Odom, Catherine Lydia
..
April 14, 1995
AFFIDAVIT
STATE OF Florida )
COUNTY OF pinellas )
I, KIMBERLY CHRISTINIA MILLS, the undersigned, do hereby attest that I am the decendant
and heir of VICKI BENNETT, deceased, who is buried in Block 16, Lot 36, Space 1, Clearwater
Cemetery. Please accept this affidavit as your authority to place the cremated remains of Catherine Lydia
Odom, my grandmother, in the same space as:Vic1ci Bennett)my mother.
,
--cl-further-agree_to_l1:lease, indeJDuifY)l!lclh9!4thc::_City of Clearwater harmless from liability in
the event of any claim arising from the use of the above described property .. for interment orcatnefine .--
Lydia Odom.
SIGNATURE
, I
K~",-~ t ~~"'A }:t~aJ\J
Kimberly Christin Mills - (Name and add'ress)
120 20th Avenue South
St. Petersburg. FL 33705
llECEI\ LD
APR 2 0 1995
CITY CLERK Dt':PT,
STATE OF
COUNTY OF
)
)
BEFORE ME, the undersigned, personally appeared Kimberly Christina Mills at the City of
Largo ,~, 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, and who has produced a
Drivers License as means of identification.
WITNESS my hand and official seal this 19th day of Apri 1
, 19..95... .
~~~
Notary Public .
Print/type name: Marilyn L. Carleton
(SEAL) Notary Public, State 01 FlOTilla
My Comm. Exp, July 11, 1995
Bonded thru PICHARD Ins. Agencv
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