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Lewis, Joanne Cemetery Call Work Sheet Date: la / / a01( Funeral Home/ Monument Company: Contact Name: -Ioanr..e Levi ,5 ( f - ) (`t`i`t 60,c Circle TeI. #: (G7g ) - �1 tio — 113 Fax#: 1i.n .) CAA .3(.76, go . �G 8) V1-) 3 .S7 Reason for call: Staking Request (Interment/Disinterment) jc.t I a 2 y P. coo—Lc at, he-f. Affidavit (Burial Rights) 13 arr-a cor - unt� Monument (Marker) being placed (No fee for staking of monument) X Verifying Burial space 2( Other reason: tJA K.-fe p ant frvvo- z /16,4 1b4.. **************************************** ****************,*******1k*********** ****J'^k)*********** Interment: (One full burial and one urn, or two urns per space) 13-Q o ck- 15 Lot f t v S . (I ) E'r - giLL, rX R �e n v lr• Full Burial Urn Space y) S/L./cf Owner of Plot: Deceased Name: Q e o ck W S J Lo'f I I O Block Lot Space 6�xn4 Spk c e a — Ueicw�� ioQ.e ) Coed racf. WaJ k- b(Qt Date of Birth: / / Date of Death / / e k z Date of Burial: / / Time: am/pm (OdvLei Ms LQwiS 7-L . $30.00 Staking Fee (Funeral Home) — received on: / / Copy of permit faxed to Joe Taylor/P&R — Fax No. 6551 on: / I # a I`F.°a ************************************************************************************************** fc,, 5 f : (a) Disinterment: The following authorization should be obtained prior to disinterment: 1.) A disinterment permit and burial/cremation transit permit 2.) Written authorization from the individual(s) who currently own the burial rights for the plot; and 3.) Written authorization from the individual(s) who would be permitted to authorize burial Revised 6/29/11 ' INST # 96-141502 MAY 23, 1996 3:12PM CEMETERY DEty PINELLAS COUNTY FLA. ,1�H OFF.REC.BK 9352 PG 337 THIS INDENTURE made this /`7/ of IJ . . , 1996, between the City of Clearwatej, Florida, a municipal c• oration as Grantor 11 RECORDING and DOROTHY B. HENRY, whose mailing address 1100 Druid Road, ACCT/B®, X) Apartment 609, Clearwater, FL, 34616, of the County of Pinellas, State of Florida, as Grantee: REC WITNESSETH:That the said Grantor, for and in consideration of the sum FEES of $500.00, to it in hand paid by the said Grantee, the receipt whereof is MTF hereby acknowledged, has remised released and quit-claimed unto the said PTG �cumentary Tax Pd $ �Sd Grantee, and their heirs forever, all the right, title and interest, which the PAC 3 --__�. said Grantor has in and to the following described parcel of land, lying and DOC Irteng;h?e Tax -•., being in Pinellas County, State of Florida, to wit: Spike One (1) Lot One INT K.a►lean F. p=g;- ..� C4>rk Ping;;; C, Hundred Ten (110);Ski&Fifteen-(16), Clearwater Cemetery, as recorded in TOTAL ' By Plat Book 60, Page 30, Public Records of Pinellas County, Florida. i Deputy C""' This conveyance is subject to the condition that Grantee herein shall not assign or convey said property without the written consent of the Grantor, and to the further condition that said property shall be used only for cemetery purposes as human burial sites and is subject to such other rules and regulations the City of Clearwater may adopt pertaining to use of said property. TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said Grantee and their heirs and assigns forever. IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor Commissioner, by its City Manager, and to be attested and its corporate seal affixed by the City Clerk on the day and year first above written. Co 1t! 1,•,d: / ITY OF CLEARWATER, FLORIDA A ;,,i...,_i By: Rita Garvey, Mayor-Commiss'� er Elizab'h De la, Cfty/ .n•ge Attest: -44. 00 i i '4 - /44.41i SSL Susan Stephenson, Deputy ity Clerk STATE OF FLORIDA 1 COUNTY OF PINELLAS) Before me, the undersigned, personally appeared Rita Garvey, the Mayor-Commissioner of the City of Clearwater, Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be her free act and deed for the use and purposes herein set forth. WITNESS my hand and official seal this 9 day of , 1996. , (SEAL) Notary Public Print/type name: may,FE, CAROLYN L.BRINK 1 ,„ krOMmissiON t Cl� ■,: EXPIRES MAY 22,1999 STATE OF FLORIDA ) .':a.J N BONDED TWO COUNTY OF PINELLAS) M Or ATLANTIC BONDING CO„INC. Before me, the undersigned, personally appeared Elizabeth M. Deptula, the City Manager of the City of Clearwater, Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be her free act and deed for the use and purposes herein set forth. WITNESS my hand and official seal this 9 14— ay of , 1996. (SEAL) .��` .�e� COMMISSION CC 4f? �ry Public Approved as to form and legal sufficiency: Print/type name: i t-i E' EXPIRES MAY 22,1999 �. — r I '�;d�`� L� C 8O TMRU INC. •;:.i!:.,i�, l O. Of O� ATLANTIC BONDNNG CO.. John Carassas, Assistant City Attorney c:i v C tj,i( i O i O,'FCE BOX 4748 C(.FARWAT ER, FL 3:618-4748 1 a CITY OF CLEARWATER V rr . CITY CLERK DEPARTMENT 4-a — Q; POST OFFICE BOX 4748 41r/ ti CLEARWATER, FLORIDA 33758-4748 � , PHONE: 562-4090 4TE k �' August 16, 2000 Mrs . Dorothy B. Henry 1001 N. Greenwood Avenue, Apt . 10 Clearwater, FL 33755 Dear Mrs. Henry; Reference is made to the agreement you entered into with the City of Clearwater on May 30, 1996 for cemetery property described as Block 15, Lot 110, Space 2 . We have not heard from you or received any payment from you since July 8, 1998 . Your $100 .00 non-refundable deposit and payment of $200 . 00 leaves a balance of $214 . 00 on your space. We must receive the balance of $214 . 00 in full by September 1, 2000, in order to save that space for you Please let us hear from you as soon as possible. Please help me to take care of this. Siicerel , `lam Camille Motley, COV(IV Central Records Special-i\ cm gL \)1(71%--‘'.\ \Z • CITY OF CLEARWATER SERE" ' ;A041 ;',:', * CITY CLERK DEPARTMENT ;— lYm 4c� POST OFFICE BOX 4748 Q CLEARWATER, FLORIDA 33758-4748 '9� . ��4Ps PHONE: 562-4090 4TER,,, August 1, 2000 Mrs. Dorothy B. Henry / G or) 2.065 N. Highland Ave #C-116 bQd - --C f/6 Clearwate 5 1325 012ku_t_ 3 37S Dear Mrs. Henry, Reference is made to the agreement you entered into with the City of Clearwater on May 30, 1996 for cemetery property described as Block 15, Lot 110, Space 2 . We have not heard from you or received any payment from you since July 8, 1998 . Your $100 .00 non-refundable deposit and payments of $200 . 00 leave a balance of $214 . 00 on your space. We must receive the balance of $214 . 00 in full by September 1, 2000, in order to save the space for you. Please let us hear from you as soon as possible . Thank you. 2 Yo rs very truly, 4111.-e. Camille Motley Central Records Specialist cm Enc. • CITY OF CLEARWATER SEt►LK''r _ r < CITY CLERK DEPARTMENT Q POST OFFICE BOX 4748 :1"; CLEARWATER, FLORIDA 33758-4748 99�gtEQ��O� January 21, 1998 Mrs. Dorothy B. Henry ivt,t) 04&Ls,____e___ Clearwater, FL 33756 Dear Mrs. Henry; I found a note, dated November 5, 1996, indicating that we had a conversation regarding the cemetery property you purchased by way of an installment agreement with the City of Clearwater. During that conversation, you stated you were having some financial difficulties and asked if we would continue to hold the space which is described as Space Two (2) , Lot One-hundred ten (110) , Block Fifteen (15) . Our records indicate you have paid $150.00 and have a balance of $364 .00. The money received is not refundable. The payment terms you agreed to were "four monthly installments at the rate of $100.00 each beginning with the first installment June 30, 1996, and three monthly payments of $100.00 thereafter. The final (fourth) payment of $114.00 includes the $100.00 monthly payment and the recording fee of $14.00". The terms have not been met. Our normal procedure for non-payment is to re-open the space for purchase. However, we know that you have other family members buried in that lot and we want to do everything in our power to fulfill your intent for purchasing that space. Please let us hear from you. If you are unable to make the original terms, we can attempt to alter them to better meet your needs. Please call me at 562-4098 or my Supervisor, Susan Stephenson at 562-4097 to talk about this or to schedule an appointment to come in and discuss it. Yours very truly, Camille Motley, V /14, ty we �/, Ceta Records�ial s p � �0 Up r 7y� v ' � / 0 0 — a fa-1- �/ 1,0k4J0 Ca-4—c— 51-cifieLC.,ZaZa ...... CITY OF CLEARWATER Contract Li Cemetery Property Payment Record Paid in Full 0 act. ._ , ..--- Description: Space Lot_ Block...._/........ -------- No. of Spaces / A AJZ 6 ° (1?- 4 , • / -&) 9 Sale Price -0 es ----- Sold to • _ hddress ' , . Contract Date 5 :1) --Y,L Terms of ....S—._%W. le:0-2._ ,, _ ,y - &dale/ . _ Deed Issued to Address Deed Date Deed No... _Funeral Directors -;-77-7--- _STATEMENTS OTHER INFORMATION DATE PAID RECEIPT NO. IIEISTTS 'CItioftliPS -:--.....--="--.....AX:=.':.Z.:=77....----.7..= =7"----.---.7- --.....--...7.7.------.-......-.=.--- -- :=.7_-....=----....=-.::.=.....---...- -7"...----=. =.=:.7.MIX..: 7.:..:7:-.2. '. .1.,..1. ..:-.■=7,:.:.---. Z:--.7.7Z. " -- sj2.1./.7 / • • A li , .. I._ 'c/5_. 40 ____ . 6 q k „ I CL--r-4-- 1/-5---`76 _ _...... . ._._.. •-- to)._,,,Ack_ , k,_. 1,0 le,0 A af--)-1-31/4. A54.4)--,-v.-4- I k 1 — ________.. _ _.__. _____. ... __ - -- *L., 6.. -.- --------- ----------•-- ---- ... it.9_,(2,,( 41U,, 19.‹.., krz_4_, ' bt-c._ et- ,/etil-Z-' H --------• - -- . , • tl it. t ., 1 - ...... .....,A 4404�nl or•AC E CHECK LIST // DA rE: S - 3 o - b OWNER'S.NAME v d a.•$ ` ' PHONE N ER ADDRESS // U a • d �• j 6 O '— BLOCK l�l LOT /�D SPACE cam-- (Include G'""^•✓nlArr Man r.nerr,vf INTERRED: COST OF SPACE $ S60 RECORDING FEE $ / Y STAKING FEE $ `�� RECEIPT NO. < i6 U TOTAL $ S-7 — The Purchaser will first visit the cemetery and obtain the legal description of the space selected from the caretaker at the cemete . The following steps shall then be followed in their listed order. l/ (� ry Check Availability of space 7 l ' j/ Prepare receipt for purchaser`s-- GO(:1---- Color in green plat (located in binder in overhead cabinet at receptionist's station NOTE,_ FOLLOWING.STEPS WIJ1,BE HANDLED BY EMPLOYEES WHO ARE ROZ777NEL}'RESPONSIBLE F;OR'CEMETERY RECORD KEEPING :IF t HIS 1S AN AT'NEED PURCHASE, PLEASE SEE ADDITIONAL STEPS FORAT NEED USE OF SPACE (INTERMENT "AT BOTIQM OF PACT ..... �............. _Fill in ownership f'y-m.79 ion in Lot Ownership Book <4 4�. 'i Prepare decd for each space,purc/msed Fill in Florida Dept. of Revenue form Prepare routing memo to route deed'crud reve:Tik farm fo�r�signatures and route Enter document information re deed in Document Tracking System After deed is returned to Clerk Dept.fully executed, send for recording and enter necessary information in Document Tracking System When deed comes back from recording, mark colnpleted in ocument Tracking System �l Prepare transmittal letter scndi �-- ���"� ���° 3'- 3 ,O;9 t File.Copy Of deed in cemetery) u /-,., , ,,,,,„__,_, Ci/{4(-).175 74 Md-ij 11-4---1 ........■ ADDITIONAL STEPS FOR AT-NJ , , / ) 0 /, Fill out burial permit / V p (located, G�_ 1 / -1- / /� G��� - x /}'1'1 ,Liz Fax permit to cemetery and pa � A' " ' , jr I Prepare receipt when staking f, Q / 4.8 /(Q__A 6 6c.p',( cA., i.e,-'" -c.- ITUS�MCEMCKZSJ.FRM �'j `C 1 j Z C 2J xJ June 27,1994 J CO___---A-- _ _ -----.- ----- _ _ -- CITY OF CLEARWATER ..... fitt-d, *z Cm CLERK -': Ai' U.S.POSI .•1 r 1:P172— el; n Ue, •.- r: tai =_:r.0\.::__ •V osT FFICE Box 4748 I AUG'7 ,, e 4 a 4 • „... )V 'Afj40' C 3 I,F.ARWATLR, FLORIDA 33758-4748 , ni --- 0 3 . ..., ,.., • Mrs . Dorothy B . Henry 1001 N. Greenwood Avenue, Apt . 10 Clearwater, FL 11111.1111, RECEIVED ... .-----Limin AU6 25 2000 _ ;LiuRt4 10 5 E i.1 0 I P'-'-C-2-- r! DEL:VPRAE1L' . - c;f1 • ,, .r. erriti nr:On OTRAENT ss I cm(Ci_ nt•lit..., rts s.rif■ Ac) ACORESSEO (. . ) ..,.. TO 1- n F,V,1t..:`—: . .. ,.....,,,, ......,. . ), 1 _ _ --....mmilmmrmimmwmpw.m.mmummmm. CITY OF C LEARWATER CrrY CLERK "Y\: RECEIVED Posr OFFICE Box 4748 AUG-2.or, Nt17.0.° - CLFA A I L FLORIDA 33758-4748 I IM n it — • CITY CLERK DEPARTMENT Mrs . Dorothy B. Henry 2065 N. Highland Ave #C-116 Clearwater, FL 33j E 1 tilOi SE'Alit_Pt' • ,,,(4) 000Z t•?• LiELIVERAA E N" m S ADDRESSED I 14 4) NArnE TP, A 1.110. 1.11111111111111. _ _ -------------- C I T Y O F C L E A R W A T E .R w `, AM P4 ���`�"�"' ,� 9 I< Cm CLERK �t%�� y POST OFFICE Box 4748 0 JA' 2 2'9 8 mr s*1 0 2 5 4 ,'► -J7Ek�� CLEAR��ATLR FLORIDA 33758-4748 / {;r, 'f ' � � � L`:MFiEH *" R 7201935. U.S. POSTAGE • • • Mr S. Dorothy B. Henry 1100 Druid Road East, Apt 609 Clearwz.t'r, F -- WENR100* 337562063 1197 14 01/26/96 FORWARD TIME t?XP RTN TO 5F_Nr) 7-30 206RY 0 jj 2065 N i-iIGi}LAND AVE stC-116 CLEANWA I ER PL B3755-1525 1114741110447311ft LaCosse, Judith From: LaCosse, Judith Sent: Friday, March 23, 2012 3:28 PM To: 'jc11234 @comcast.net' Subject: RE: Cemetery Plot Importance: High Hello again Ms. Lewis, On my previous email to you I mentioned that I will be mailing two documents to your attention for your mom's signature. It turns out that I will be mailing only the "Contract to Purchase Cemetery Space" document. Your mom needs to sign over the line that states Purchaser. (I put a sticker on the document,Sign Here with an arrow) We also need two signatures on the two lines below where it states(Witness as to Purchaser)and to the right of the page we need addresses where it states address(please print). You and another family member could sign on these two lines. I will be mailing the "Contract to Purchase Cemetery Space" document today so you will probably get it sometime next week. The "Cemetery Deed" document is being routed for city officials signatures and then it will be sent for recording. Your mom will get the original cemetery deed document in the mail when the transaction is completed. If you have any questions, please give me a call. Best regards and have a nice weekend !! Judith LaCosse Staff Assistant Official Records and Legislative Services Dept. 727-562-4093 From:ic11234Ca�comcast.net jmailto:jc112340comcast.netj Sent: Friday, March 23, 2012 3:02 PM To: LaCosse, Judith Subject: Re: Cemetery Plot To:Mrs Lacosse thank you very much for letting me know. I will be waiting on them to return. Have a nice weekend. From: "Judith LaCosse" <Judith.LaCosse(c�myClearwater.com> To: jc11234@comcast.net Sent: Friday, March 23, 2012 12:04:37 PM Subject: Cemetery Plot Hello Ms. Lewis, 1 Today I received your two money orders for the balance due of$214.00 for cemetery space 2 in Block 15, Lot 110, and the recording fee of$19.90. I will be mailing two documents today to your attention so that you could have your mom sign them. After she signs these documents, please return to my attention as soon as possible. The documents will then be sent for the city officials signatures and they will be sent to the Pinellas County courthouse for recording. Thank you and if you have any other questions, please give me a call. Best regards, Judith LaCosse Staf.`'Assistant Official Records and Legislative Services Dept. 727-562-4093 2 CONTRACT TO PURCHASE CEMETERY SPACE THIS CONTRACT, made and entered into this 30th day of May, 1996,between the City of Clearwater as Grantor and DOROTHY B.HENRY whose mailing address is 1100 Druid Rd. E., Apt. 609, Clearwater, FL 34616 of the County of Pinellas,State of Florida,as"PURCHASER": WITNESSETH: That the in consideration of the mutual promises and covenants herein contained,and other valuable considerations,the City agrees to sell and the Purchaser agrees to buy the following described space: Space Two (2), Lot One Hundred-Ten (110), Block Fifteen (15), Clearwater Cemetery, as recorded in Plat Book 60, Page 30, Public Records of Pinellas County,Florida. PURCHASE PRICE $ 500.00 less Deposit $ 100.00 Rec'd 5/30/96 Balance due $400.00 PAYABLE,in four monthly installments at the rate of$ 100.00 each beginning with the first installment June 30, 1996 and three (3) monthly of $100.00 thereafter. The final (fourth) payment of S 114.00 includes the $100.00 monthly payment and the recording fee of$14.00. In the event of default in any monthly installment,the entire sum may be immediately declared due in full,and failure of the purchaser to make said payment shall entitle the City to retain all proceeds thereto fore paid, as liquidated damages, and may also retain title to any part or portion of said property which has not been used for grave space, and thereupon this contract shall become null and void. NO SPACE SHALL BE USED AS A BURIAL SITE UNTIL THE CONTRACT HAS BEEN PAID IN FULL, THE PURCHASER FURTHER AGREES to abide by all rules and regulations governing the use and maintenance of space(s) in Clearwater Cemetery. This contract shall not be assigned nor shall any grave space sold hereunder be transferred without the written consent of the City of Clearwater. The obligations and benefits under this contract shall extend to the personal representatives and heirs of the Purchaser and the succcessors of the City. IN WITNESS WHEREOF,said parties have set their hands and seals the day and year first above written. PURCHASER (Witness(2)as to Purchaser) (Witness)names and addresses) (name type/print) Attest: CITY OF CLEARWATER,FLORIDA By: Susan Stephenson,Deputy City Clerk Elizabeth Deptula, City Manager Approved as to form and legal sufficiency: COUNTERSIGNED: John Carassas,Assistant City Attorney Rita Garvey,Mayor-Commissioner STATE OF FLORIDA ) COUNTY OF PINELLAS) Before me personally appeared Rita Garvey,the Mayor-Commissioner of the above named city, who acknowledged that she executed the foregoing instrument. She is personally known to me and did not take an oath. WITNESS my hand and official seal this day of , 1996. Notary Public (SEAL) Print/type name: STATE OF FLORIDA ► COUNTY OF PINELLAS) Before me personally appeared Elizabeth M. Deptula, the City Manager of the above-named city, who acknowledged that she executed the foregoing instrument. She is personally known to me and did not take an oath. WITNESS my hand and official seal this day of , 1996. (SEAL) Notary Public Print/type name: 9700-0027 CONTRACT.DOC Rev.5/96 a��O f.rt.OSs � Y �r � 1\ ' s Vii; CITY OF CLEARWATER r�� q ;- "„czc POST OFFICE Box 4748,CLEARWATER,FLORIDA 33758-4748 o• CITY HALL, 112 SOUTH OSCEOLA AVENUE,CLEJARWATER,FLORIDA 33756 �4 �� TELEPHONE(727) 562-4090 FAx (727) 562-4086 4TER`(X49 OFFICIAL RECORDS AND LEGISI.ATIVE SERVICES March 23,2012 Joanne Lewis 1494 Box Circle Winder, GA 30680 Re: City of Clearwater Municipal Cemetery Block 15,Lot 110, Space 2 Dear Ms. Lewis: Enclosed please find the"Contract to Purchase Cemetery Space" document. Please have your mom sign this document over the line that states Purchaser, next to the sign here sticker. We also need two signatures on the two lines below where it states (Witness as to Purchaser)and to the right of the page we need addresses where it states address(please print). You and another family member could sign on these two lines. Please complete your portion of this document as stated above and return to my attention as soon as possible. We need to route this document for city officials signatures and then it needs to go to the Pinellas County courthouse for recording. If you have any questions,please give me a call at 727-562-4093. Sincerely, dith LaCosse taff Assistant Enclosures .Mr E,,MP1 01Nit.nI vyI Alill nIy A(Ho. '1.R" CONTRACT TO PURCHASE CEMETERY SPACE T IS CONTRACT, made and entered into this 23 day of M c4ch , 20 I.1 , between the City of Clearwater as "GRANTOR" and Dorothy M. Henry, whose mailing address is 1494 Box Circle , Winder, GA 30680, of the County of Barrow, State of Georgia, as "PURCHASER": WITNESSETH: That in consideration of the mutual promises and covenants herein contained, and other valuable considerations, the Grantor agrees to sell and the Purchaser agrees to buy the following described space: KEN BURKE,CLERK OF COURT Space 2, Lot 110, Block 15, Clearwater Cemetery, as recorded in Plat Book PINELLAS COUNTY FLORIDA 60, Page 30, Public Records of Pinellas County, Florida. INST# 2012126547 05/03/2012 at 10:20 AM OFF REC BK:17589 PG: 1435-1435 PURCHASE PRICE $500.00 DocType:AGM RECORDING: $10.00 Less Deposit $ 100.00 Rec'd 5/30/96 Payment made $200.00 — Balance due $200.00 plus$14.00 Recording fee Total balance due of$214.00 is due by the end of March 31, 2012. In the event of default in the balance due by the end of March, the entire sum may be immediately declared due in full. Failure of the purchaser to make said payment shall entitle the Grantor to retain all proceeds theretofore paid, as liquidated damages, and may also retain title to any part or portion of said property which has not been used for grave space, and thereupon this contract shall become null and void. NO SPACE SHALL BE USED AS A BURIAL SITE UNTIL THE CONTRACT HAS BEEN PAID IN FULL. THE PURCHASER FURTHER AGREES to abide by all rules and regulations governing the use and maintenance of space(s) in Clearwater Cemetery. This contract shall not be assigned nor shall any grave space sold hereunder be transferred without the written consent of the City of Clearwater. The obligations and benefits under this contract shall extend to the personal representatives and heirs of the Purchaser and the successors of the City. IN WITNESS WHEREOF, said parties have set their hands and seals the day and year first above written. / / -,,i At_ •-.�.�_ PURCHASER (Witness as to Purchaser) (Witless as to Purchaser) tn C�!v AJA/E t�. r L w/.S fa 24 J5Ox c/4 l '/m'ERI,6A.3O 6 Sd ;me 11aserpnnv _, ..�..,,,,,,, address(please print) 3(sa't4/ Attest: --- S 101t. /;% CITY OF CLEARWATER, FLORIDA f f ' ' AWAl.:i 40 ByrAll-Cel-k.t..' att44, 17--A- 41.1.6b . Nicole Sprague, Dep ty Cit' erk r, _ &,}i William B. Home, City Manager 4,._ COUNTERSIGNED: App oved as to form and legal su ciency�� `` ,�!!'P e• � ��'` ,O.. B — Leslie Dougall-Sides, A. City Attorney, II George N. Cretekos, Mayor STATE OF FLORIDA ) COUNTY OF PINELLAS) Before me personally appeared William B. Home, the City Manager of the above named city, who acknowledged that he executed the foregoing instrument. He is personally known to me aq did not take an oath. WITNESS my hand and official seal this \ "'day of ,201'2., ��. Y• SANDRA HARRIGER jo-----g---"-" (SEAL) gQ•f;. ' NOTARY PUBLIC STATE OF FLORIDA �r ` .Comm#EE142238 Print name: 6} ...AI,. Not ryy Public �NCe�' .• Expires 1/4/2016 Before me personally appeared George N. Cretekos, the Mayor of the above named city, who acknowledged that he executed the foregoing instrument. He is personally known to me and did t take an oath. WITNESS my hand and official seal this // day of ,20/2-- Ala....t,.c.,44.e... . (SEAL) ,/ ?"Y ;; DIANE E MANN! Print name. r /�^�G /-(���/ (40 `= MY COMMISSION#DD952018 Notary Public EXPIRES March 06,2014 (4,077)398-0153 FloridallotaryServrce.com 9700-0027 CONTRACT.DOC Received APR 0 6 2012 CITY OF CLEARWATER City Attorney Interdepartment Correspondence TO: Legal Dept. FROM: Official Records &Leg. Services Dept. SUBJECT: Contract to Purchase Cemetery Space DATE: April 6, 2012 The following document needs to be routed for city officials signatures and needs to be notarized. RE: Cemetery Space Purchase Dorothy M. Henry—Block 15,Lot 110, Space 2 Thank you. Please return to Judith LaCosse, Staff Assistant 3 -21- /z To WdoM �T.f MAy ConcenA , DL7 1 2 i,lPs Av 6 LAcge ai�liYt 60A /ice poy /�� �0 gee s tieRe is �e 9 dot l' of GialL qv „e 511‘E, 131ock-if llo-kRce 2 � � 5d 7�1P �q I' WU k �0 d Ca r� p1eqs � hu C l� �,�� s � h �.e�+� a��� � � .� was � ld �� .�� �, as save a5 i)mibisg , � o� M�' botti She ca+� r�q ; I qAp W I 60.11� � �w,� � 1 he a�' Adf c° � � fog` I i& pe, 4 ,_i_a_ rfeo I l r So vev-�� r�1,�ct,, nAr hdp ) Qiikd opt( e cv a ; ki hu P- IA miz, 1 1 /-, 6 _i tu v r voS JoadC h PA-e_ ‘ okot.etl r , itaii Lail v(//lif j b6ort. q4 aAcloi( iivelvak i'l\- ( LI-4-1\-ICS (-z;r ‘9 ,,,vv, crm ,af< <m. Neese 145 .423 -, 0-0 ; 714-theita(.Ai\ii 6-11414' 2 ( 4 , 00 i -- I9tic 1(' Li-ea_ r JT E Coi• 1 ,,I Ea % -t.tc c 4 62„, RECEIVED � � , '4 MAR 2 3 2012 OFFICIAL RECORDS MD teOUumE suers Mr B 4 is',.9) ! @ 1 .t f':y.,,t7pF, 44.7.„5 DV `t 11" j 1 468752 8 L t,0 0u03 qui p EXAcTLY HUNDRED FOURTEEN DOLLARS AND i?O CENTS P TO �`Li, PAYMENT FOR/ACCT.# al R c J4 30(980, PU 'U SIGNATURE 1: 1\ 2 L004001: 40 1446875 2689811' 111"11.DM TO II(117 � ��7� 1 f 4 �r 1 I,6 T U '�'"�." � �R' � �. � aeyew.. ,'i. i a ' i n: +ha 4U iCn!'akir* q ¢ 1b 8Ho Rfc0PA n ..Fte, r� k ."0,211 14-468752690 r 1523 16 144687 26,0x7 PAY EXACTLY Ni,N 1 EiiN ht.,D NINETY PAY TO THE C(VI O F C 1 f�7i D AT-k7R PAYMENT FOR/ACCT. OFIDER OF f (� 4 F Vt^ '\ v v `d'Bo)4. Cit\ WI et-- q.&A ?)o b 0 © ERS 1: 10 2 L004001: 40 L4468 7 5 2690 ?Ii' ,r,,..,��. '�Sti11'L0" CITY OF CLEARWATER 41 Q� POST OFFICE Box 4748,CLEARWATER,FLORIDA 33758-4748 :r. CITY HALL, 112 SOUTH OSCEOLAAVENUE,CLEARWATER,FLORIDA 33756 :9TER, � �� TELEPHONE(727) 562-4090 FAX(727) 562-4086 ♦ - ilik OFFICIAL RECORDS AND LEGISLATIVE SERVICES May 11,2012 Dorothy M. Henry c/o Joanne Lewis 1494 Box Circle Winder, GA 30680 Re: City of Clearwater Municipal Cemetery Block 15,Lot 110, Space 2 Enclosed is the original cemetery deed which indicates that you own Space 2 in Block 15, Lot 110 in the Clearwater Municipal Cemetery. Also enclosed is the original Contract to Purchase Cemetery Space. These documents have been recorded with the Pinellas County Courthouse on May 3,2012. It is important to keep these documents in a safe place and to make a separate note of the official record book and page numbers. In the event the original documents are lost or destroyed, this information will be needed to obtain a copy from the Pinellas County Courthouse. Our Cemetery program and files have been updated to reflect this information. If we may be of service in the future,please call our department at 727-562-4093. Sincerely, J dith LaCosse taff Assistant Enclosures .«r "EQOAI.EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER" CEMETERY DEED THIS INDENTURE made this day of ,2012,between the City of Clearwater, Florida,a municipal corporation as Grantor and Dorothy M. Henry, whose mailing address is 1494 Box Circle,Winder, GA 30680 of the County of Barrow,State of Georgia,as Grantee: WITNESSETH:That the said Grantor,for and in consideration of the sum of$500.00,to it in hand paid by the said Grantee,the receipt whereof is hereby acknowledged, has remised, released and quit-claimed unto the said Grantee,and their heirs forever,all the right,title and interest,which the said Grantor has in and to the following described parcel of land,lying and being in Pinellas County,State of Florida,to wit: Space Two(2), Lot One Hundred Ten(110),Block Fifteen(15), Clearwater Cemetery,as recorded in Plat Book 60, Page 30,Public Records of Pinellas County,Florida. This conveyance is subject to the condition that Grantee herein shall not assign or convey said property without the written consent of the Grantor, and to the further condition that said property shall be used only for cemetery purposes as human burial sites and is subject to such other rules and regulations the City of Clearwater may adopt pertaining to use of said property. TO HAVE AND TO HOLD the same to the only proper use,benefit,and behoof of the said Grantee and their heirs and assigns forever. IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor, by its City Manager, and to be attested and its corporate seal affixed by the City Clerk on the day and year first above written. Countersigned: /CITY OFFpCL^EAARWATER,FLORIDA -,� leO(te ( 1 Cr Q[`1"0J By:r/O� �t. la t4LIAi----- George N.Cretekos,Mayor William B. Horn(�e,,II,City Manager , ._±` 04IHEC,r Approved as to form: Attest , . ;'+� Nicole Sprague, De ty City _ '� , Z646.c....--,r. �� V` Leslie Dougall-Sides, •, City Attorney, II rii+ / \S-,t4AVATrrolkk 41 STATE OF FLORIDA ) COUNTY OF PINELLAS) Before me, the undersigned, personally appeared George N. Cretekos, the Mayor of the City of Clearwater, Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be his free act and deed for the use and purposes herein set forth. G WITNESS my hand and official seal this /A day of * f 42.44.1&_,2012. oLtx44,e_ . )7 . , "Votary Public (SEAL) Print/type name: t;,p':f. , .y9 ; DV NE E MANNI =.' :,`' Pr"COMMISSION#DD952018 STATE OF FLORIDA ) q„ o.:. EXPIRES March 06,2014 COUNTY OF PINELLAS) (407)398-0153 FloridallotaryService.com Before me,the undersigned, personally appeared William B. Home, II, the City Manager of the City of Clearwater, Florida, to me well known to be the person who executed the foregoing instrument and acknowledged the execution thereof to be his free act and deed for the use and purposes herein set forth. f�(� �p WITNESS my hand and official seal this �W day of �►1.�C 1 i ,2012. - '�•ublic li i , 1 :\i ■ (SEAL) Print/type name: MMI it . ) j 1 ""'% AnneMarie Wills :?f�,:. �� KEN BURKE,CLERK OF COURT yCOMMISSION#DD841107 PINELLAS COUNTY FLORIDA =` 'mac EXPIRES:NOV.24,2012 .i OF p,a INST# 2012126548 0510312012 at 10:20 AM ani%%% WWW.AAR0NN0TARUM OFF REC T PG: 1436-1436 CEMETERY DEED.DOC DocTyp :DEED BK: RECORDING: $10.00 D DOC STAMP:17569$3.50 Received Rest. :,n. ., APR 16 2012 b . City Manager's Office APR 13 20 z CITY OF CLEARWATER City Attorney Interdepartment Correspondence TO: Legal Dept. FROM: Official Records &Leg. Services Dept. SUBJECT: Cemetery Deed DATE: April 13, 2012 The following document needs to be routed for city officials signatures and needs to be notarized. RE: Cemetery Space Purchase Dorothy M. Henry—Block 15,Lot 110, Space 2 Thank you. Please return to Judith LaCosse, Staff Assistant