Boyd, Douglas Paul and Kathleen
AFFIDA VIT
STATEOF FLOflfDtlr )
COUNTY OF S "'N'f'A- Ro'>/o/ )
I, the undersigned, Marie Boy~ Street, do hereby Grant Rights of Interment to:
Douglas Paul Boyd, my brother, in Space 4, Lot 108, Block 7; and
Kathleen Boyd, h is wife, in Space 1, Lot 91, Block 7 in Clearwater Municipal Cemetery,
"/'
I further agree to release, indemnify and hold the City of Clearwater harmless from liability in
the event of any claim arising from the use of the above described property for the interment of Douglas
P. Boyd and Kathleen Boyd.
SIGNATURE
RELATIONSHIP
7>JtVu~ 4~,~
Marie Boyd Street
,;;JJ s r t;'7f!.
(Address)
P:O'~;1.'/'30. P<'A.a.t:O!.. ~'- .1;U-I?
Witness
(Address)
Witness
(Address)
td ,k. /.
The foregoing instrument was acknowledged before me thisM day of'Uf!11Jil.!, 19~, by
Marie Boyd Street, who produced identification in the form of rU)L# S5h3'3'12?3-5f3-() and who
did/did not take an oath. .I
, {:1!!:A~;~f:<~
~~~;!i?t~;.~~:
------mANE MENOo"ZA-"- "',;:
MY COMMiSSION ~ CC 333528 J
EXPIRES: Docember 2, 1997 ,i
onded Thm Notary Public Uni~er,vri:ars r
--< ~..J
My commission expires:
(SEAL)