Faison, WillieAFFIDAVIT
1, Willie Faison, the undersigned, do hereby attest that I am the nephew of Marie
Laster (deceased), who is the owner of Block 14, Lot 317, Space 00, in the Clearwater
Municipal Cemetery. My aunt, Marie Laster (deceased), is buried in Block 14, Lot 317,
Space 00 and my mother, Mattie Faison (deceased), is her sister.
Please take this affidavit as your authority to assign urn interment rights in space
00 of Block 14, Lot 317 to my mother, Mattie Faison, at the foot of the grave.
We 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
illie Faison
•
STATE OF FLORIDA
COUNTY OF PINELLAS
IL,12 leyraM /7r
(kQrr 4J or/ r r�a . 33 75-5-
07A7) X2 -3-027r0
Sworn to (or affirmed) and subscribed before rle by means of [Prphysical presence or
Li online notarization, this ` "" day of "W/(/'.C' 4-- , 2021 by Willie Faison.
j
Notary Public
////3' ,2G'1..
DENARVIS L FULLER
Commisslon # GG 247517
Explres November 13, 2022
Bonded Thru Budget Notary Servkee
y c mission expires:
(NOTARY SEAL)
Personally Known OR Produced Identification v
Type of Identification Produced