Summerford, Myrtle
January 5, 1998
AFFIDAVIT
WE, the undersigned, do hereby attest that Myrtle Summerford, deceased, was
a decendant of Captain Tom Roberf,;, the original cemetery property owner and as his
heir, has a right to be burled In Block 2, Lot 4. Space 25 at Clearwater Municipal
Cemetery, Myrtle Summerford was the daughter of Joseph and Alice Lenora Roberts,
both deceased. Jo~eph Roberts was the son of David Roberts who was the brother of
the origInal lot owner of cemetery property described as Block 2, Lot 4 which was a
forty~two space lot but now consists of 9 unused spaces,
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 Myrtle Summerford.
SIGNATURE/
RELATIONSHIP TO DECEASED
ADDRESS
~~t!~
M Alice Carver, daughter
1011 Gandy Boulevard, #104
at. Petersburg, FL 33702
Phone 813-578-4584
~&-~
Cly e london, son
4829 Caesar Way S.
St. Petersburg, FL 33712
Phone 813-867-4788
SWORN TO and subscribed before me this 6th day of January, 1996, by Mary
Allee Carver who Is personally known to me.
.......... Mlch eI J Meado
11 .,..
~ :-':' :.. MY COMMISSION I CC485281 EXPIRES
\..h..O..... ~.\.1.o...~\....,.~ ~~ :1 August 1. 1999
Notary Signature/(Prlnted name) "'~.w.,lil" 80NDf.01IR.ITROYFAlNINSIMIANCE.lI<<:.
~,(..~'- ~.'('(\e.~~
SWORN TO and subscribed before me this 6th day of January, 1996, by
Clyde London who Is personally known to me.
4:"~~ MIchael J. Meadows
), \.u~L..Q ':\. .u.().~\..~..~ t=~i.i MYCOMMISS1ONICC485281 EXPIRES
Notary Signature/(Printed name) "'~iif..f;.W BOIIlEDTIfIU~F~~.lI<<:.
{'(\,,<.....-.~E.~ ~. '{'t\~....~