Collins, Frances Elaine
01/11/1994 19:59
8134430253
RHODES FUNERAL HM
PAGE 01
.:... ... :,.:... -', _' I.
July I 1.2000
AFFIDA VlT
STATE OF FLORIDA )
COUNTY OF PINELLAS )
WE. the undmfped, do hereby aU.cst that we am the dtcendanbl, ,ollt survi"ors and heirs of HAROLD s,
AND ANNIE L. BARNES, deceased, who Ire buried in BIoek Two (2)" lQt Foul' (4), Space(s) fifteen (15) and
Si)(leen (16) n::$pccliv~ly, in CicaIW8b:r CanCt~1ry. We authcria the Intenllent of our si5ter, Frances Elaine Collin!l, ir.
B!ock Two (2). Lol FOl.lf (4). Space SrVl!l11een (17).
WE furth~r agree to r~I('... i11dernnlfY and hold Ibe Ci1y of'CJearwatcr harmless (rom liability in the evem of
Bny ~laim lU'1~JJlC &oln the use of the llbove-dac;:ribcd ptopeny for me ~rcnnept of Franees Elaine Collinll'
SIGNA TVRE
X~!J,tJ~
(and addrur)
if491 '71 . i. / I;). Ij.. ~';<:, .
~r~, ~/,0A. ~ifLf~8
SIGNATURE
(lI&1d~'" t.Q~fh .~u~:___
j.1 7 9~ (38 ~ 0. L rv
cJ~J ~ :33 Vtf7
PRINTED NAME & RELATIONSHIP
{/ory MM((~ - r;;.Pier/4! O/~4:ft,y
~'<k6~
SWORN t and subscribed before me this .J.L.. day o~, 2000, by L~. /5
ell r y k.10' to me Of has made him/heT
5clfknown to me by i>H'~ :~e. (idcalifk8tJoIt).
f'f\ ~\ tt::... \::\~ ~ ..~~~~ Michelle Howard
'N~t:I'Y Signature! (Printed "*1''':) >':1)'':; MY COMMISSION , CC915749 EXPI~ES
~:. : ; March 5, 2004
~->:P.r:,\'\{, ' 80NOED 1l1RU TI1QHAIN INSURANCF..INC,
SWO.RN TO end :'Jubsrnb8d betore mil: thi, day of . :000. b>'
personally ic:nown to me or hils "lade him/ner
selfknowl1 to tne by _ (idmtifialt1on).
Notary Sijplaturc/ (Printed Name)