Kimberly Gargano
T-'S-02; ~:2&AM;CITy CLE~K DE~T,
JUL 18 '02 10:21 FR MOSS FEASTER DUNEDIN 727 562 2043 TO 95867329
P.03/03
:72T 562 4086
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July 18, 2002
AFFIDAVIT
We, Robert Chisholm and Bonnie Blake, are the grandchildren and soJe survivors of
Remmie R. C'hisholm 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 th~, e eve fa' ,', .ng from the use of the above described property for the
interment~
ADDRESSlPHONE
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Bonn Slake
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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~ion 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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Notary Public
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My commission expires:
JUL 1 R 'A;:I 1il=1::~ 1
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