WALTON MCLEAN BYARS JR
i ~
'\., RetUfJ!t . (enclose self-addressed stamp,e, d envelope)
Name: STEWART TITLE OF CLEARWATER, INC.
''',' A;ldres : 1290 Court Street '- ,I
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'~' ~ L Clearwater, Florida 33756
This Instrument Prepared by: LAURIE BRIEF
of STEWART TITLE OF CLEARWATER INC.
-, '
as a necessary incidenlto the fultillment of conditions
cont1.-tfed ir.} title insurance commitment issued by it.
Property Appraisers Parcel Identitication (Folio) Number(s):
15-29-15-54450-003-0050
Grantee(s) S.S.#(s):
FILE NO: 99090042
. '.
88-34211'6
PI NELLR') COOC~K 18;ok88~8 p5 : 48PM
----'_JIIII~1~lIm~~111I~11111I1111111111111I1 1844
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WARRANTY DEED
(TIlt: (trms "grantor" and "granlt:e" herdn shall be conslrutd to include aU genders and singular or pluraJ as (he COnltXI irujjcau:s.)
This Warranty Deed Made this 15th day of October A.D. 19 99, by
WALTON McLEAN BYARS, JR., TRUSTEE, Individaually and as Trustee of
the WALTON McLEAN BYARS, JR., TRUST, u/ a/ dMARCH 26, 1996
whose marital status is:
hereinafter called the grantor, whose post office address is:
10 CI'l'T OF 'CLEARWATE:R:-FLORiDA-;~' Municipal Corporation
whose post office address is: P.o. BOX 4748, CLEARWATER FL 34618
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hereinafter 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, hereby grants, bargains, sells, aliens, remises, releases, conveys and contirms unto the
grantee, all that certain land situate in Pine 11 as County. Florida, viz:
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The West One-Half (W 1/2) of Lot Five (5), MAGNOLIA PARK
according to the Plat thereof, as recorded in Plat Book 3, Page
43, of the Public Records of Pinellas County, Florida.
TOGETHER WITH:
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The North 10.88 feet of a vacated alley lying North of Block
"A", COACHMAN HEIGHTS, as recorded in Plat Book 20, Page 26, of
the Public Records of Pinellas County, Florida, and being
adjacent to the West half of Lot 5, Block 3, MAGNOLIA PARK, as
recorded in Plat Book 3, Page 43, of the Public Records of
Pinellas County, Florida,
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BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
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Begin at the SW corner of said Lot 5, Block 3, MAGNOLIA PARK,
as recorded in Plat Book 3, Page 43, of the Public Records of
Pinellas County, Florida, for a point of Beginning; thence run
Easterly along the South line of said West half of Lot 5, Block
3, MAGNOLIA PARK, a distance of 50.95 feet; thence Southerly,
10.88 feet; thence Westerly along a line parallel to the South
line of said Lot 5, a distance of 50.95 feet; thence Northerly
10.88 feet to the Point of Beginning, as vacated in Ordiance
No. 1777 filed in O.R. Book 4700, Page 361, of the Public
Records of Pinellas County, Florida.
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KARLEEN F. DE BLAKER1 CLERK OF COURT
PINELLAS COUNTY, FLOKIDA
~="...,...,.c_....,. ..;~lO~3~,Q:19-1999 15:49:03 "DK
51' ~"BT~ JK'LLtHK."'~K
0000000000
RECORDING 002 PAGES
DOC STA"P - DR219
-- .--'-.--'- -.- -----~
TOTAL:
P CHECK A"T.TENDERED:
, CHANGE:
BY rn()~ DEPUTY CLERK
1
3
$10.50
$630.00
$640.50
$640.50
$.00
TOTALbItf50
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CHG AMT '~
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JINELLRS COUNTY FLR
OFF,REC.8K 10595 PG 1945
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Thitpropt;'~ [00 [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 98, 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.
Signed, Sealed and Delivered in Our Presence:
- /
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Witness Signature: ,~ "~
-----'--wnness l'rmredNiiine:.... RONALD E. SOMERS
_~JYJc ,p~Seal)
WALTON McLEAN BYARS, _ ; ",.,~, 7'", r E
TRU~ /)/r -/11 :--fJ. , ' f-Jb ' 9
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WALIDN McLEAN BYARS, JR., INDIVIDUALLY
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 15 t h
by WALTON McLEAN BYARS, JR., TRUSTEE,
the WALTON McLEAN BYARS, JR., TRUST,
day of October
Individaually
u/a/d
,19 99
and as Trustee of
/o:::~:g~s;>
\~~
OFFICIAL NOTARY SEAL
Ronald E. Somers
COMMISSION NUMBER
CC 782274
MY COMMISSION EXP
NOVEMBER 7, 2002
RONALD E. SOMERS
~~[~;~~Klfdt~K)X~i1):~~ who has/have produced driver licensees) as identific
My Commission expires:
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 licensees) as identification.
My Commission expires:
Printed Name:
Notary Public
Serial Number:
'I'.
,,7;....,
Page 2 of2
ALT-A OWNER'S POL'CY,- 10-17-92 WITH FLORIDA MODIFICATIONS
"If you want informatjon~bout.coverage or need assistance to resolve complaints, please call 1-800-729-1902. If ypu m~ke.a claim under your policy,
you,must furnish written notice' in accordance with S[tion 3 of the Cond~tions and. Stipulations," I
Visit our World-Wide Web site at: htto:/Iwww,stewart om
'~
POliCY OF TITLE INSURANCE ISSUED BY
99090042
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STEWART TITLE
GUARANTY COMPANY
SUBJECT TO THE EXCLUSIONS FROM COVERAGE, THE EXCEPTIONS FROM COVERAGE CONTAINED IN
SCHEDULE B AND THE CONDITIONS AND S1IPULATIONS, STEWART TITLE GUARANTY COMPANY, a Texas
corporation, herein called the Company, insures,>a.E) 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. Lack of a right of access to and from the land.
The Company ,will ~Iso,pay the .c.osts,a~~r~~I~:,1~~~,.,;:~~g,~~~=I>.!~CU~1~,',"; in defense of the title, as insured, but only
to the extent provided In the Conditions ani!f!Sfl~;"~ .'..q ,".," 1;1,
IN WITNESS WHEREOF, Stewart TitIElG~arallt~Company has caused this policy to be signed and sealed by its
duly authorized officers as of the Date of. P()Iicy sh<)wnin Schedule A.
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Sl,".WART T1r.rLE
......G'Il'.,llANTy COMPANy
Company
City, State
EXCLUSIONS FROM COVERAGE
The following matters are expressly excluded from the coverage of this 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 of
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 the
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
Policy _ _
Senal No,
255756
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SCHEDULE A
FILE NO.
POllCY NUMBER
DATE OF POllCY
October 18, 1999
3:49 PM
AMOUNT OF INSURANCE
99090042
0-2125-255756
$90,000.00
1. Name of Insured:
CITY OF CLEARWATER, FLORIDA, a Municipal Corporation
2. The estate or interest ill the land which IS covered by this Policy IS:
FEE SIMPLE
3. Title to the estate or interest ill the land IS vested ill the Insured.
4. The land referred to ill this policy IS described as follows:
The West One-Half (W 1/2) of Lot Five (5), MAGNOLIA PARK
according to the Plat thereof, as recorded in Plat Book 3, Page
43, of the Public Records of Pinellas County, Florida
TOGETHER WITH:
The North 10.88 feet of a vacated alley lying North of Block
"A", COACHMAN HEIGHTS, as recorded in Plat Book 20, Page 26, of
the Public Records of Pinellas County, Florida, and being
adjacent to the West half of Lot 5, Block 3, MAGNOLIA PARK, as
recorded in Plat Book 3, Page 43, of the Public Records of
Pinellas County, Florida,
BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
Begin at the SW corner of said Lot 5, Block 3, MAGNOLIA PARK,
as recorded in Plat Book 3, Page 43, of the Public Records of
Pinellas County, Florida, for a point of Beginning; thence run
Easterly along the South line of said West half of Lot 5, Block
3, MAGNOLIA PARK, a distance of 50.95 feet; thence Southerly,
10.88 feet; thence Westerly along a line parallel to the South
line of said Lot 5, a distance of 50 95 feet; thence Northerly
10.88 feet to the Point of Beginning, as vacated in Ordiance
No. 1777 filed in 0 R. Book 4700, Page 361, of the Public
For Company reference Purposes Only
According to insured representation or vesting instrument(s), the street address of the property IS:
Street Name: 91 7 PARK STREET
City/State/Zip: CLEARWATER, FL 33756
County: Pinellas PinITax #: 15-29-15-54450-003-0050
The Company does not represent or Insure the above address IS accurate
STEWART TITLE
Reg. D 0012 Rev. 11-91
GUARANTY COMPANY
ALTA OWkR'S POLI~Y SC~DULE A - COJTINUED
POLICY NO. 0-2125-255756
FILE NO: 99090042
Records of Pinellas County, Florida.
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.lit._~i:!.ffi~"iiMII"]
Policy Number: 0- 2125-255756
File No: 99090042
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 19
2000
and thereafter and assessments, if any, not recorded in the public records.
8. Subject to terms, provisions, covenants, conditions, and
restrictions, easements, charges, assessments and liens
provided in the Covenants, Conditions and Restrictions as
recorded in O.R. Book 4699, Pages 143 through 145, inclusive,
but omitting any covenant, condition or restriction, if any,
based on race, color, religion, sex, handicap, familial status
or national origin unless and only to the extent that the
covenant, condition or restriction (a) is exempt under Title
42 of the United States Code, or (b) relates to handicap, but
does not discriminate against handicapped persons, of the
Public Records of Pinellas County, Florida.
9. Print of survey by OVERBECK & ELLIOTT, INC., dated October 4,
1999 shows the pilaster and the concrete steps encroaching on
the westerly boundary.
10. Subject to facts of survey by OVERBECK & ELLIOTT, INC., dated
October 4, 1999.
11. 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.
12. Any lien provided by Chapter 159 of Florida Statutes in favor
Exceptions numbered
1 and 4
are hereby deleted from the Owners Policy.
:
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ALTA OWNER'S POLICY SCHEDULE B - CONTINUED
POLICY NO. 0-2125-255756
FILE NO: 99090042
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.
13. Subject to zoning and/or other governmental prohibition or
regulations affecting the use of the property.
14. Title to any furniture, furnishings, fixtures, or chattels or
personal property located in, to or upon the land described in
Schedule "A" hereof.
15. Subject to unrecorded leases and/or options to purchase
affecting subject premises.
16. 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.
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A. ~.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT B.TYPE OF LOAN
.Jo- . " I
1. [ l FHA 2. [ lFMHA I 3. [ lCONV. UNINS.
4. [ lVA 5. [ lCONV. INS. [Xl Cash (6)
,
6. FILE NUMBER: 7. LOAN NUMBER:
99090042
8. MTG. INS. CASE NO.:
C.NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown, Items marked
("p.o,c. ") were paid outside the closing: they are shown here for information purposes and are not included in the totals,
D. NAME OF BORROWER: CITY OF CLEARYATER
ADDRESS: P.O. BOX 4748" CLEARYATER, FL 34618-4748
E. NAME OF SELLER: YALTON MCLEAN BYARS, JR.
ADDRESS: 100 PALMVIEY RD E NO. 66, SELLER TIN:
F. NAME OF LENDER: CASH
ADDRESS:
G.PROPERTY LOCATION: Lot 5 Block 3 MAGNOLIA PARK
917 PARK STREET CLEARYATER FL 33756
H. SETTLEMENT AGENT: STEYART TITLE OF CLEARYATER PHONE NUMBER: NOT ON FILE
ADDRESS: 1290 COURT ST.
CLEARYATER, FL 33756 SETTLEMENT AGENT TIN: 59-1433918
PLACE OF SETTLEMENT: STEYART TITLE OF CLEARYATER I.SETTLEMENT DATE
ADDRESS: 1290 COURT ST. Closing date: 10/15/99
CLEARYATER, FL 33756 Proration date: 10/15/99
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100, GROSS AMOUNT DUE FROM BORROWER: 400, GROSS AMOUNT DUE TO SELLER:
10 1. Contract sales price 90,000.00 401. Contract sales price 90,000.00
102, Personal property 402, Personal property
103, Settlement charges to borrower(line 1400) 1,374.20 403.
104, 404.
105, 405,
Adjustments for items paid by seller in advance: Adjustments for items paid for seller in advance:
106. Cityltown taxes to 406, Cityltown taxes to
107, County taxes to 407. County taxes 01/01/99 10 10/15/99 <720.16)
108. Assessments to 408, Assessments to
109. 409.
110. 410,
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER: 420. GROSS AMOUNT DUE TO SELLER:
91,374.20 89,279.84
200, AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500, REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 501. Excess deposit(see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller(line 1400)
203, Existing loan(s) taken subject to 503, Existing loan(s) taken subject 10
204. 504, Payoff of first mortgage loan
205, 505, Payoff of second mortgage loan
206, 506,
207, 507,
208, 508,
209, 509,
Adjustments for items unpaid by seller: Adjustments for items unpaid by seller:
210, City/town taxes to 510, City/town taxes to
211. County taxes to 511. County taxes to
212, Assessments to 512, Assessments to
213, 513,
214, 514.
215, 515,
216, 516,
217, 517.
218, 518,
219. 519.
220. TOTAL PAID BY/FOR BORROWER: 520, TOTAL REDUCTION IN AMOUNT:
300, CASH AT SETTLEMENT FROM/TO BORROWER: 600, CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross amount due from borrower(line 120) 91,374.20 601, Gross amount due to seller(line 420) 89,279.84
302. Less amounts paid by/for borrower(line 220) 602, Less total reductions in amount due seller(line 520)
303, CASH [X FROM] [ TO] BORROWER: 91,374.20 603, CASH [X TO] [ FROM] SELLER: 89,279.84
SUBSTITUTE FORM 1099 SELLER STATEMENT-The information contained in Blocks E,G,H and I and on line 401 (or, if line 401 is asterisked, lines 403 and 404)
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,
SELLER INSTRUCTION-If this real estate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax
return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040),
You are required by law to provide Stewart Title of Clearwater, Inc. with your correct taxpayer identification number.
If you do not provide Stewart Title of Clearwater, Inc. with your correct taxpayer identification number, you may be subject 10 civil or criminal penalties,
Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number.
~;CASHIERS CHECK & PHOTO I.D. REQUIRED AT CLDSING!!
Seller
F-ll~ ~09CQ42 L. SETTLEMEfT CHARGES I PAID FROM PAID FROM
BORROWER'S SELLER'S
FUNDS FUNDS
700. TOTAL SALES/BROKER'S COMMISION Based on ~ @ %= . AT SETTLEMENT AT SETTLEMENT
Division of Commission (line 700) as follows:
701. $ to
1--'
702, $ to
703, Commission paid at senlement
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
90S,
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 properly 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:
11 0 1. Settlement or closing fee to STC 50.00
1102. Abstract or title search to STC 100.00
1103, Title examination to STC 25.00
1104, Title insurance binder to
1105, Document preparation to
1106, Notary fee to
1107, Anorney's fee to to
(includes above items No,:
1108, Title insurance to STE~ART TITLE OF CLEAR~ATER 517.50
(includes above items No.: )
1109, Lender's coverage $
1110. Owner's coverage 90,000.00 $ 517.50
1111. fl risk rate($517.50)
1112. to
lIB, to
1114. to
1200, GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: Deed $ 10.50 Mrtg $ ReI. $ 10.50
1202, City/county tax/stamps: Deed $ Mrtg $
1203, State tax/stamps: Deed $ 630.00 Mrtg $ 630.00
1204, RECORD AFF IDAVIT to CLERK OF THE CIRCUIT COURT 6.00
1205, RECORD CORRECTIVE Q.C.D. to CLERK OF THE CIRCUIT COURT 11.20
1206, RECORD TRUSTEE AFFIDAVIT to CLERK OF THE CIRCUIT COURT 24.00
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) 1,374.20
CERTIFlCA nON; I have carefully reviewed the HUD-l Settlement Statement and 10 the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my accoum or by me in lhis
transaction, I cenil)< lhall have r ..' a copy of HU 1 Seulemenl Statement. , .. _,.
E
Borrowers CITY OF CLEARWATER Sellers WAL'IDN McLEAN BYARS
To lhe btsl of my knowledge, the HUD-. Sewement Stawment which I have prepared is a true and accurate accoum of the funds which were received and have been or will be disburstd by tht undersigned as 3art of
OClDBER 15, 1999
Senlement Agent Date
SELl.,ER'S 1ND/OR PURCHAS~'.s STATEMEr,T Seller's ~ Purchaser's s~""!H'e hereon ,~~wled.les his/l~i~roVa1 oft~ wor~~,\'
l1\t:e~~tet,8~ ~r:ip~n,lihe:r.' C ..\rll"is)i~~:o~ X'~ ~~J'iri:lr~~~ea'::J'.'in:i.:d"lQ ess:fYalf'~1 r'ec~s~ I s lr~~::'n ,Je:,.V''r.
Ih~le i"~:nprJ; comfcuter. accow~~ ~ audit ~ervlc~ [irec.lry or thrOlJ5,h i Sl:Jl3filte.!N~tl ~ i(almra'ted WI~ t~e an..!:, ru:y ch~~e
~l~~~t~~~~. e ~ne:fie ~w ~ ~ne :3 f~ ~v~nder In ~~ t~~n~I~O o:~~~~r ~ ~I i~l~nfn~~~8ers co r~ha' ut~:et~ ac w
wlitch 'I',,& E:o~""y ~ or ~y ve !~\1\<rlJallI\mg rer.\ion:fulCf ~ fJnl.>er consenllo 'id rel'6Jloo beC"le COlr4'any lor Its~Ii'\;.les of any
attl~f:gp~%:ha;.a~~e~~~bo~~~ten::r:st.lt~J::~~~f:6: r aso~ recll~i~~~:r~ SaJ rf:e;r~~ s~ and recognize Title Company is rdfi
Purchasers//Borrowers Sellers
CITY OF WAL
WARNING; It is a crime to kaowlaaJy make ralst stalemaats to the Volitd States on this or any olher Ilndlar ronn. Peualth:s upon cODvlclioD can Include a fiDe and imprisonment.
INFORMATION1'OR REAL ESTATE 1099 REPORT~ILING
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:
99090042
TAXPAYER LD. #
2C7'-0.)-- 30)7
SELLER NAME:
WALTON McLEAN BYARS, JR., TRUSTEE
Other (Name of Entity):
MAILING ADDRESS
}J G --8 <yy
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Street:
City:
State:
Zip Code:
'3 '3 r:; 7'1
TRANSACTION INFORMATION
Closing Date:
October 15, 1999
Description of Property:
917 PARK STREET CLEARWATER, FL 33756
Contract Sales Price:
$90,000.00
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)
CERTIFICA nON
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:
October 15, 1999
/II ai!;,1
Seller's Signature
711 ~/t/\ -13~~:u(.o 5-7
t/ .>
SETTLEMENT AGENT INFORMATION
STEWART TITLE OF CLEARWATER, INC.
1290 Court Street
Clearwater, Florida 33756
(72 7)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
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. This Instrument Prepared by and Return to:
Marianne Schaffer I
of STEWART 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):
15-29-15-54450-003-0050
FILE NO: 99090042
GENERAL AFFIDA VIT
STATE OF FLORIDA
COUNTY OF PINELLAS
Before the undersigned, an officer duly commissioned by the laws of Florida, on the 15 th
day of October , 19 99 , personally appeared WALTON McLEAN BYARS, JR.
who having been first duly sworn depose(s) and state(s):
Affiant, WALTON M. BYARS, JR., is the Grantee of that certain
QUIT CLAIM DEED, executed by SUSAN W. BUYARS, which Deed is
dated 7/2/75, recorded 7/8/75 in O.R. Book 4306, Page 1261,
Public Records of Pinellas County, Florida;
At the time the aforementioned Quit Claim Deed was executed,
Susan W. Byars and Walton M. Byars, Jr. were in fact husband
and wife;
This Affidavit is executed to complete the Public Records of
Pinellas County, Florida, as to the marital status of Grantor.
FURTHER AFFIANT SAYETH NOT.
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.
')fa.'
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WALTON McLEAN BYARS, JR. v ~~
Sworn to and subscribed before me this 15th day of October
19 99 , by WALTON McLEAN BYARS, JR.
~h.~xi~~~lOCl.\IBm who has/have produced driver lice
OFFICIAL NOTARY SEAL
My Commission eXPires~i,';"X(;~;f:, CO~~I~~I~~~~~~ER
\,,;~/'<:i CC 782274
\1~;;.",~~i MY COMMISSION EXP
....~ OFf';:......
'"..",0 NOVEMBER 7,2002
. This Instrument Prepared by and Return to:
:."." ,.:"'"Marianne Schaffer I
o f STEW ART TITLE OF CLEARWATER, INC.
1290 Court Street
Clearwater, Florida 33756
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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):
15-29-15-54450-003-0050
TRUSTEE AFFIDAVIT
FILE NO: 99090042
STATE OF FLORIDA
COUNTY OF PINELLAS
Before me, the undersigned, authority, duly commissioned by the laws of Florida, on the 15 th
day of October ,1999, personlly appeared WALTON McCLEAN BYARS, JR.
who having been first duly sworn deposes and says:
1. Affiant is the Trustee of the WALTON McCLEAN BYARS, JR.
as evidenced by page 1 of the Trust (attached).
2. The following property is included in the Trust:
See Attached Schedule IIAII
3. Affiant has full power and authority to sell and or mortgage the above described property
as evidenced by page 5 of the Trust (attached) 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.
'?fCdl;~ }Jt G ~~1 r3u ~V1~ 9r
WALTON McCLEAN BYARS, JR~ /' r T P--
Sworn to and subscribed before me this 15th day of October
WALTON McCLEAN BYARS, JR.
xW~~~~>>imRU~~W~IDc2~d~x who has produced driver license
19 99 ,by
My Commission expires:
/iA~~iP(;~~,)
t*: j*
\~"-", .,.;-:~1
'<t.9ij;:;~>'
OFFICIAL NOTARY SEAL
Ronald E. Somers
COMMISSION NUMBER
CC 782274
MY COMMISSION EXP
NOVEMBER 7, 2002
.~
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I
,,,
EXHIBIT "A"
The West One-Half (W 1/2) of Lot Five (5), MAGNOLIA PARK
according to the Plat thereof, as recorded in Plat Book 3, Page
43, of the Public Records of Pinellas County, Florida.
TOGETHER WITH:
The North 10.88 feet of a vacated alley lying North of Block
II A" , COACHMAN HEIGHTS, as recorded in Plat Book 20, Page 26, of
the Public Records of pinellas County, Florida, and being
adjacent to the West half of Lot 5, Block 3, MAGNOLIA PARK, as
recorded in Plat Book 3, Page 43, of the Public Records of
Pinellas County, Florida,
BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
Begin at the SW corner of said Lot 5, Block 3, MAGNOLIA PARK,
as recorded in Plat Book 3, Page 43, of the Public Records of
Pinellas County, Florida, for a point of Beginning; thence run
Easterly along the South line of said West half of Lot 5, Block
3, MAGNOLIA PARK, a distance of 50.95 feet; thence Southerly,
10.88 feet; thence Westerly along a line parallel to the South
line of said Lot 5, a distance of 50.95 feet; thence Northerly
10.88 feet to the Point of Beginning, as vacated in Oridance
No. 1777 filed in O.R. Book 4700, Page 361, of the Public
Records of Pinellas County, Florida.
I
I
AUTHORIZATION AND ACKNOWLEDGEMENT FORM
DATE: Octob~r 15, 1999
i
I
FILE NO.: 99090042
LEGAL:
SEE EXHIBIT A
SELLER:
WAnTON McLEAN BYARS, JR., TRUSTEE
I
i
CIiY OF CLEARWATER , FLORIDA, a Municipal Corporation
BUYER:
/
We hereby ap~rove and acknowledge receipt of a copy the
Statement anq actual cost (DISCLOSURE/SETTLEMENT S TEMENT - HUD
FORM 1) and duthorized disbursement of funds as own therein this
15th day of Qctober, 1999. We further acknowl ge that we
understand utility bills are not included i this statement and
that the proiation of taxes as shown in e statement of actual
cost is baseq on the latest informatio available. If any
changes are qo be made in this prora 'on when the tax bill is
received, it Iwill be handled betwe the parties of this
transaction. ISt~wart Tit~e Campa of Clearwater, Inc., will, not
be held respqns1ble. It 1S fur er understood that Stewart T1tle
Company of C~earwater, Inc., annat, at this time, ascertain if
there will b~ personal pro rty tax on subject property or an
amount on wh~ch to base a roration. Any proration necessary
when tax bil]s become av lable will be handled between the
parties to tHis transac ion, outside of Stewart Title Company of
Clearwater, ~nc. Stew t Title of Clearwater will not be held
responsible. I
,
I
INITIALS
iINITIALS
INITIALS
INITIALS
SELLER'S
BUYER'S
CITY OF CLEARWATER
')(G~ 71( ~
WALTO McLE~ BYARS, JR.,
)l~~c~~
WALTDN McLEAN BYARS, JR., 1001
!
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akJLJr
DALLY
SELLER'S
7 0 --t8~'
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~a TJe 336 7<1
I
HOME PHONE# f't7 / 7 -;z. / d 2' J '3
FORWARDING ADDRESS:
/ D g- g s-
BUYER'S FORWARDING ADDRESS:
HOME PHONE#
f..-.-4
WORK PHONE# WORK PHONE#
THIS IS TO FURTHER AUTHORIZE ~~ ~
APPROVE ANY CHANGES NECE SARY TO THE CI~SING STATEMENT.
TO
STEWART
BY:
ORDER NO:
NON-FOREIGN CEI1TIFICATION BY INDIVIDUAl, TRANSFEROR
I, Section 1445 of the Internal Revenue Code provides that a transferee of the 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
- WALTON Mc:T.FAN BYARS J JR~ J TRUSTEE
of the United States real property described as follows:
SEE EXHIBIT A
the undersigned transferor certifies and declares by means of this certification, the following:
(a) I/We am/are not non-resident alien(s) for purposes of United States income taxations and,
(b) My United States taxpayer identifying number(s) (Social Security) is/are:
NAME
SOCIAL SECURITY NUMDER
WALliN t-tLEAN BYARS, JR., TRUSTEE
#- 2.67.0~--Jol7
#
(c) My home address is:
(d) There are no other persons who have an ownership interest in the above.described property other
than those persons set forth above in subparagraph (b),
3, The undersigned hereby further certifies and declares:
(a) I/We understand that the purchaser of the above described property intends to rely on the
foregoing representations in connection with the United States Foreign Investment in Real
Property Act. (94 Statute 2682 as amended).
(b) IIW e understand this certification may be disclosed to the Internal Revenue Service by transferee
and that any false statement contained in this certification may be punished by fine, imprisonment
or both.
Under penalties of perjury I/we declare I/we have examined carefully this certification and it is true, correct and
complete,
7f;L;;;4l /11 (~l ~&:t cl/~t() ;Jt _
WALliN McLEAN BYARS, JR., TRus1EE / T t:
(This document must be retained until the end of the fifth taxable year following the taxable year in which the transfer
takes place) CONSULT YOUR ATTORNEY AND/OR TAX ADVISOR - NO REPRESENTATION OR
RECOMMENDATION IS MADE BY STEWART TITLE INSURANCE COMPANY AND/OR STEWART
TITLE GUARANTY COMPANY/ STEWART TITLE COMPANY OF CLEARWATER, INC. CONCERNING
THE LEGAL SUFFICIENCY AND/OR TAX CONSEQUENCES OF THIS DOCUMENT. YOU MAY BE
REQUIRED TO FILE A COpy OF TInS DOCUMENT WITH THE INTERNAL REVENUE SERVICE, THESE
ARE QUESTIONS FOR YOUR ATTORNEY OR TAX ADVISOR,
STATE OF FLORIDA
CO U NTY OF PINELlAS
The foregoing instrument was acknowledged before me this 15
by WALliN McLEAN BYARS, JR., TRUSTEE
who has/have produced arlvers llcense
oath,
day of OCIDBER
1999
(Nolary Seal)
(~~'Jb':';':::"':;;:~\!
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\:,;,~",~.,;'
....,~,.,..
0FF!GIAL NOTARY SEAL
, HOiK.!d E, Somers
COMMISSION NUMBER
CC 782274
MY COMMISSION EX?
NOVEMBER 7, 2002
and who did take an
Nota ublic
My Commission Expires:
ORDER NO: 99090042
I
D I S C LOS U R E
I
We, the Owners/Purchasers of that certain real property
located at: 917 PARK STREET, CLEARWATER, FL 33756
Pinellas County, Florida, do hereby disclose the following facts
known to me which may materially affect the value or desirability
proP,erty. ~tJugfl-lY bE/M5 z>u~Jf:'d 'j4s,';'SY ~A~
~~-0 r I r ~it!F
I HEREBY CERTIFY that I have no knowledge of any facts or
of said
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
brokerl the selling brokerl and any prospective buyer.
I HEREBY CERTIFY that as the buyer(s) I have inspected the above
property and accept same.
STATE OF FLORIDA
COUNTY OF PINELLAS
7~ J;; L ~ -f3c;; cth:J92
WALIDN McLEAN BYARS, JR.t{ INDIVIDUALLY
CITY OF CLEARWATER
.~c:cL~
The foregoing instrument was acknowledged before me this 15th day
of Octoberl 19991 by WALTON McLEAN BYARS 1 JR'I TRUSTEE 1 who as
produced drivers license 1 as identifJ:..oa'f'io and who d' take
an oath.
N T RY
My Commission Expires: OFFICIALNOYAFtV EAL
/~;~i.-";(;&-( Ronald E. Somers
STATE OF FLORIDA /~,"A',",t~\ COMMISSION NUMBER
\~ I",} CC 782274
COUNTY OF PINELLAS ~':,>"'o~/ MY COMMISSION EXP
~!;., NOVEMBER 7,2002
The foregoing instrument was acknowledged before me this 15th day
of Octoberl 19991 by 1 as
OF CLEARWATER 1 FLORIDA1 a Municipal Corporat'
drivers license 1 as identif icatiol'1 an wh
My Commission Expires:
OFFICIAL NOTARY SEAL
.(~~y:~~&>" F~ona1d E. Somers
iri'b."~:)t;)' COMMISSION NUMBER
;.\~,'; CC 7B2274
~;'~"""""'O~I MY COMMISSION EXP
"OFf'i,..',"
.,........ NOVEMBER 7,2002
I
SELLER'S AFFIDAVIT (GAP)
I
STATE OF FLORIDA
FILE NO: 99090042
COUNTY OF PINELLAS
BEFORE ME, the undersigned, this day personally appeared WALTON McLEAN BYARS r JR. r
TRUSTEE
("Affiant(s)"), who, being by me first duly sworn, says:
1. WALTON McLEAN BYARSr JR'r 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- 99090042 bearing an effective date of September 23 r 1999 5: 00 PM
(the "Commitment").
3. There have been to my knowledge no documents recorded in the Public Records of Pinellas
County, Florida subsequent to September 23 r 1999 5: 00 PM 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 CLEARWATERr INC. , to issue an Owner's Title Insurance Policy to
CITY OF CLEARWATERr FLORIDAr a Municipal Corporation
Dated, this 15th day of October
, 19 99 .
Sworn to and subscribed before me this 15th day of October
WALTON McLEAN BYARSr JR'r TRUSTEE
, 19
, by
who has/have produced driver license(s) as identification.
,.m. OFFICIAL NOTARY SEAL
My commission eXPi~~A,~'~'!.~,e,:'~~,' Ronald E, Somers
:( '\~\ COMMISSION NUMBER
,0;,.' /~j CC 782274
\~;!iiFf~?'5' MY COMMISSION EXP
._,.- NOVEMBER 7, 2002
TO BE FILLED IN PERSONALLY
BY SELLER OR BQAROWER IN HIS OWN HANQWRITING
INDEMNITY AND AF'DAVIT AS TO DEaTS, LIENS, AND poSstSSION
USE Sl:PARATE FORM FOR EACH PARTY -
WALlDN McLEAN BYARS, JR., TRUSTEE
SEE EXHIBIT A
Seller or Owner-Borrower
CITY OF CLEARWATER
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, Ooor 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 0 c prop ecured by a financing statement, security agreement or otherwise except the
follow.' g: (If none, so state.)
NAME AND A RESS OF SECURED PA Approximate Amount
Approximate Amount
4. I, e purchaser, represent that I have no knowledge of any debts or liens of any kind other than those listed
above, cept: (If no e, so state.)
NAME AND ADDRESS ED PARTY, CREDITOR, SUPPLIER OF
LABOR OR MA TERIALS Approxlmllte Amount
,5, I, the owner-borrower, or purchaser, have not been given notice of the furnishing or intent to furnish any labor,
services, or materials in connection with any improvements or repairs to said property from any person or firms,
except: (If none, so state.)
SUPPLIER OR LABOR, SERVICES OR MATERIALS ADDRESS
6. I, the undersigned owner, further certify th",t the real estate and personal property above described are in the
actual possession of the undersigned and is not in the possession, actual or constructive, of any person, persons,
or organizations holding or claiming same, adversely to the undersigned under contract, lease, or any other color
of title or right of possession.
The improvements or repairs to said property arc now completed and have been accepted by purchaser and/or
owner-borrower.
INDEMNITY: I, THE SELLER, OWNER-BORROWER, AND/OR CONTRACTOR, AGREE TO PA Y ON DEMAND
TO THE PURCHASERS AND/OR LENDER IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL
AMOUNTS SECURED BY ANY AND ALL LIENS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS
AND ATl'QRNEY'S FEES THAT SAID PARTIES MA Y INCUR IN CONNECTION WITH SUCH UNMENTIQNED
LIENS, PROVIDED SAID LIENS EITHER CURRENTLY APPLY TO SUBJECT PROPERTY, OR A PART THERE-
OF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME,
KNOWN TO ME OR HA VE AN INCEPTION DATE PRIOR TO THE CONSUMMATION OF THIS TRANSACTION.
I realize that the purchaser and/or lender in this transaction are relying on the representation contained herein in purchasing
same or lending money thereon and would not purchase same or lend money thereon unless said representations were made.
7hJk /J1 C- ~~~ TrE
_ WALlDN McL~ BYARS , JR'~, ' USTEE
1 ')
day of
CITY OF CLEARWATER
OcroBER
.. '11099
OFFIl;IAL 1..J0 M\. I
;"~p(I', Ronald E. Somers
!~"~A"""~~~\ COMMISSION N~MBER
.. I., . ) " C 78227
My CommIssIon ~Q, ~,~} Y CgMMI5SION EX?
FlDRIDA ~~~.,"""" 04:' M 02
"".,,2~J:..'" NOVEMBER 7,20
Rev, 1/88
NOTE: Thil 'orm h 10 be ,j,ncd by wile, in UK 01 ~k. II no uk, Ie la 10 be .I,ned by 1M o'*ncr.bonowu. lI.hen I. any MW conltruclion. the COOIlICIOI mu.. aha join In IhiJ lorm
or .ian I KP&(.U one.
DISCLOSjRE, ' CONSENT AND GRANT OF PERMISjION
TO Jt\RN INTEREST ON ESCROWED FUNDS I
STEWART TITLE OF CLEARWATER, INC. ("Stewart"),
is providing title insurance and closing services, and has issued Commitment No. C - 99090042
dated September 23, 1999 5: 00 PM 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 hereof) 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 PurchaserIBorrower
!XI 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,
CITY OF CLEARWATER
October IS, 1999
Date
Print Name: ~ W ~&
As ~...-vr of e../' 0
(Title) Corporate or other entity name, If Applicable)
please check all that apply ~ Buyer / _Seller / _ Mortgagor
Date
Print Name:
As of
(Title) (Corporate or other entity name, if Applicable)
please check all that apply _ Buyer / _Seller / _ Mortgagor
October IS, 1999
Date
j~/d;, / K C~V1'\.(f / (V~,) ~
Print Name: WALTON McLEAN BYARS, J: ., -:;! Tic
As TRUSTEE of
(Title) (Corporate or other entity name, if Applicable)
please check all that apply _ Buyer / ~ Seller / _ Mortgagor
Date
Print Name:
As of
(Title) (Corporate or other entity name, if Applicable)
please check all that apply _ Buyer / _Seller / _ Mortgagor