Hart, Robert Jessie
April 8, 1999
AFFIDAVIT
I, the undersigned, do hereby attest that my father, Robert Jessie Hart,
deceased, is the spouse of Edna Hart, deceased. Edna Hart's cremated remains are
interred in Space 13, Lot Two (2), Block Three (3) along with Harry Roger Kisby who is
related to Robert Jessie Hart's mother, Marie K. Hart, deceased.
Please take this letter as your authority to inter the cremated remains of Robert
Jessie Hart, deceased, whose birth date was August 21, 1927 and death date was
March 18, 1999, in space Twelve (12), Lot Two (2), Block Three (3) along with his
mother, Marie K. Hart .
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 the cremated remains of Robert Jessie Hart.
SIGNATURE!
RELATIONSHIP TO DECEASED
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ADDRESS
4606 West Creek Circle
Killeen, TX 76543
SWORN TO and subscribed before me this
11 ~ Q:,'. County, state of Florida.
r day of April, 1999, in
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