LaFortune, Eunice M
)-
City of Clearwater
P. O. Box 4748
Clearwater, FL 34618
September 20, 1994
AFFIDA VIT
I, the undersigned, do hereby attest that I am the lot owner of Block 10, Lot 5, Space(s) 3 and
4 respectively, in Clearwater Cemetery. I wish to grant right of interment in Block 10, Lot 5, Space 3
to Eunice M. LaFortune.
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 Eunice
M. LaFortune.
?J; r /lJr
Leslie McManning
/ SIGNATURE
674 Canterbury Road
Clearwater, FL 34624
/ WITNESS
647 Canterbury Road
Clearwater, FL 346
/ WITNESS
1140 ldlewild Dr. S.
Dunedin, FL 34698
STATE OF FLORIDA )
COUNTY OF )
BEFORE ME, the undersigned, personally appeared Leslie McManning at
C/ ear ~./-(. r , F L- ,who executed the foregoing instrument and acknowledged the
execution thereof to be his free act and deed for the use and purposes herein set forth, and who has
produced a F"L.. I> L:# hi z55' S- 3b - on - as means of identification.
I ~..2. - 0 If'
WITNESS my hand and official seal this ~#- day of ;Jri/)~, 19~
di~.. !J: c4~ )
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= : MY COMM. EXPIRES ~ ::
: -: SEPlUllllER 5, 1995 ': E
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POST OFFICE Box 60
802 NORTH FT HARRISON AVE
CLEARWATER. FLORIDA
Estate of Rose Mary UcManninr
Rt. #? Box 807 - Lart:O, i"lorida
Comple te 1'\.l!19:!'ll 01' Has e :.a:i'Y kCJ'.lar:ni:"1p,
inc111dinl:: HI Pr:l.:o::ssion;i=. and Di~ect;)rial
Set"vices; Silver lir:~shej ,\::-mco ;';etal Casket;
C".':apel qosary, ':';~I1l::-ch and Ce-;1€'tery Services
1I\'filaeT't~' ;.sphrll t a:1rJ. C;cnc~fCte Bllrirt~ 1hml t
State Sal."s Tax
Cit'{ of Clearwo.ter, U;2- ~Al":, 5 Block 10
Clean/ateI' Cemeterjr
Music at Qmrch
Has pi tal EquipHlent rental, 2 'i'leeks @ $2.50
" 56..'1 .00
.;p
120.GO
5.)()
8o~00
10 .00
5.00
$ 7 80 .hO
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RECEIVED PAYMENT /0-
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