Hendry, Sylvia
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JGEC-09-1993 11:50
CLEARWRTER CITY CLEF'V
813 462 6488 P.002
~~ -".
AFFIDA VIT
STATE OF Florida )
COUNTY OF Brevard )
WE, the undersigned, Sylvia Porter and Dora Ward~ do hereby attest that we are the sole
surviving heirs of Sylvia Hendry, deceased, who cremated remains are to be interred in Block 2, Lot 17,
Space 9, in the Clearwater Municipal Cemetery in Clearwater, Florida. Please take this letter as your
authority to place the cremated remains for Melissa Renwick in Block 2~ Lot 17, 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 inter.ment of the
cremated remains of Melissa Renwick.
SIGNATURES
RELA TIONSHIP TO DECEASED
Dora Ward
(Address)
~~//AL_Al'/ ~
SYJ~~~t~;-
Qc;lughter
(Address)
3003 s. Vassar st.
Melbourne, FL 32901
The foregoing instrument was acknowledged before me thi~ ~ day of Jlp~pmhPt99..1" by Dora Ward
and Sylvia Poner, who produced identification in th~ form of Drivers License and who
did~take an oath.
"
. ~Publ\:
NOla GOR.Y S. MAXWELL
M ry PUblic, Slale of Flo 'd
ycomm' n a
C . eXDlre~ '''RII 8 1M
My c8m'lM~~tGR_pi'lIe!;:o
(SEAL)
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~
[EC-09-1993 11:50
CLERR~JATER C I r( CLERI<
813 462 6488 P.002
~.-
AFFIDA VIT
STATE OF Iowa
COUNTY OF Polk
)
)
WE, the undersigned, Sylvia Porter and Dora Ward, do hereby attest that we are the sole
surviving heirs of Sylvia Hendry, deceased, who cremated remains are to be interred in Block 2, Lot 17,
Space 9, in the Clearwater Municipal Cemetery in Clearwater, Florida, Please take this letter as your
authority to place the cremated remains for Melissa Renwick in Block 2, Lot 17, 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 the
cremated remains of Melissa Renwick.
SIGNATURES
RELA TIONSHIP TO DECEASED
~ ~~d
Dora Ward
d~~~
(Address)
Sylvia Porter
(Address)
,>
The foregoing instrument was acknowledged before me this I~~ay of D4P', 199..3, by Dora Ward
and Sylvia PoneI', who produced identification in the form of ~. 1 /I~ and who
did/did not take an oath.
d - 1- '1"
My commission expire!;:
(SEAL)