Metz, Eleanor Alyce
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July 23, 1996
AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, the undersigned, do hereby attest that I am the decendant, sole survivor and heir of Alice
Gordon, deceased, who is buried in Block 6, Lot 7, Space 12, Clearwater Cemetery. I am the heir to the
four (4) remaining cemetery spaces, described as Block 6, Lot 7, Spaces 1, 2, 3, and 10. I wish to
reserve space ten (10) for myself.
I, further wish to revoke burial rights for Cassie T. Capalary, in Block 6, Lot 7, Space 1,
Clearwater Cemetery, which I had previously granted on July 8, 1993.
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.
SIGNATURE
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1!li!ii\OI':<tyce Mea" ? ,
~506 Pine Street /0:;2 ~ ~/eait.d-e r
CI@arwatBr, FI. 34616 ~c-\j IL./C^-~(,
WITNESSES:
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STATE OF FLORIDA )
COUNTY OF PINELLAS )
BEFORE ME, the undersigned, personally appeared Eleanor Alyce Metz at the City of
Clearwater, Florida, who executed the foregoing instrument and acknowledged the execution thereof to
be her free act and deed for the use and purposes herein set forth, and who has produced a Social Security
Card as means of identification.
WITNESS my hand and official ~ this ,;? Yl<<day of -iI1J-. 1916
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Notary Public I - " - L
Print/type name: 0wUt.- d":1 n J. ~ferJ'
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July 8, 1993
AFFlDA VIT
STATE OF FLORIDA )
COUNTY OF PINELLAS)
iheTZ-
I, the undersigned, do hereby attest that I am the decendant, sole survivor and heir of Alice
Gordon, deceased, who is buried in Block 6, Lot 7, Space 12, Clearwater Cemetery. I am the heir to
the four (4) remaining cemetery spaces, described as Block 6, Lot 7, Spaces 1,2, 3, and 10. I wish to
reserve space ten (10) for myself and grant Cassie T. Capalary the right to be interred in Block 6, Lot
7, Space 1, Clearwater Cemetery.
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 Cassie
T. Capalary.
SIGNATURE ~
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Eleanor Alyce Metz
506 Pine Street
Clearwater, FL 34616
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BEFOR
Clearwater, Flori a, who executed e foreg
be her free act ahd deed for the use d
Security Card as means of identification.
sonally appeared Eleanor Alyce Metz at the City of
ng instrument and acknowledged the execution thereof to
rposes herein set forth, and who has produced a Social
WITNESS my hand and official seal this
8 ~ day of
,1911.