fEET TO THE NORTHEAST BOUNDARY CORNER OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL II IN OfFICIAL RECORDS BOOK 9956. PAGE 1415, SAME ALSO BEING THE
SOUTHEAST BOUNDARY CORNER Of THAT CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915. PAGE 103 Of THE
PUBLIC RECORDS OF P/NEllAS COUNTY, FLORIDA: THENCE lEAVING SAID EAST BOUNDARY liNE Of THE WEST 1/2
Of THE NORTHEAST 1/4 OF THE NORTKt'EST 1/4 OF SECTION 15, N 89-12'05. W. ALONG THE NORTH BOUNDARY
liNE Of SAID CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL RECORDS BOOK 9956. PAGE 1415, SAME
ALSO BEING THE SOUTH BOUNDARY LINE Of SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915. PAGE 103.
FOR ~.70 FEET TO THE SOUTHW[ST BOUNDARY CORNER OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK
9/~, PAGE 103: THENCE LEAVING SAID NORTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL
I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415. S 03-08'56" W, FOR 164.64 FEET TO THE NORTHEAST
BOUNDARY CORNER OF LOT I, REVISED MAP Of R.H. PADGETT'S SUBDIVISION. AS RECORDED IN PLAT BOOK 4,
PAGE 32 Of THE PUBLIC RECORDS OF P/NELLAS COUNTY, FLORIDA, SAME ALSO 8EING THE POINT Of INTERSECTION
WITH THE SOUTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OfFICIAL RECORDS
BOOK 9956. PAGE 1415, SAME ALSO BEING AFORESAID SOUTH BOUNDARY LINE or THE NORTHEAST 1/4 Of THE
NORTHWEST 1/4 Of SECTION 15: THENCE S 89- 12'OS" E. ALONG SAID SOUTH BOUNDARY LINE Of THE NORTHEAST
I/~ Of THE NORTHWEST I/~ or SECTION IS, SAME ALSO BEING SAID SOUTH BOUNDARY LINE OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956, PAGE 1415. FOR 5.05 FEET TO THE
SOUTHWEST BOUNDARY CORNER or AFORESAID CERTAIN PROPERTY AS DESCRIBED IN OFFICIAL RE~ORDS BOOK 3219.
PAGE 346: THENCE LEAVING SAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 OF lHE NORTHWEST 1/4 or
SECTION 15. N 09-23'45" E. ALONG lHE WEST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN
OFFICIAL RECORDS BOOK 3219. PAGE 346. FOR 53.27 FEET TO THE POINT OF BEGINNING AND CONTAINING 1.289
SQUARE FEET OR 0.0296 ACRES. MORE OR LESS.
I
CONDITIONS AND STIPULATIONS Continued
(continued and concluded from reverse side of Policy Face)
I
(a) The liability of the Company under this policy shall not exceed the least
of:
(i) the Amount of Insurance stated in Schedule A; or,
(ii) the difference between the value of the insured estate or interest as
insured and the value of the insured estate or interest subject to the defect, lien
or encumbrance insured against by this policy.
(Q) (This paraqraph removed in Florida policies.)
(c) The Company will pay only those costs, attorneys' fees and expenses
incurred in accordance with Section 4 of the Conditions and Stipulations.
8. APPORTIONMENT.
If the land described in Schedule A consists of two or more porcels which are
not used as a single site, and a loss is established affecting one or more of the
parcels but not all, the loss shall be computed and settled on a pro rata basis as
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 parcel by the Company and the insured
at the time of the issuance of this policy and shown by an express statement or by
an endorsement attached to this policy.
9. LIMITATION OF LIABILITY.
(a) If the Company establishes the title, or removes the alleged defect, lien
or encumbrance, or cures the lack of a right of access to or from the land, or
cures the claim of unmarketability of title, all as insured, in a reasonably diligent
manner by any method, including litigation and the completion of any appeals
therefrom, it shall have fully performed its obligations with respect to that matter
ond shall not be liable for any loss or damage caused thereby.
(b) In the event of any litigation, including litigation by the Company or with
the Company's consent, the Company shall have no liability for loss or damage
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.
(c) The Company shall not be liable for loss or damage to any insured for
liability voluntarily assumed by the insured in settling any claim or suit without the
prior written consent of the Company.
10. REDUCTION OF INSURANCE; REDUCTION OR TERMINATION 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.
11. 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
a mortgage to which exception is taken in Schedule B or to which the insured
hos agreed, assumed, or taken subject, or which is hereafter executed by an
insured and 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 lhis policy to the insured owner.
12. PAYMENT OF LOSS.
(a) No payment shall be made without producing this policy for endorse-
ment of the payment unless the policy has been lost or destroyed, in which case
proof of loss or destruction shall be furnished to the satisfaction of the Company.
(b) When liability and the extent of loss or damage has been definitely
fixed in accordance with these Conditions and Stipulations, the loss or damage
sholl be payable within 30 days thereafter.
13. SUBROGATION UPON PAYMENT OR SETTLEMENT.
(a) The Company's Right of Subrogation.
Whenever the Company shall have settled and paid a claim under this pol-
icy, 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 reme-
dies which the insured claimant would have had against any person or property
in respect to the claim had this policy not been issued. If requested by the Com-
pany, the insured claimant shall transfer to the Company all rights and remedies
against any person or property necessary in order to perfect this right of subro-
gation. The insured claimant shall permit the Company to sue, compromise or
settle in the name of the insured claimant and to use the name of the insured
claimant in any transaction or litigation involving these rights or remedies.
If a payment on account of a claim does not fully cover the loss of the
insured claimant, the Company shall be subrogated to these rights and remedies
in the proportion which the Company's payment bears to the whole amount of
the loss.
If loss should result from any act of the insured claimant, as stated above,
that 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 by this policy which
shall exceed the amount, if any, lost to the Company by reason of the impair-
ment by the insured claimant of the Company's right of subrogation.
(b) The Company's Rights Against Non-insured Obligors.
The Company's right of subrogation against non-insured obligors shall exist
and shall include, without limitation, the rights of the insured to indemnities, gua-
ranties, other policies of insurance or bonds, notwithstanding any terms or condi-
tions contained in those instruments which provide for subrogation rights by rea.
son of this policy.
14. ARBITRATION
Unless prohibited by applicable law, arbitration pursuant to the Title Insur:
ance Arbitration Rules of the American Arbitration Association may be demanded
if aqreed to by both the Company and the insured. Arbitroble matters moy
include, but are not limited to, any controversy or claim between the Compony
and the insured arisinq out of or relatinq to this policy, any service of the
Company in connection with its issuance or the breach of a policy provision or
other obliqation. Arbitration pursuant to this policy and under the Rules in effect
on the date the demand for arbitration is made or, at the option of the insured,
the Rules in effect at Date of Policy shall be bindinq upon the parties. The award
may include attorneys' fees only if the laws of the state in which the land is
located permit a court to award attorneys' fees to a prevailinq party. Judqment
upon the award rendered by the Arbitrator(s) may be entered in any court
havinq iurisdiction thereof.
The law of the situs of the land sholl apply to an arbitration under the Title
Insurance Arbitrotion Rules.
A copy of the Rules may be obtained from the Company upon request.
15. LIABILITY LIMITED TO THIS POLICY; POLICY ENTIRE CONTRACT:
(a) This policy together with all endorsements, if any, attached hereto by
the Company is the entire policy and contract between the insured and the Com-
pany. In interpreting any provision of this policy, this policy shall be construed as
a whole.
(b) 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
by any action asserting such claim, shall be restricted to this policy.
(c) No amendment of or endorsement to this policy can be made except by
a writing endorsed hereon or attoched hereto signed by either the President, a
Vice President, the Secretary, an Assistant Secretary, or validating officer or
authorized signatory of the Company.
16. SEVERABILITY.
In the event any provision of the policy is held invalid or unenforceable under
applicable law, the rolicy shall be deemed not to include that provision and all
other provisions shal remain in full force and effect.
17. NOTICES, WHERE SENT.
All notices required to be given the Company and any statement in writing
required to be Furnished the Company sholl include the number of this policy
and sholl be addressed to the Company at P.O. Box 2029, Houston, Texas
77252-2029.
STE'VAI~T TI'TLE
GUARANTY COMPANY
. DISCLbsURE, CONSENT AND GRANT OF PERl\LSSION
TO EARN INTEREST ON ESCROWED FllNDS
STEWART TITLE OF CLEARWATER, INC. ("Stewart"),
is providing title insurance and closing services, and has issued Commitment No. C - 99010086
dated February 23, 1999 5: 00 p. m . in connection with a real estate transaction in which you
are a party as a buyer, seller or mortgagor ("Transaction").
Disclosure: Money owned by a party or parties to your Transaction will be received by Stewart in connection with the
Transaction and will be held by Stewart in Trust ("Escrowed Funds") until disbursement is properly authorized. As a title
insurance agent licensed by the Florida Department of Insurance ("Department"), Stewart is required by law and
Department rule to immediately deposit Escrowed Funds, when received, in an escrow trust account in a financial
institution insured by an agency of the federal government and located within this state.
Stewart intends, upon receiving all consents required in connection with the Transaction, to (a) deposit Escrowed Funds
from the Transaction, together with similar funds from other transactions, in an interest-bearing trust account, and (b)
retain the interest earnings from such trust account in consideration for services provided in administering and properly
disbursing the Escrowed Funds. Any escrow fee paid by any party involved in this transaction shall only be for check
writing and computer input, but not for any of the accounting, bookkeeping, auditing, messenger, and other services.
Department rules provide that a title agent may not deposit such funds in an interest-bearing trust account without the
written consent of the buyer and the seller in a sale transaction, or "use" money in its escrow trust accounts without
permission of the owner of the money, given after full disclosure of the circumstances. Therefore, if this form (or a
counterpart hereoO is not signed (by both buyer and seller if a sale transaction, or by the owner of the Escrowed Funds
if a financing transaction) and received by Stewart prior to Stewart's receipt of the Escrowed Funds in its capacity as
escrow agent in the Transaction, the Escrowed Funds in this Transaction will be deposited in a trust account on which
no interest is earned.
Grant of Permission: Having read and understood the foregoing "Disclosure", I/we Purchaser/Borrower
o do, or 0 do not, and Seller 0 do , or 0 do not hereby grant permission for and consent to Stewart's deposit
of the Escrowed Funds in a trust account upon which interest will be paid to and retained by Stewart.
CI~lOF CL~RWATER, FLORIDA,
Date
Pri~~:-- \::j
As of
(Title) (Corporate or other entity name, if Applicable)
please check all that apply ~ Buyer / _Seller / _ Mortgagor
Print Name:
As of
(Title) (Corporate or other entity name, if Applicable)
please check all that apply _ Buyer / _Seller / _ Mortgagor
Date
w-- l-q'Cf
~~~~:::
As of
(Title) (Corporate or other entity name, if Applicable)
please check all that apply _ Buyer / ~ Seller / _ Mortgagor
TRUSTEE
Date
Date
Print Name:
As of
(Title) (Corporate or other entity name, if Applicable)
please check all that apply _ Buyer / _Seller / _ Mortgagor
1
I
SELLER'S AFFIDAVIT (GAP)
STATE OF FLORIDA
FILE NO: 99010086
COUNTY OF Pinellas
BEFORE ME, the undersigned, this day personally appeared GEORGE W. STONE, TRUSTEE
("Affiant(s)"), who, being by me first duly sworn, says:
1. GEORGE W. STONE, TRUSTEE
is/are the owner(s) of certain real property located in Pinellas County, Florida, which is
more particularly described on Exhibit "A" attached hereto and made a part hereof (the "Property").
2. Affiant(s) is familiar with Stewart Title Guaranty Company's Owner's Title Insurance Commitment
No. C-99010086 bearing an effective date of February 23, 1999 5:00 p.m.
(the "Commitment").
3. There have been to my knowledge no documents recorded in the Public Records of Pinellas
County, Florida subsequent to February 23, 1999 5: 00 p. m. which affect title to the Property
insured; and (i) that there are no matters pending against them that could give rise to a lien that would
attach to the subject property between the effective date of the Commitment and the recording of the
instruments giving rise to the interest to be insured, and (ii) that the affiants have not executed and will
not execute any instrument that would adversely affect the title to the subject property or the lien of any
mortgage to be insured pursuant to the Commitment, save and except the following:
4. This affidavit is given to induce Stewart Title Guaranty Company and its authorized Agent,
STEWART TITLE OF CLEARWATER, INC. , to issue an Owner's Title Insurance Policy to
CITY OF CLEARWATER, FLORIDA,a Florida Municipal Corporation
Dated, this
/
day of
b:tr'irqlYlLf../
, 1999
. _tZ---
TRUSTEE
Sworn to and subscribed before me this
GEORGE W. STONE, TRUSTEE
I
day of
.MY" Cf~
,19 99 ,by
is/are personally known to me or who has/have produced driver license(s) as identification.
,
"~"c:.
"" ~
~ Ii
DEBRA A. BORGH
Notary Public. Stale 01 Florida
My COllllnillion EIpi'" Jln. 30, 2001
CommlIIiOIl. CeSt1H7
~~ ~fv
Printed Name:
Notary Public
Serial Number
My commission expo
ORDER NP: ~9010~6
I
D I S C LOS U R E
We, the Owners/Purchasers of that certain real property
located at: MADISON AVENUE,
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 affect 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.
CERTIFY that as the buyer(s) I have inspected the above
accept same.
~~..~(t~
GE R W. STONE, TRUSTEE
WITNESS
WITNESS
STATE OF FLORIDA
COUNTY OF Pinellas
The foregoing instrument was acknowledged before me this Is~ day
of~, 1999, by GEORGE W. STONE, TRUSTEE, who has produced
~'v~ . as identifica ion and who did take an oath.
My Commission Expires:
STATE OF FLORIDA
COUNTY OF Pinellas
~~~(;
.. ,.
o -
& n
DEBRA A. BORGH
Public Slall 01 Florida
Notary . sian Elpiltl Jan. 30. ~I
My eoc:;:..illion . CC~'l~'__
The foregoing
of May, 1999,
produced
an oath.
instrument was acknowledged before me this 24th day
by , as of, who has
, as identification and who did take
NOTARY PUBLIC
My Commission Expires:
I
I
onDEn NO:
NON-FOREIGN CEWl'IFICATION BY INDIVIDUAL TRANSFEROR
--------------------------------------------------
1. section 1445 of the Internal Revenue Code provides that a
transferee of a united states real property interest must
withhold tax if the transferor is a foreign person.
2. In order to inform the transferee that withholding of tax is not
required upon the disposition by
GEORGE W. STONE, TRUSTEE of the United States real
property described as follows:
SEE EXHIBIT A
the undersigned transferor certlfles and declares by means of
tlds cer.tifica\:ion, the following:
(a) 1 (We) am (are) not non-resldent alien(s) for purposes of unlted
States income taxatlons and,
(b) Hy United States taxpayer identifyJng number(s) (Social Security)
is(are):
NAME SOCIAL SECURITY NUMBER
GEORGE W. STONE, I
TRUSTEE #
(c)
(d)
My home address is
(attached additional page if necessary)
'I'here are no other persons who have an ownershIp interest in the
above-described property other than those persons set forth above
in subparagraph (b).
( b)
'l'he undersigned hereby further certif ies and declares:
I (We) understand that the purchaser of the above described property
intends to rely on the foreg01ng representations 1n connection
with the UnJted States Foreign Investment in Real Property Act.
(94 Statute 2602 as amended).
I (we) understand this certification may be disclosed to the Interna
Hevenue Service by tr.ansferee and that any false statement contained
in this certification may be punished by f1ne, imprisonment or both.
J .
(a)
Ullder penalties of perjury I (we) declare I (we) have examined carefully
this certification and it is true, correct and complete.
~~
('1'his document must be retained until the end of the fifth taxable
year following the taxable year in which the transfer takes place).
CONSUl,'I' YOUR A'I'TORNEY At.JO/OR 'l'AX ADVISOR - NO REPRESEN'rA'rION OR
RECOMMENDA'l'ION IS MADE BY S'l'J~WAnT 'l'rl'J.JE HISUHANCE COMPANY AND/on
-.STFYART TTl1.F. ~IJARANIY..()'JofPANY _ CONCEIUHNG TilE LEGAL
SUFFICIENCY AND/OR TAX CONSEQUENCES OF 'rillS DOCUMEN'1'. YOU MAY BE
REQUIRED 1'0 FILE A COpy OF 'rillS DOCUMEN1' Wl'rll TilE IN1'ERNAL REVENUE
SERVICE. 1'HESE AHE QUESTIONS FOIl YOun A'l"l'ORNEY OR 'I'AX ADVISOH.
s'rATE OF FLORIDA
COUNTY OF .PlNELlAS
'l'he foreqoing instrument was acknowledged
1999 by GEORGE W. STONE, TRUsrEE
. who has produced
who did take an oath.
'-7U--t1-
. before me this )44- d~y of_'-MAV-
as identification and
My commission Expires:
~~ Q,6hgl----
t 'ARY PUBLIC'
~~."
'" ,.
o _
Z n
DEBRA A. BORGH
Notary Public, StlI. 01 florida
t.ly Commission bpi'" Jan. 30, 2001
Commission' CC5t7H7
". !
1
I
AUTHORIZATION AND ACKNOWLEDGEMENT FORM
DATE:
FILE NO.: 99010086
LEGAL:
SEE EXHIBIT A
SELLER:
GEORGE W. STONE, TRUSTEE
BUYER:
CITY OF CLEARWATER, FLORIDA, a Florida Municipal
Corporation
We hereby approve and acknowledge receipt of a copy of the
Statement and actual cost (DISCLOSURE/SETTLEMENT STATEMENT - HUD
FORM 1) and authorized disbursement of funds as shown therein this
day of, 19. 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
Company of Clearwater, Inc., will not be held responsible. It is
further understood that Stewart Title Company of Clearwater,
Inc., cannot, at this time, ascertain 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 of Clearwater,
Inc. Stewart Title of Clearwater will not be held responsible.
THAT ALL UTILITY BILLS (WATER, SEWER, ELECTRIC, MAINTENANCE
FEES) HAVE BEEN PAID OR WILL BE PAID UPON RECEIPT OF FINAL BILLS.
~INITIALS INITIALS INITIALS INITIALS
SELLER'S BUYER'S
CITY OF CLEARWATER, FLORIDA,
~;t ~~~~EE
SELLER'S FORWARDING ADDRESS:
f O. {}yA- i78lJ10
(Q~~) _111 iQ ~ I r L- ?:J.../lDtL..
HOME PHONE#
BUYER'S FORWARDING ADDRESS:
HOME PHONE#
WORK PHONE#
WORK PHONE#
THIS IS TO FURTHER AUTHORIZE TO
APPROVE ANY CHANGES NECESSARY TO THE CLOSING STATEMENT.
STEWART TITLE OF CLEARWATER, INC.
BY:
,;oJ
. '
_ This Instrument Prepared by a,nd Retur1to:
MARIANNE SCHAFFER
of STEW ART TITLE OF CLEARWATER, INC.
1290 Court Street
Clearwater, Florida 33756
I
as a necessary incident to the fulfillment of conditions
contained in a title insurance commitment issued by it.
Property Appraisers Parcel Identification (Folio) Number(s):
15-29-15-00000-210-0700
TRUSTEE AFFIDAVIT
FILE NO: 99010086
STATE OF Florida
COUNTY OF Citrus
Before me, the undersigned, authority, duly commissioned by the laws of Florida, on the ;l. <t:i- t,
day of April , 19 99, personlly appeared SUNTRUST BANK, Nature Coast,
by:
who having been first duly sworn deposes and says:
/Successor
1. Affiant is the Trustee of the Mari tal Trust as established by Article VI of the
Last Will and Testament of Ira A. Desper, dated March 9, 1989
as evidenced by ~xXBf the Trust~.
2. The following property is included in the Trust:
See Attached Schedule "A"
3. Affiant has full power and authority to sell and or mortgage the above described property
as evidenced by IWxxxxx~the Trust (aUoobe14) and no contrary powers or restrictions
appear in the trust document.
4. The Trust is in full force and effect and has been during the period of ownership of the
above described property.
THIS AFFIDAVIT IS MADE WITH THE FULL KNOWLEDGE THAT STEWART TITLE OF
CLEARWATER, INC. WILL RELY ON THE TRUTH OF THE
STATEMENTS MADE IN THIS AFFIDAVIT TO INDUCE SAID COMPANY TO ISSUE
A POllCY OF TITLE INSURANCE.
BAN , Nature Coast, a;;; Succes
the Ira A. Desper Marital Trust
by:"'vic!.-- PR~/lJcNrrJ TftuO- DFF~CER
Sworn to and subscribed before me this 2E -II- day of
SUNTRUST BANK, Nature CoastJ----
who is personally known to me or who has produced driver license(s) as identification.
April
19 99, by
,~ Craig H Coppedge
*.*My CommIssIon CC738879
\;....:1 expires April 28, 2002
1!ttJ~
Notary Pub ic
Serial Number
My Commission expires:
."
~ . !
..d.;AL DtSCRIPT ION: ,
A PARCEL Of LAND BE ING A POR~ON ~ THAT CERTAIN PROPERTY DESCRIB 0 AS PARCEL I I IN OFF ICIAL RECORDS
BOOK 9956. PAGE 1415 ~ THE PUBLIC RECORDS or PINELLAS COUNTY, FLORIDA, LYING WITHIN THE WEST 1/2 OF
THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 OF SECTION 15, TOWNSHIP 29 SOUTH. RANGE IS EAST. CITY OF
.CLEARWATER. PINELLAS COUNTY, FLORIDA, BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
CCMv€NCE AT THE SOUTtMST CORNER ~ THE NORTHEAST 1/4 OF THE NORTtMST 1/4 Of SECTION IS, TC7NNSHIP
29 SOUTH. RANGE IS EAST. CITY Of CLEARWATER. PINELLAS COUNTY, FLORIDA: THENCE S 89.IZ'OS" E. ALONG
THE SOUTH BOUNDARY LINE OF SAID NORTHEAST 1/4 OF THE NORTHWEST 1/4 Of SECTION IS (BEING THE BASIS OF
BEARINGS FOR THIS DESCRIPTION). FOR 66S.~6 FEET TO THE SOUTHEAST CORNER Of THE WEST 1/2 Of SAID
NORTHEAST I I~ OF' THE NORTHtt'EST I I" OF SECT I ON 15, S~ ALSO BE I NG THE SOUTHEAST BOUNDARY CORNER OF
THAT CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956, PAGE 1415 OF TK: PueLIC
RECORDS OF P INELLAS COUNTY. FLORIDA. SM€ ALSO BE INO THE SOUTHEAST BOUNDARY CORNER OF THAT CERTAIN
PROPERTY AS DESCRIBED IN OFFICIAL RECORDS BOOK 3219, PAGE 346 OF THE PUBLIC RECORDS OF PINELLAS
COUNTY, FLORIDA: THENCE LEAVING SAID SOUTH BOUNDARY LINE Of THE NORTHEAST 1/4 Of THE NORTKftEST 1/4
Of" SECTION IS, N 00.00'08- W. AlOHG THE EAST BOUNDARY LINE OF SAID WEST 1/2 Of THE NORTHEAST 1/4 OF
THE NORTHWEST 1/4 OF SECTION IS. SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS
DESCRIBED IN OfFICIAL RECORDS BOOK 3219, PAGE 346. SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID
CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OfFICIAL RECORDS BOOK 9956. PAGE 1415, FOR 52.68 FEET TO
THE NORTHERN MOST BOUNDARY CORNER Of SAID CERTAIN PROPERTY AS DESCRIBED IN OfFICIAL RECORDS BOOK
3219. PAGE 346. SAME ALSO BEING THE POINT or BEGINNING; THENCE CONTINUE N 00.00'08. W, ALONG SAID
EAST BOUNDARY L I HE Of THE WEST 1/2 OF THE NORTHEAST I I~ OF THE NOR1JMST 1/4 OF SECT! ON 15, SM'E
ALSO BEING SAID EAST BOUNDARY LINE OF THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL
RECORDS BOOK 9956. PAGE 141S. FOR I II .84 FEET TO THE NORTHEAST BOUNDARY CORNER OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956. PAGE 141S, SAME ALSO BEING THE
SOUTHEAST BOUNDARY CORNER or THAT CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915, PAGE 103 OF THE
PVBLI C RECORDS Of PI NELLAS COUNTY, FLOR IDA: THENCE LEAV I NG SA I D EAST BOUNDARY L I HE Of THE WEST I/Z
OF TliE NORTHEAST 1/4 ~ Tl€ NORTHWEST 1/4 OF SECTION IS, " 89.12'05- W. ALONG THE NORTH BOUNDARY
LINE OF SAID CERTAIN PRoPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 99S6, PAGE 1415. SMIE
ALSO BEING THE SOUTH BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK giS, PAGE 103.
fOR 4.70 FEET TO THE SOUTHW(ST BOUNDARY CORNER OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK
91S. PAGE 103: THENCE LEAVING SAID NORTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL
I I IN OfFICIAL RECORDS BOOK 9956. PAGE 1415. S 03.08'5'".. FOR 164.64 FEET TO THE NORTHEAST
BQI.H)ARY CORNER OF LOT I. REVISED MAP Of R.H. PADGETT'S SUBDIVISION. AS RECORDED IN PLAT BOOK 4.
PAGE 32 or THE PUBLIC RECORDS or PINELLAS COUNTY, FLORIDA, SAME ALSO BEING THE POINT OF INTERSECTION
WITH THE SOUTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OfFICIAL RECORDS
BOOK 9956. PAGE 1415. SAME ALSO BEING A~ORESAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 or THE
NORTHWEST 1/4 OF SECTION IS: THENCE $ 89.IZ'OS' E. ALONG SAID SOUTH BOUNDARY LINE Of THE NORTHEAST
1/4 or THE NORTHWEST 1/4 OF SECTION 15. SAME ALSO BEING SAID SOUTH BOUNDARY LINE OF SAID CERTAIN
PRoPERTY DESCRIBED AS PARCEL I I IN OfFICIAL RECORDS BOOK 9956. PAGE 1415. FOR 5.05 FEET TO THE
SOUTHWEST BOUNDARY CORNER Of AFORESAID CERTAIN PROPERTY AS DESCRIBED IN OfFICIAL RE~ORDS BOO~ 3219.
PAGE 346; THENCE LEAVING $AID SOU1H BOUNDARY LINE or THE NORTHEAST 1/4 or THE NORTHWEST 1/4 or
SECTION 15. N 09.Z3'45- E. ALONG THE WEST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN
OFFICIAL RECORDS BOOK 3219. PAGE 346. fOR 53.27 FEET TO THE POINT Of BEGINNING AND CONTAINING I,ZB9
SQUARE FEET OR 0.0296 ACRES. MORE OR LESS.
'lJ.is Ins/rument Prepared by and Return to:
MARIANNE SCHAFFER I
<.Ji STEWART TITLE OF CLEARWAn.\, INC.
1290 Court Street
Clearwater, Florida 33756
a
as a necessary incident to the fulfillment of conditions
contained in a title insurance commitment issued by it.
Properly Appraisers Parcel Identification (Folio) Number(s):
15-29-15-00000-210-0700
TRUSTEE AFFIDAVIT
FILE NO: 99010086
STATE OF Florida
COUNTY OF pinellas
Before me, the undersigned, authority, duly commissioned by the laws of Florida, on the I sJ-"
day of ~~ 19 99, person1ly appeared GEORGE W. STONE
who having been first duly sworn deposes and says:
1. Affiant is the Trustee of the J. O. STONE GRANDCHILDREN'S TRUST
as evidenced by~Kg~xxXXXN}(he Trust (XK!~.
2. The following property is included in the Trust:
See Attached Schedule "A"
3. Affiant has full power and authority to sell and or mortgage the above described property
as evidenced byctsK~XX~the Trust tat~~ and no contrary powers or restrictions
appear in the trust document.
4. The Trust is in full force and effect and has been during the period of ownership of the
above described property.
THIS AFFIDAVIT IS MADE WITH THE FULL KNOWLEDGE THAT STEWART TITLE OF
CLEARWATER, INC. WILL RELY ON THE TRUTH OF THE
STATEMENTS MADE IN THIS AFFIDAVIT TO INDUCE SAID COMPANY TO ISSUE
A POLICY OF TITLE INSURANCE.
~~~~~
Sworn to and subscribed before me this J 54-- day of ~ 19 99 ,by
GEORGE W. STONE
who is personally known to me or who has produced driver license(s) as identification.
My Commission expires:
~~dL~~: (JuPMrf
Notary Public
Serial Number
---....
~~"G-
... ,.
o -
,. n
\
DEBRA A. BORG~I . j
Public Slale 01 Fh:,lt .
~~mlaslon ilpil" J.... 10. "J'
Y COIII"",.iOn . CC59h~~ '
---.........
. ~
I
I
LE.GAl.. Dt.SCR I P1 ION:
A PARCEL Of LAND BEING A PORTION OF THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OfFICIAL RECORDS
BOOK 9956. PAGE 1415 Of THE PUBLIC RECORDS OF PINELLAS COUNTY, FLORIDA. lYING WITHIN THE WEST 1/2 OF
. THE NORTHEAST 1/4 rF THE NORTK'NEST 1/4 Of SECTION I~, TOWNSHIP 29 SOUTH. RANGE I~ EAST. cln OF
CL~ATER, PINELLAS COUNTY. FLORIDA. BEING MORE PARTICULARLY DESCRIBED AS FOlLOWS:
CCMvENCE AT THE SOUTHN(ST CORNER OF THE NORTHEAST 1/4 OF THE NORTKNEST 1/4 OF SECTION 15. TCfNNSHIP
29 SOUTH. RANGE 15 EAST. CITY OF CLEARWATER, PINELLAS COUNTY, FLORIDA; THENCE S 89-12'05' E. ALONG
THE SOUTH BOUNDARY LINE OF SAID NORTHEAST 1/4 OF THE NORTHWEST 1/4 Of SECTION 15 (BEING THE BASIS OF
BEARINGS FOR THIS DESCRIPTION), FOR 665.46 FEET TO THE SOUTHEAST CORNER OF THE WEST 1/2 OF ~AID
NORTHEAST 1/4 Of THE NORTtMST 1/4 Of SECTION 15, SAME ALSO BEING THE SOUTHEAST BOUNDARY CORNER OF
THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFFICIAL RECORDS BOOK 9956. PAGE 1415 OF THE PUBLIC
RECORDS Of PINELLAS COUNTY. FLORIDA. SAME ALSO BEING THE SOUTHEAST BOUNDARY CORNER OF THAT CERTAIN
PROPERTY AS DESCRIBED IN OfFICIAL RECORDS BOOK 3219, PAGE 346 OF THE PUBLIC RECORDS OF PINELLAS
COUNTY, FLORIDA: THENCE LEAVING SAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 OF THE NORTHWEST 1/4
OF SECTION 15, N 00-00'08- W. ALONG THE EAST BOUNDARY LINE Of. SAID WEST 1/2 OF THE NORTHEAST 1/4 OF
THE NORTHWEST 1/4 rF SECTION I~. SAME ALSO BEING THE EAST BOUNDARY LINE Of SAID CERTAIN PROPERTY AS
DESCRIBED IN OFFICIAL RECORDS BOOK 3219. PAGE 346. SAME ALSO BEING THE EAST BOUNDARY LINE OF SAID
CERTAIN PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415, fOR 52.68 fEET TO
THE NORTHERN MOST BOUNDARY CORNER Of SAID CERTAIN PROPERTY AS DESCRIBED IN OFFICIAL RECORDS BOOK
3219, PAGE 346. SAME ALSO BEING THE POINT OF BEGINNING: THENCE CONTINUE N 00-00'08- W, ALONG SAID
EAST BOU~DARY L1~ Of THE WEST 1/2 Of THE NORTHEAST 1/4 OF THE NORTHWEST 1/4 Of SECTION 15. SM'(
ALSO BEING SAID EAST BOUNDARY LINE OF THAT CERTAIN PROPERTY DESCRIBED AS PARCEL II IN OFfiCIAL
RECORDS BOOK 9956. PAGE I~IS. fOR 111.84 FEET TO THE NORTHEAST BOUNDARY CORNER OF SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415. SAME ALSO BEING THE
SOUTHEAST BOUNDARY CORNER OF THAT CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK 915. PAGE 103 OF THE
PueLIC RECORDS or PINELLAS COUNTY. FLORIDA: THENCE LEAVING SAID EAST BOUNDARY LINE OF THE WEST 1/2
OF THE NORTHEAST I/e OF ra: NORTtft'EST 1/4 OF SECTION 15. N 89-12'05- W. ALONG THE NORTH BOUNDARY
LINE OF SAID CERTAIN PRoPERTY DESCRIBED AS PARCEL II IN OffICIAL RECORDS BOOK 9956, PAGE 1415. SAME
ALSO BE ING THE SOUTH BOUNDARY LINE OF SAID CERTAIN PRoPERTY AS DESCRIBED IN DEED BOOK 915. PAGE 103.
FOR 4.70 ftET TO THE SOUT~STBOUNDARY CORNER OF SAID CERTAIN PROPERTY AS DESCRIBED IN DEED BOOK
91~. PAGE 103: THENCE LEAVING SAID NORTH BOUNDARY LINE OF SAID CERTAIN PROPERTY DESCRIBED AS PARCEL
I I IN OFFICIAL RECORDS BOOK 9956. PAGE 1415. S 03.08'~60 W. fOR 164.64 fEET TO THE NORTHEAST
BOtN>ARY CORNER rF LOT I. REV I SED MAP OF R.H. PADGETT'S SUBD I V I S ION. AS RECORDED I N PLAT BOOK 4.
PAGE 32 OF THE PU8LIC RECORDS OF PIHELLAS COUNTY, FLORIDA. SM'( ALSO BEING THE POINT OF INTERSECTION
WITH THE SOUTH BOUNDARY LINE OF SAID CERTAIN PRoPERTY DESCRIBED AS PARCEL II IN OfFICIAL RECORDS
BOOK 9956. PAGE 1415. SAME ALSO BEING AFORESAID SOUTH BOUNDARY liNE or THE NORTHEAST 1/4 Of THE
NORTHWEST 1/4 Of SECTION I~: THENCE S 89- Il'O~o E. ALONG SAID SOUTH BOUNDARY LINE Of THE NORTHEAST
1/4 OF THE NORTHW[ST 1/4 or SECTION 15. SAME ALSO BEING SAID SOUTH BOUNDARY LINE Of SAID CERTAIN
PROPERTY DESCRIBED AS PARCEL I I IN OfFICIAL RECORDS BOOK 9956. PAGE 1415. fOR 5.05 FEET TO THE
SOUTHWEST BOUNDARY CORNER OF AFORESAID CERTAIN PROPERTY AS DESCRIBED IN OfFICIAL REOORDS BOOK 3219.
PAGE 346: THENCE LEAVING SAID SOUTH BOUNDARY LINE OF THE NORTHEAST 1/4 or THE HQRTHW[ST 1/4 OF
SECTION 15. N 09.23'450 E. ALONG THE WEST BOUNDARY LINE OF SAID CERTAIN PROPERTY AS DESCRIBED IN
OFfiCIAL RECORDS BOOK 3219. PAGE )46. ~OR 53.27 FEET TO THE POINT or BEGINNING AND CONTAINING I.Z89
SQUARE FEET OR 0.Ol96 ACRES. MORE OR LESS.
I I
INFORMATION FOR REAL ESTATE 1099 REPORT FILING
as Required by the Internal Revenue Service
Section 6045 of the Internal Revenue Code, as amended by the Tax Reform Act of 1986, requires the reporting of
certain information to the IRS on real estate transactions. From the information you provide below, a Form 1099-S
will be produced and a copy of it will be furnished to the I.R.S. If you fail to furnish adequate information (in
particular, a taxpayer ID number), then you will be subject to all I.R.S. Regulations, including the possible
withholding of twenty percent (20%) of the current sales price.
FILE NO:
99010086
TAXPAYER I.D. #
SELLER NAME:
GEORGE W. STONE, TRUSTEE
Other (Name of Entity):
MAILING ADDRESS
Street: f O. -.b')'f.....
City: C:~(^j'Pf\t~
(rgl2 ()
fL
State:
Zip Code:
J Y ltJ~ -z--
TRANSACTION INFORMATION
Closing Date:
Description of Property: MADISON AVENUE
Contract Sales Price: $ 9 , 023 . 00
Hud Line 406
Hud Line 407
Total Seller Tax Credit - $
0.00
If multiple Sellers - Request is hereby made that you allocate the sales price among the sellers as follows:
Has the seller received (or will receive) property (other than cash and consideration treated as cash) or services as
part of the consideration for this transaction? (YES or NO)
CERTIFICATION
Under penalties of perjury, I certify that the number shown on this form is my correct Taxpayer Identification Number.
I also certify that the other information shown herein is correct. I ACKNOWLEDGE RECEIPT OF A COpy OF THIS
FORM.
DATE:
(p ) I )qq
sel~~
SETTLEMENT AGENT INFORMATION
STEWART TITLE OF CLEARWATER, INC.
1290 Court Street
Clearwater, Florida 33756
(727)441-2689
Taxpayer I.D. Number
59-1433918
SUBSTITUTE FORM 1099
This is important Tax Information and is being furnished to the Internal Revenue Service. If you are required to file
a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the
IRS determines that it has not been reported.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ... .-. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
(Completion of this form checked by
'TolsE FILLED IN PERSONALL 1
DY SEL.LER on !30RROWER IN '.IIS OWN HANDWRITING
INDEMNITY AND AFFIDAVIT AS TO DEOTS, LIENS, AND POSSESSION
USE 8EPAnATE FonM Fon EACII.l*-'!'!Y~ 'f.'''''' ...,
GEORGE W. STONE, TRUSTEE
SEE EXHIBIT.A
Seller or Owner-Dorrower
Contraclor (Ir new con.lruclloll)
.,
I'urchuer
penonally known 10 me 10 be Ihe penon who.e nlme I. .ub.crlbed herelo, and upon hi. ollh depo.es and uY':
I, Ihe seller, owner-borrower, and/or contraclor, repre.enl 10 Ihe purchuer and/or lender In Ihl. tranucllon
Ih,1 10 my knowledge Ihere arc: ./.
I. No IInpald debl. for plumbing flxlures, waler healeu, noor (urnllce., air condltlonera, radio or lelevlslon an-
Icnnae, carpellng, rugs, lawn sprinkling .y.lems, venellan blinds, window .hadca, drlperlea, eleclrlc applllllcCI,
rCllces, slreel I,avlng, or any Ileuonalllroperly or flxlures Ihal Dre localed on Ihe .ubJecI prollerly deacribed
above, and IhRI no such Items hRve been purcluued on lime IJaymenl contracls, and Ihere Rre no .ecurily
Inlcresh on .lIch properly .ccured by a financing "alemenl, .ecmlly asreemenl or olherwlse excepl Ihe
following: (If none, 10 II ale.)
NAME AND ADDIlESS OF SECURED PARTY Approllmate Amounl
.
1. No loalls of any kind on uld properly excepl Ihe following: (If none, 10 Ilale.)
NAME ANI) ADDRESS OF CREDITOR Approllmale Amounl
I
;
3. All lobor and malerlal used In Ihe construction of Improvemenls or repaln on Ihe above described properly
hRve been pRld for Rnd Ihere are now no unpaid labor or malerlal claims I,alnll Ihe Imllrovemenls or Ihe
prollerly \lIIon which Sftme are silualecl, and I hereby declare lhal all lunu of money due for Ihe erecllon of
Improvemenls or re(lRlrs have been fully paid Ind SBllsfied, excel'l: (If 1I0ne, 10 .llIe.)
NAME AND A[)UHESS OF SUPPLIER OF LADOIl, SERVICES OR MATEIlIAI.S Approximate Amount
"
4. I, Ihe purchaser, represenl Ihal I have no knowledge or Rny debts or liens of any kind olher Ihnn Ihole lisled
above, excepl: (If nOlle, so IIIlle.)
NAME AND ADIJnESS OF SECUnED rAlnV, CIlEDITOR, SUrl'UER OF
LADOn OR MA l"ERIALS Approllmlle Amounl
S. I, Ihe owner-borrower, or purchaser, havc nol been given notice or lhe furnishing or Inlenllo furnish any labor,
.ervlces, or malerlals In connecllon wllh Iny Improvemenls or repairs 10 nld properly horn any penon or nrnll,
. excel'l: (If none, .0 .Iale.)
SUI'rI.lER OR LADUR, SEItVICES Ult MATERIALS AUDRESS
6. I, Ihe undersigned owner, fU!lher cer!lfy 1111'1.1 Ihe real eslale Iud I'ersonall'rol'erty above described are illlhe
aClunlpossessiun of Ihe undersigned and Is nollnlhe possession, aclual ur construcllve, of any person, perso""
or organilDiions hulding or claiming same, adversely 10 Ihe undersigned under conlrRcl, lease. or Rny olher color
ur lille or rlghl of possession.
lhe Improvemenls or tepalu 10 laid properly are now coml'leled Ind have been accelJled by purchaaer and/or
owner-borrower.
INDEMNITY: I, TilE SELLER, OWNER-DOIlRO\VER, AND/OR CONTRACTOR, AORI!I! TO I'A Y ON DEMAND
TO TJlll I'UIlCIIASEIlS AND/OR I.l!NDllR IN TillS TRANSACTION, THEm SUCCl!SSOIlS ANn ASSIGNS, ALL
AMOUNTS SECllllED IIY ANV ANI> ALL 1.I1!NS NOT SHOWN AIlOVE, TOOETHr..n WITII ALL COSTS, LOSS
AU!) ATHJIlNEY'S FEES THAT SAID l'AllTIl!S MA v INCUn IN CONNI!CTION WITH SUCII UNMENTlllNElJ
LIENS, I'I\OVII)EI> SAil> LIENS EITIIHIl CtlRRI!NTLY API'L V TO SUIJJECT pnOI'lHlTY, on A I'Aln TIIEIll!-
OF, on AilE SlJlJSEQUENTLY ESTAIJl.lSlIlH) AGAINST SAIl> l'IH>rEIlTY ANI> ARI! CIlEATEU IJV ME,
KNOWN TO ME Oil IIA VE AN INCEPTION UATI! I'RIOR TO Till! coNSUMMATION OF TillS TRANSACTION.
I reaUze Ihal Ihe purchaser and/or lellder IlIlhls IrlnJlcllon ate relylns olllhe representallon conlalned herein In purchasing
IImc or lending money Ihereon alld would nol purchase lime or lend money lhereon unless IIld repre.enlallon. were made.
~'1'1: Q&"~
STONE TRUSTEE
SWORN TO AND SUDSCRIDED DI!PORI! MI! TillS -1Lday or
~H?I- ClAst!Hp .
Nolary Public In and ror Tn"~~ T . ~ Counly,
~cru.,tt..L
, 19 99
DEBRA A. BORGH
~"G. ~fol Public Slall 01 Florida
My Com"II(j 1!x fU1r.... ':!II2001
r"T "'" T "'. Z n Commil!o('n , CC~97~67
~
EXHIBIT 1
I
~
CERTIFICATION FOR NO INFORMATION REPORTING
ON THE SALE OR EXCHANGE OF A PRINCIPAL RESIDENCE
This form may be completed by the seller of a principal residence. This information is necessary
to deternline whether the sale or exchange should be reported to the seller, and to the Internal
Revenue Service on Form 1099-S, Proceeds From Real Estate Transactions. If the seller
properly completes Parts I and Part III, and makes a "yes" response to assurances (I) through (4)
in Part II, no information reporting to the seller or to the Service will be required for that seller.
The term "seller" includes each owner ofthe residence that is sold or exchanged. Thus, if a
residence has more than one owner, a real estate reporting person must either obtain a
certification from each owner (whether married or not) or file an information return and furnish a
payee statement for any owner that does not make. the certification.
Part I.
Seller Information
I.
Name
GEORGE W. S'IONE, 1RUSTEE
2. Address or legal description (including city, state, and ZIP code) of residence being sold
or exchanged.
SEE EXHIBIT A
3. Taxpayer Identification Number (TIN)
Part II.
Seller Assurances
Check "yes" or "no" for assurances (I) through (4)
Yes No
(I) I owned and used the residence as my principal residence for
periods aggregating 2 years or more during the 5-year period
ending on the date of the sale or exchange of the residence.
(2) I have not sold or exchanged another principal residence
during the 2-year period ending on the date of the sale or
exchange of the residence (not taking into account any sale or
exchange before May 7, 1997).
(3) No portion of the residence has been used for business or
rental purposes by' me (or my spouse if I am married) after May
6, 1997.
(4) At least one of the following three statements applies:
The sale or exchange is of the entire residence for $250,000 or
less.
OR
I am married, the sale or exchange is of the entire residence for
$500,000 or less, and the gain on the sale or exchange of the
entire residence is $250,000 or less.
QR
I am married, the sale or exchange is of the entire residence for
$500,000 or less, and (a) I intend to file a joint return for the
year of the sale or exchange, (b) my spouse also used the
residence as his or her principal residence for periods
aggregating 2 years or more during the 5 year period ending on
the date of the sale or exchange of the residence, and (c) my
spouse also has not sold or exchanged another principal
residence during the 2-year period ending on the, date of the sale
or exchange of the residence (not taking into account any sale
or exchange before May 7, 1997).
Part III.
Seller Certification
(g~ HI
Date
~~ ,
F it~ 9\}Q 1 G:l86 L. SE'fTLEl\}ENT CHARGES I PAID FROM PAID FROM
BORROWER'S SELLER'S
700. TOTAL SALES/BROKER'S COMMISION Based on $ FUNDS FUNDS
@ %= AT SETTLEMENT AT SETTLEMENT
Division of Commission (line 700) as follows:
701. $ to
702. $ to
703. Commission paid at settlement
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 to
806. Mortgage Insurance application fee to
807. Assumption Fee to
808. to
809. to
810. to
811. to
812. to
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE.
901. Interest from to @$ /day
902. Mortgage insurance premium for mo. to
903. Hazard insurance premium for yrs. to
904. yrs. to
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance mo.@$ per mo.
1002. Mortgage insurance mo.@$ per mo.
1003. City property taxes mo.@$ per mo.
1004. County property taxes mo.@$ per mo.
1005. Annual assessments (Main!.) mo.@$ per mo.
1006. mo.@$ per mo.
1007. mo.@$ per mo.
1008. mo.@$ per mo.
1100. TITLE CHARGES:
1101. Settlement or closing fee to STC 50.00
1102. Abstract or title search to STC 100.00
1103. Title examination to STC 45.00
1104. Title insurance binder to
1105. Document preparation to
1106. Notary fee to
1107. Attorney's fee to to
(includes above items No.:
1108. Title insurance to STEWART TITLE OF CLEARWATER 100.00
(includes above items No.: )
11 09. Lender's coverage 0.00 $ 100.00
1110. Owner's coverage $
1111. to
1112. fl risk rate ($ 100)
1113. to
1114. to
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed $ 60.00 Mrtg $ ReI. $ 60.00
1202. City/county tax/stamps: Deed $ Mrtg $
1203. State tax/stamps: Deed $ 64.40 Mrtg $ 64.40
1204. RECORD 2 TRUSTEES AFFIDAVITS to CLERK OF THE CIRCUIT COURT 21.00
1205. to
1206. to
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest inspection to
1303. to
1304. to
1305. to
1400. TOTAL SETTLEMENT CHARGES (entered on lines 103, Section J and 502, Section K) 440.40
CERTlFlCA TION: I have carefully reviewed the ~\tlement St~~~ beSI of my knowledge and belier, it is a true and C/latement of all receiP~~t~ m~e on my accounl or by me in this
transaction. I furt ~ify tha~ve receiv~ cop UD-. Seule nl Sla . J I'l. I A
- /- I ../
{ &iI? L".F ~ 'l (jf! orl!e Iv.' ~tone 'lrustee
Borrowers Jlr'T'l<'l . Sellers '-..J
C IT OF ClEARW
R BY. EARL BARREIT
To the best o~.my knowledge, the HUD-l Settlement Stateme".t,~~~~h,,~ ,~_v~..P_~iS a true and accurate account of the funds which Wl:re received and have been or will be disbursed by the undersigned as part of the settlement of this U'3nsacrion.
.'~ ~ '-.' JUNE 1, 1999
nf"A~nt Date
SELl.ER'S AND/OR PURCHASER'.S STATEMENT s and Purchaser's signalllre hereon ac~WledKeS hIS/tl1ei~rpVal of I'll' Rror~li l!S and~i niijes their und~r~t;ing Ih~tWororations W~\f basCII on taxes foOhe preceding year,
r elil~ateli.f!}t the current ye~r, and I~ the e.l(enl of a e fQr the current yea,i, all """essary ~s nTs I11\lSl be belween ~lIer Pun; r' likeWIse any. de.a!on ~elon enlta~e~ WI be rell1)bursed 10 Tille I,.ompany by
. ~e er. Tlfle compank, on lls c~aclty as pscro,/! .' I and has been autnonied IQ de~$lr a. $ II rec~lyeli.}g t s transaclion on~ '~ 'll$lilVliop, whether a I lated Qr ot. Such linanc[alll\Slilullon may pro.vlde
ule O~lY compule accOlll1.t\n and audll ;iervleel Ill)' or thro)J2,h lJ s!;parrree~lty Ich, If a lIiated With Tltlt~an~rnaY c ge In;IJlClal instItution reas.p le,and jljDer...so~nsatlOR the~rore a.nd retain ~ny profits
t refrr.; rly e~clow ees pa'd b any ~nvo ved on 's ",",saclion Shat' on y or c ~k~ntin~ancj~ i', UIIQ lI1e co Ie s, but oot 0", a preSatat~cot;,ling and aUdlt=rvlc~s. Ille CO any sha .not be li~ble for lUJy onte~eSl or
01 r c ei,on the e~rneSf Inone and be under (lO ,tv Jo onv~st or reonvesl s.tv: by" at 'L\I Sellers n; here ackoowl Xl': COl\Seql tQ lI1e It 0 lliI' escr w money In fin;IQCI~llnslllullons WJ)h
w I~h It Lomp~y has or m~y' ave.~ r I~ ~ation$tllgf ~Q furtber consent n ~d retc!ntlon 6-T11 e Company lor Its I iates any am a rbene Its (lIlcludmg tageous mterest rates oh oans) Title Company and or its
a ft~~~~rt%:y,ca~~~l~3rn,~~boV~~~te~~t.'~~~nr~ ~~~~ rJcU~i~~J~~~:'~ ~:~erY:e~r:~o ~~I and recognize Title Co"1>any is relying on the same.
P.urdlltllerS/ /Borrowers Sellers
ClTY OF CLEARWAl.l:~.:1{ lW: tAJ{L J)A.RRt:n GEORGE TN. STONE, TRIISTFF
W ARNlNG: II is a crime 10 kno\l'lngly make false statement! 10 Ih. Unlled Slates on this or any other similar fonn. Penalties upon ~nvltlloa tan Intlude _ nne and Imprisonment. For detAIls set: lll1e 18: U.S. Code Sec::tIon 1001 and Secllon tOl0.