BERNARD DIXON-MAXINE DIXON-AUDREY DIXON MYRICK-MARGARET DIXON ALGEE
'0; (enclose self.addressed stamped envelope
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~iS Instrument Prepared by: n~',":::.C":;f ;,:;";'!',.,
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,_060110 ,
IN~3T :1\: 7:1."-34::,:;:'03
:L ~ 4S,lPt1 :'0
~,'TT"rtlIVIO.
~l
PINELLAS COUNTY FLA.
OFF.REC.BK 7762 PG 261
~_:~.,:f;, h':;~.~:~~ ;:/S,;"
Add....:
(]t",/ii'~':i ~:i.~~!'. fi'L 3'ii.J:~ ':1
"'hleh Ir~:5~l'UnKn. wa~, ~'J::epal('d ~r!(?tIJ.i'~7',~~.;;
to writin~ oi ~ I'iUe In~{)runc';; Po~k'~',
Properly Appraisers Parcel Identification IFolio) Numberls):
$
K
a
;} L/O W
Pd. $ _
___ Inl~ngible Tax Pd.
lark, Pinellas County
Deputy Clerk
SPACE ABOVE THIS LINE FOR RECORDING DATA
Grantee[s) S.S. #[s):
SPACE ABOVE THIS LINE FOR PROCESSING DATA
'i ,I'
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w~ri.6 arrant V, ii'h ilea Made the 16' da, y of : Dec;ember , A.D. 19 91 by
BERNARD DIXON, a .~ man; MAXINE DIXON, a 5tl1.qlt..- .woman;
hereinafter called the grantor, to AUDREY DIXON MYRICK, a/Ytflf1JlucL woman and HARGARET DIXON
ALGEE, a h"JJ.-I(tUl woman, Grantors
whose post office address is CITY OF CLEARWATER, FLORIDA, Grantee
P.O. Box 4748, Clearwater, Fl. 34617-4748
hereinafter called the grantee:
(Wherever used herein the tAl...... 'grantor' and 'grantee' include all the pard.. to this instrument and the
heirs, legal repre.entaUve. and ....ign. of individual., and the .uooe..ol'8 and assigns of oorporations)
_itntlllld!t: That the grantor, for and in consideration of the sum of $ 10.00 and other
valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises,
releases, conveys and corifirms unto the grantee all that certain land situate in Pinellas
County, State of Florida , viz:
Lots 8, 9 and 11 less south 50 ft. for street, Block 2, MOASE AND HARRISON'S SUB,
PH H-2, Pg, 85, Pinellas County, Florida. ALSO DESCRIBED AS:
Lots 8, 9 and 11 less south 50 ft. for street, Block 2, MOASE AND HARRISON'S
SUBDIVISION of Lot 7 of R.H. PADGETT'S SUBDIVISION, according to the Plat thereof,
as recorded in Plat Book 2, Page 85 of the Public Records of Hillsborough County,
Florida of which Pinellas County was formerly a part. _
Parcel no. 15/29/15/58338/002/0080 Grantors soc. sec. It,;?" S--""tf6 -rs~ 7 (BERNARD)
'. :J-4' 7- ~ tv - 935(0 (MAXINE)/ 8&'~ 3h-/.tj&) (AUDREY)g J if It' - ,;; ,:< - &3~~GARET
Property is not the principal residence of the Grantors, ~hey}n fact reside at:
Bernard -(;2..'119 c 19(2 e/(? J/f-~(,f) ;:13t1~ :Maxine-X.. F':O.I~ox I'lia _ '
Au ey - 3')/9- ~33?IMargaret -! . f1t..~uLlflrA, Q.
. un a an appur enances re 0 e ongmg r l.n anyWiSe~ 1
appertaining.
<lin )lane anb tn )loth. the same in fee simple forever.
Anb 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, and he1'eby war1'ants the
title to said land and will defend the same against the lawful claims of all persons whomsoever; and that sa1:d land
is free of all encumbrances, except taxes ac~ruing su.bseq.uent to pecembe'd. 91, 19 91, and all easements
1Jn Bitnellll _!ttttnf. the said gc;.~nt&~a~~t~JifJWd ~al{llh~fe presents the day and year first above
written.
01 RECO' D r
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Pri~~ !i~ature ~Ni~~
t~Of~"" '461 - L...osS\) P I 3Y~yy
AUDREY
STATE OF FTj)RIDA
COUNTY OF PINELLAS
, I HEREBY CERTIFY that on this daL.!?.!!19!:.e_me", an officer duly aut,horized in the Sta, te aforesaid and in the County jlfOl:esajd to take
acknowled~ents. perBOn~Jly appeared Bt;J:li\JAJID JJIXON, a /"no. i' {U tL- ma~ll" MAJClNE DIXON, a ':J Lf1.1..\~ woman
XON MYRICK, a~L woman and MARGARET DIXON ALGEE, a l6'Mt!~~o(J;/?o'bet~9>W~bh descl1bed in and
who executed the foregoing instrument and they acknowledged befo",re',m, e that th~"X executed" the same,
WITNESS my hand ~~d_Of~cial SeaI.in the County and State jt afO~",i~ Z~ 10:'\ daY;? ",~ ~e~em~e~,. A.D. 1991.
'- " ota ~,U L:.JT.. (JiLIn fl/U
SEA.L _ ~. "
Printed Notary Signature
My Commission Expires:
q~acf.1;)
KARLEEN F. DEBLAKER,
RECORD VERIFIED BY:
Ci...EF:K
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CERI'IE'IED 'IO &
PREPARED FOR: cny of ~LE.AR. WATE.R.,
STE.WART TlTLE. (DMPANY tf CLEAF?WATe~, INC,.
SoIE-WA.RT TlTL-c.. GUARANTe:e:.. COMPANY
SEC. !L TWP. Z9S RGE. ~
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A SURVEY OF L.OTS B f ~ 1 BLO~"- 2.., MOA~e. ;. H.A~t={.so~:S $ue-
DIVI;>/ON Of L.u-r 7 of- R..... PA~ETT.s SUe>P'VI.:>IO,,",
AS RECORDED IN PLAT BOOK ~ , PAGE ...2!2.. , OF THE PUBLIC RECORDS
OF HillsboroughCOlUlty, Florida, of which Pinellas COlUlty was fonnerly a part.
+1 RM ZQ,..J e:.. Co
I HEREBY CERTIFY THAT THE SURVEY REPRESENTED HEREON MEETS THE MINIMUM
REQUIREMENTS OF CHAPTER 21 HH-6, OF THE FLORIDA ADMINISTRATIVE CODE.
DATE: 1-1~-91
EVANS LAND SURVEYING
BOUNDAR.y SuRvE.Y o,.JL.--(
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U\R "L EVANS
Ro. Reg. No. 2937
OWN. BY: Lf.
: INV. NO. : 91-38lA
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2}OO MAIN STREET -UNIT H
DUNEDIN, FLORIDA 34698 PH: 734 - 3821
. ,~ 'CERrIFIED TO &
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A SURVEY OF LoT t 1, SL.O~ 2-, MOAS,E. ~ ~A~R::'..')ONS 5u~-
DIVtS,O,J Of LOT 7 Of ~. H. PADGoETT5 SuBDIVISION
AS RECORDED IN PLAT BOOK ~ , PAGE 6~ . OF THE PUBLIC RECORDS
OF Hillsborough County, Florida, of which Pinellas County was forr-erly a part.
rr ~^" ZDt-J €. C-
I HEREBV CERTIFY THAT THE SURVEY REPRESENTED HEREON MEETS THE MINIMUM
REQUIREMENTS OF CHAPTER 21 HH-6, OF THE FLORIDA ADMINISTRATM CODE.
DATE: 7-1G:.-9'
OWN. IV: Lf...
-
.., INV. NO. ~ t..)I-3al
..,
EVANS LAND SURVEYING
(,
Z300MAIN STREET - UNIT H
DUNEDIN, FLORIDA 34698 PH: 734 - 3821
BouN DAf<:'-( SI,)~VE. Y o~c..y
~
L EVANS
No. 2937
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,\"",.,;t, ',t! Contra,.!
RONALD IRONI E. SOMERS
President
1290 Court Street
Clearwater, Florida 34616
S'l'EWAII'r'l'rrI...E
OF CLEARWATER
P.O. Box 2756
Clearwater, Florida 34617
(B 131 441.2689
AUTHORIZATION AND ACKNOWLEIX;EMENT FORM
Reference:
FILE NO.
91060110
LEx;AL
!illS 8,9 and 11, LESS S 50' FOR S'IREET, BLK 2,
MOASE & HARRISON SUB
BERNARD DIXON
SELLER
BUYER
CI'IY'OF CLEARWATER, FLORIDA
We hereby approve and acknowledge receipt of a copy of the Statement. and actual
cost (DISCLOSURE/SE'ITLEl'1ENT STATEMENT - BUD FORM 1) and authorized disbursement
of funds as shown therein this 17 day of DECEMBER , 19 91 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 infoDnation available. If any changes are to be made in this
proration when the tax bill is received, it will be handled L'€tween the p."1rties 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, 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 P3rties to this
transaction, outside of Stewart Title Company Company of Clearwater, Inc.
Stewart Title ComP3ny of Clearwater, Inc., will be not held responsible.
'!HAT ALL urIT.ITY BILLS (WATER, SEWER, El...EX:.lRIC, M1\INl'mANCE FEES)
OR WILL BE PAlD UPON ROCEIPr OF FINAL BllLS. /~. - ?W
~ ( (,;.;;!
&~~/r . INIT~
BERNARD DIXON
HAVE BEEN PAID
INr.ITM.S
SELLER'S FORWARDING ADDRESS:
/:? ?tP// r;Xl/ZI)~ e-~Z
.
BUYER'S FORWARDING ADDRESS:
L4/Z.~& .,e-/
Ha1E PBONE# .J7 '7 ~~ f' (;.- /
\<<)RK PHONE#t ,.5 '/ ;J- - :J q 7 ~
H<X1E PHONE#t
WORK PHONE#
TIUS IS TO FUR1HER AUTHORIZE
mANGES NECESSARY TO 1HE CLOSING STATEl'1ENT.
TO APPROVE:ANY
~
<!
Td BE 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
BERNARD DIXON
..
Seller or Owner-Borrower
LarS 8,9 and 11, LESS S 50' FOR STREET, BLK 2, MOASE & HARRISON SUB
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 SECUR~TY
Ir; /rk '
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
pc i\.( r
~i2)
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
N'CJ/I(C-
ytD
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 MA TERIALS 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 thto.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 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 purchase same or lend money thereon unless said representations were made.
BERNARD DIXON
DECEMBER
91
,19_.
SW
Q SUBSCRIBED BEFORE ME THIS
/~
......
/J
County, FLORIDA
My Commission Expires:
9;~ 0' ?jc:7-
Rev. 1/88
NOTE: nit form i. 10 he .i.nod by leller in eliI' of llle. If no llle. it it '0 he Ii..... by the owner-bonower. If ,he... it Iny new eonllruction. the eonlrlC\or mull 11,0 join in lhi. form
or lian . .,a,...1 OM.
I
I
SflIII"/;ly "I f."ofllmrl
RONALD (RONI E. SOMERS
President
1290 Courl Street
Clearweter, Florida 34616
s'rEWAI{~r ~rrrLB
OF CLEARWATER
P.O. Box 2756
Clearwater. F Imida 34617
(813) 441.2689
D I S C LOS U R E
We, the Owners of that certain real property located at
wrs 8,9 and 11, LESS S 50 I FOR STREET, BLK 2, MOASE & HARRISON SUB
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.
~~<;/
BERNARD DIXON
'1fk~~AIb-'-
WI. ness
STATE OF
COUNTY OF
FLORIDA
PINELLAS
SWORN TO AND SUBSCRIBED BEFORE ME THIS
17~-
DAY OF
DECEMBER
, 19 91.
My Commission Expires: OJ t!}C( - q;)
I
I
NON-fOllE.lGN cr.:;n'1'.lFlcm'.lOI~ BY INIJ1VllJUA(j '1HI\HSFEHon
1. SecU.ulI Vt<15 or tho llltenlt'll Hevollue Code Pl'ovJuen thnt 0 In"l\lSferee ul: 0 Ullited
Stoles real pl'uperty interest Illual withhold lux :If lhe lUlIlBCel"Or is IJ Coreiyn t~rson.
2. 111 order Lo 111[01.111 Lhe tnllls[oreo Lhut wiLhholtHllV or Lox J.o Ilut required upun lhe
c.llspus.l.Uol1 hy BERNARD DIXON
of the UnlLed Stotes reill l'toperty uescdbeu os [ollows:
rms 8,9 and 11, LESS S 50' FOR STREET, BLK 2, !\K)ASE & HARRISON SUB
the unuel-signee.] trallsfet-or certifies alld declares Uy lI1eallS of lIlls certificatioll, lhe
followillg:
(a) 1 (We) am (ore) not 1I01l-residellt o11ell(s) for txJrposes of Ullited States illcOllle
taxa HUll olle.1,
(b) ,.ly Ullil r.<J States taYPolle.t; identifying nllllloor(s) (Social Security Number) is/on:!:
~ SOCll\rJ S~".CUlU'1"i NU\'~
BERNARD DIXON
" 2.? S- - ~ h :..-' 1 S/--I )-
If
II
"
(e) ,.ly hOllle nc.ldreu9 ;1.8
(utlodI(X) odc.lJUullol lJtJge .i.r Ilece8sm:y)
(d) Theu~ ote 110 oLhor iJel:SOIlO who hove nil ownoJ:6hJp .I.lIteresL J.II L11l! uIJOvo-t1oucd.bed
property olll~r LImn thuse 1JOI:SOIIS set rot'llt obuve ill sub[^,J."oyroph (b).
J. '.llIe \IJltlersJgned hereby furlher cert.trJ.es olld tleclOl:es:
(0) I (Wp.) ul1<.lerstOlKJ that the txJrchoser of the above described properly illLelK.ls '
lo rely Oil the foregoillU r.epresonlatJolls 111 conllectloll wJ.lh the lInJted !:Rnles
(Potelgll IIlVcsllllellt ill Ueal Properly '!'ux 1\cL. (94 Slotute 2GU2 (1S 1I1l1ellded).
(b) J (wo) ulldot:nlulld LIds cerUr.tcol.l.oll Ilny IJa tllseJoned lo lho Illltnllal lleVellUe
Ser.vJ.ce by LJ:Ollsreree olld lhat OilY falso statemenl contained ill thls cerUrJcoL!ulI
may Ix! l.lulllsIJ(!( I hy L1J IU, JJl1pd.HOlllllOllt UI: lx>tIJ.
Under [X1l1ull1es uf [Jel'jury 1 (we) declare I (we) have examlneu carefully lhis corl1-
f!cation one.) it is Lrue, correct and cumplete.
DECEMBER
1991 at
PI~3
BERNARD DIXON
FLORIDA
.r
/~
(
W tile s
('lhis document hlUSt:. be retained ulll:!1 the end of the fiflh taxable year following lhe.'
taxable year in wh.Le" the transfer takes pIoce).
CONSUJJl' 'fOUn l\'l'J'OltNl!:Y I\NIJ/OIt 'l'l\X I\I)VlSOlt - NO ltEPlU!:Sl!Nl'l\'1'lON un HECUoINENlJl\TION IS Nl\1J1!: UY
S'.l'I!,W1\lfl' 'lTJ'lJI~ INStJH1\NCI!: Ol'II?l\NY 1\NlJ/uH CONC1~nNJ.NG 'filE:
LEG/\IJ sun~.ICll::NCY 1\NIJ/Olt 'J.'1\X CONSQUI1'NC1!:S Oli' '11US l.XJCUr-'I~~.r:-vOlJ ",l\Y HE: HEQUlmU TO ~~J.LE:
l\ COpy Oll' TilLS I)(X:Ur-WNl' W.I'l1J 'l'Il1~ IN'l'EltNl\rJ ltI!:V~:NlJI~ SI~ItV.lC~:. 'I1m:sg I\HI!: QUI~S'J'.LONS run Youn
I\'1T()HNI~'i OH T1\X I\l)v 1 sun .
'I. ",'
.'
,',',
S'1'I\'1'B Ol!'
COUNTY 01"
FLORIDA
PINELLAS
I IIEm~OY Ct:.lt'l'll''Y that:. on L1tls day, before 11Ie, an officer uuly authorized ill the stale
aforesaid amI it, tile County aforesaid to laka acknowledyments, personally nppeared
BERNARD DIXON
to me Imow" to be llle lX!l"sC)ns descrIbed in allll WiIO executed the foreyoing lnsttlllllellt
ol1d they oclmowledyed 00(0<0 h.. thot thoy oxeeuted tho Dome. 7{J
WITNESS my hand and officiol seal ill the County nl1u S~ole last aforesaid lId.s I . doy
of DECEMBER .:' ' 19 ~1 · (A1~'./ r :. , (' r
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INFORMATION FOR REAL ESTATE 1099-S REPORT FILING
Section 6045 of the Internal Revenue Code, as amended by. the Tax
Reform Act of 1986, requires the reporting of certain information on
every real estate transaction. From the information you provide
below, a Form 1099-S will be produced, a copy of it will be furnished
to the I.R.S. and to you no later than January 31 of the next year,
and a copy may be sent to other third parties. 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 Number: · 910601110
Taxpayer 10 Number: Seller 1 :2 ~ S-- /I' [, -1'$7-1? Seller 2
Taxpayer 10 Type:
2
.(1 = business, 2 = individual)
SELLER 1 NAME:
Last:
DIXON
First & Middle:
BERNARD
SELLER 2 NAME:
Last:
First & Middle:
MAILING ADDRESS (as of January 31 of next year)
SELLER 1:
Street: / ~ q& 1/
City: /1412(;0
f;&RV/1
ei>Z
state: R-
Zip Code: ) /llGLf 3
SELLER 2:
street:
City:
state:
Zip Code:
TRANSACTION INFORMATION
Closing Date (MMDDYY):
12/17/91
Contract Sales Price: Seller 1 -
10,000.00
Seller 2 -
(If multiple sellers please allocate the sales pr1ce among the sellers)
Description of Property:
Street Address: 1127 & 1139, BRavNEIL S'IREE:r, CLEARWATER, FL 34616
Legal Description: LOrS 8,9 and 11, LESS S 50' FOR STREE:r, BLK 2. MOASE & HARRISON SUB I
Under penalties of perjury, I,
BERNARD DIXON
(Name of Seller (s))
certify that the number shown on this form is my correct Taxpayer
Identification Number and that the other information is correct to the
best of my understanding and I understand that it will appear on a Form
1099-S that will be sent to me and to. the Inter~~u.:~.s rvice.
Date: /2 -{ ( -1'; Seller - 1 S1gnatu~~~
BERNARD DIXON
Date:
Seller - 2 Signature:
CLOSING AGENT INFORMATION (to be completed by closing agent)
Name:
ST.E.WART TITLE C<l'1PANY OF CLEARWATER, INC.
Mailing Address:
1290 COURT STREE:r
City:
CLEARWATER
State:
FL
Zip Code:
34616
Taxpayer 10 Number1
59-1433918