Gornowicz, Bertha
CEMETERY DEED
KEN BURKE, CLERK OF COURT
PINELLAS COUNTY FLORIDA
INST# 2006050895 02/10/2006 at 08:06 AM
OFF REC BK: 14924 PG: 1063-1063
DocType:DEED RECORDING: $10.00
D DOC STAMP: $1.40
THIS INDENTURE made this 26th day of January , 2006, between the City of
Clearwater, Florida, a municipal corporation as Grantor and BERTHA GORNOWICZ, whose
mailing address is 11226 82nd Ave. N.. Apt. 102. Seminole, FL 33772 County of Pinellas, State
of Florida, as Grantee:
WITNESSETH: That the said Grantor, for and in consideration of the sum of $125.00 in hand paid by the said Grantee, the receipt
whereof is hereby acknowledged, has remised, released and quit-claimed unto the said Grantee, and their heirs forever, all the right,
title and interest, which the said Grantor has in and to the following described parcel of land, lying and being in Pinellas County, State
of Florida, to wit: SPACE zero (00), LOT Three Hundred Ninety Three (393), BLOCK Fourteen (14),
Clearwater Cemetery, as recordectin Plat Book 60, Page 30, Public Records of Pinellas County, Florida.
This conveyance is subject to the condition that Grantee herein shall not assign or convey said property without the written consent
of the Grantor, and to the further condition that said property shall be used only for cemetery purposes as human burial sites and is
subject to such other rules and regulations the City of Clearwater may adopt pertaining to use of said property.
TO HAVE AND TO HOLD the same to the only proper use, benefit, and behoof of the said Grantee and their heirs and assigns
forever.
IN WITNESS WHEREOF, said Grantor has caused these presents to be executed in its name by its Mayor, by its City Manager,
and to be attested and its corporate seal affixed by the City Clerk on the day and year first above written.
cou~e igned: C1l:;X 0, i~/9LEAR~A~~LO~9K
_......~ ,'. ~
'.,Sf, k V. Hibbard, Mayor
B~f3~~~
Willi B. 0 e, lity ,Manager
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared Frank V. Hibbard, the Mayor of the City of Clearwater, Florida, to me well known
to be the person 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.
WITNESS my hand and official seal this ~ day of
~"'- Denise A. Wilson .
f c; Commission # 00296233
'\ ".3 expires June 18, 2008 .
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'1\ 'til! '! '( Notary p'ublic
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name: '-. /,f2IJ (, "j t: j l j j j . "ry,-/
STATE OF FLORIDA )
COUNTY OF PINELLAS)
Before me, the undersigned, personally appeared William B. Horne, II, the City Manager of the City of Clearwater, Florida, to me
well known to be the person 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. .J ,J
.'?, II
WITNESS my hand and official seal this J day 0 ' /.
~ Denise A. Wilson
f ~c; Commission # 00296233
"4 JH Expires June 18. 2008
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Pamela K. Akin, City Attorney
CEMETERY DEED.DOC
RETURN TO: Official Records & Legislative Services
P. 0, Box 4748, Clearwater, FL 33758
9700-0026
Rev. 1/06
IIIIII1 FLORIDA DEPARTMENT OF REVENUE
RETURN FOR TRANSFERS OF INTEREST IN REAL PROPERTY
(PLEASE READ INSTRUCTIONS BEFORE COMPLETING)
1. parcelldentitication.Number I [Qjrnkrn[~I@JT~r~[ZrOOl~ DD'~~0s~D'D r
(If ParcellD not available
~I;;:a~s~~!~~~~~~perty OOOOOOD[]B~~~l]~~OOOOOOD
Multi-parcel 0
transaction? -.
trf.T
FCOR1024(ID)
DR-219
R. 07/98
2. Mark (x) all
that apply
Transaction is a split
or cutout from I)(l
another parcel? -. ~
3. Grantor (Seller):
Last
PO BOX 4748
CITY
First
MI
CLEARWATER
City
FL
State
Corporate Name (if applicable)
33756 (727p624090
Zip Code Phone No.
Mailing Address
4. Grantee (Buyer): GORNOWICZ BERTHA
Last First Ml
11226 82ND AVE. N. APT. 102 SEMINOLE
Mailing Address City
5. Date of Sale/Transfer Sale/Transfer Price
DO / [][] / OOQ]O $OOO[][?][],OOO . [Q]~ r~~~~ert:ln IPinellaS
Month Day Year (Round to the nearest dollar.)
6. Type of Document 0 ContracUAgreement fi(l Other 7. Are any mortgages on the property? If "Yes", YES 0 / 0 NO
for Deed ~ outstanding mortgage balance:
o ~:~~anty 0 ~~~dClaim (Round to the nearest dollar.) $ 0 0 00 0 00 0 0 . [Q] [Q]
FL
Corporate Name (if applicable)
3 3 7 7 2 ( 7 2 '7)3 9 9 0 8 6 0
Zip Code Phone No.
State
8. To the best of your knowledge, were there unusual circumstances or conditions to the sale/transfer
such as: Forced sale by court order? Foreclosure pending? Distress Sale? Title defects? Corrective Deed? Mineral rights? YES 0 / fi(l NO
Sale of a partial or undivided interest? Related to seller by blood or marriage. ~
9. Was the sale/transfer financed? YES 0 / ~ NO If "Yes", please indicate type or types of financing:
O 0 Agreement or 0 0
Conventional Seller Provided Contract for Deed Other
o
Industrial
o
Institutional/
Agricultural Miscellaneous
o 0
YES 0/ [!jNO
D
Cents
[Q][ill
10. Property Type:
Mark (x) all
that apply
Residential
o
Commercial
11. To the best of your knowledge, was personal property
included in the sale/transfer? If "Yes", please state the
amount attributable to the personal property. (Round to the nearest dollar.)
12. Amount of Documentary Stamp Tax
~
Government Vacant
~ 0 0
$OOOOOD,OOO
$000000000 . []eJ
YES 0 / D NO
Acreage
Timeshare
13. If no tax is due in number 12, is deed exempt from Documentary Stamp Tax under s. 201.02(6), Florida Statutes?
Under penalties of perjury, I declare that I have read the foregoing return and that the facts stated in it are true. If prepared by someone other
Lth.an the taxpayer, his/her declaration is b.a~ed on a 11:".(... m~tion o. f which he/her has any knowledge.
Signature of Grantor or Grantee or Agent' - . o.i>",-.tL...- Date j- ,;< "7 - {> r:;
WARNING: FAILURE TO FILE THIS RETURN OR ALTERNATIVE F MAP ROVED BY THE DEPARTMENT OF REVENUE SHALL RESULT INA PENALTY OF $25.00 IN ADDITION TO ANY
OTHER PENALTY IMPOSED BY THE REVENUE LAW OF FLORID .
To be completed by the Clerk of the Circuit Court's Office Clerks Date Stamp
This copy to Property Appraiser
O. R. Book 00000
and 0000
Page Number
and OOODDODDODODD
File Number
Date Recorded 00/00/0000
Month Day Year
This copy to Property Appraiser
1111111
FLORIDA DEPARTMENT OF REVENUE IN
RETURN FOR TRANSFERS OF INTEREST IN REAL PROPERTY
(PLEASE READ INSTRUCTIONS BEFORE COMPLETING) 1 . "IT
Enter numbers as shown below. If typing, enter numbers as shown below.
FDOR10240300
DR-219
R..07/98
1. Parcel Identification Number
(If ParcellD not available
please call County Property
Appraiser's Office) -.
o
23456789
0123456789
r
22-29-15-00000-220-0400
2. Mark (x) all
that apply
Multi-parcel
transaction? -.
Transaction is a split
or cutout from -.
another parcel?
)(
Property was improved
with building(s) at time
of sale/transfer? -.
CITY OF CLEARWATER
Corporate Name (if applicable)
FL 33756 (72~5624090
State Zip Code Phone No.
3. Grantor (Seller):
Last
PO BOX 4748
First MI
CLEARWATER
City
BERTHA
Mailing Address
GORNOWICZ
4. Grantee (Buyer):
Last
11226 82ND AVE. N. APT.
First
102
MI
SEMINOLE
City
SalelTransfer Price
Corporate Name (if applicable)
FL 33772 ( 7213990860
State Zip Code Phone No.
Mailing Address
5. Date of SalelTransfer
1
26
2006
$
$175
O 0 Property 62 County Code
. Located In
Month
Day
Year
(Round to the nearest dollar.)
Other 7. Are any mortgages on the property? If "Yes",
outstanding mortgage balance:
(Round to the nearest dollar.) $
YES
NO
6. Type of Document
Warranty
Deed
ContracVAgreement )t
for Deed
Quit Claim
Deed
00
8. To the best of your knowledge, were there unusual circumstances or conditions to the sale/transfer
such as: Forced sale by court order? Foreclosure pending? Distress Sale? Title defects? Corrective Deed? Mineral rights?
Sale of a partial or undivided interest? Related to seller by blood or marriage. YES
)( NO
Conventional
Seller Provided
K NO If "Yes", please indicate type or types of financing:
Agreement or
Contract. for Deed
Other
9. Was the sale/transfer financed? YES
10. Property Type: Residential Commercial Industrial
Mark (x) all
that apply
Institutional!
Agricultural Miscellaneous Government Vacant
)t
Acreage Timeshare
11. To the best of your knowledge, was personal property YES
included in the sale/transfer? If "Yes", please state the
amount attributable to the personal property. (Round to the nearest dollar.)
12. Amount of Documentary Stamp Tax
)t NO $
$
Cents
00
.
1.00
13. If no tax is due in number 12, is deed exempt from Documentary Stamp Tax under s. 201.02(6), Florida Statutes? YES NO
Under penalties of perjury, I declare that I have read the foregoing return and that the facts stated in it are true. If prepared by someone other
Lthan the taxpayer, his/her declaration is ase~ on a!Unformationpf which he/her has any knowledge.
Signature of Grantor or Grantee or Agent. . .. ~4(/ L./ Date / - .J 7 -()b
WARNING: FAILURE TO FILE THIS RETURN OR ALTERNATIVE RM PPROVED BY THE DEPARTMENT OF REVENUE SHALL RESULT IN A PENALTY OF $25.00 IN ADDITION TO ANY
OTHER PENALTY IMPOSED BYTHE REVENUE LAW OF FLORI
To be completed by the Clerk of the Circuit Court's Office Clerks Date Stamp
This copy to Department of Revenue
O. R. Book DDDDD
and DDDD
Page Number
and DDDDDDDDDDDDD
File Number
Date Recorded DD/DD/DDDD
Month Day Year
This copy to Department of Revenue