Gargano, Kimberly
7-'8-02; ~:28AM;CITV CLE~K OE~T.
JUL 18 '02 10:21 FR MOSS FEASTER DUNEDIN 727 562 2043 TO 95867329
P.03/03
:7.27 552 4086
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July 18, 2002
AFFIDAVIT
We, Robert Chisholm and Bonnie Blake, are the grandchildren and sole survivors of
Remmie R. Chisholm who is the owner of Slock 5. Lot 20, Space 8 in the Clearwater Municipal
Cemetery.
Please take this affidavit as your authority to inter the remains of KimberlY Gamano
who is the step daughter of Robert Chisholm, in Block 5, Lot 20, Space 8.
We 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 KimberlY GarcMno.
ADDRESS/PHONE
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Bonn Blake
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by
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SWORN TO and subscribed before me this~ day of . , 2002
who produced identification i the of
and who did/did not take an oath.
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Notary Public
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My comm~on expires:
SWORN TO and subscribed before me th~ day of \.\.u. .
2002 by who produced ide~orm of
and who did/did not take an oath.
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JUL 18 '02 10:21 FR MOSS FEASTER DUNEDIN 727 562 2043 TO 95867329
7-,a-o,; ~:~6AMICllY CLERK O~PT.
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P.02/03
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TO:
Dena Mgnis, Moss Feaster
FROM:
Susan Stephenson (727/562.4091)
RE:
Kimberly Gargano
DA TE:
July 18, 2002
I am sending the Affidavit to permit the burial of Kimberly Gargano's
remains in the Clearwater Municipal Cemetery. Please have both Mr.
Chisholm Qnd Ms. Blake sign the affidavit in the presenc~ of a notary. Please
return the AffidQvit with original signatures to us prior to the interment
which is scheduled for August 3. I will have the space staked after I have
received the signed affidavit. If you have any questions please feel free to
call me.
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JUL 18 '02 09:31
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727 562 4006
PAGE.el