Carlson, Florence M. (Nelson)AFFIDAVIT
STATE OF FLORIDA)
COUNTY OF PINELLAS)
I, Claudia Hutchinson, the undersigned, do hereby attest that I am the
descendant of Florence M. Nelson (Carlson), my mother, owner of Spaces 1 & 2 of
Block 9, Lot 106 in the Clearwater Municipal Cemetery. Andrew Carlson is buried
Space 1 and Space 2 is currently vacant. My mother is buried out of state.
Please take this affidavit as your authority to note the right to property described
above to myself. Per the City of Clearwater Rules and Restrictions the maximum
capacity of a space is two burials provided at least one person is cremated or two
cremated remains.
I 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 as
stated above.
SIGNATURE ADDRESS /PHONE
CIa dia Hutchinson
15230 NE 150 Place
Fort McCoy, FL 32134
It
SWORN TO and subscribed before me this I day of
2O 1S by Claudia Hutchinson who produ ntification in e f rm. of
F1`Or4Cfor DAa's ttausz, and who di /did no ke a. oath.
DOROTA WASILEWSKA
:f.. MY COMMISSION k EE 830049
EXPIRES: August 23, 2016
Bonded Thru Notary Public Underwriters
Nota
Public
My commission expires: