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458334
CHICAGO TITLE INSURANCE COI~ANY
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AFFIUA'VIT
OF
• _ CONTINUOUS Z~IARRIAGB FLORIDA
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STATE O~Ft10RfDA) .
COUNTSf OF ~/4+d1~) _
BEFORE lam, the undersigned authority; on this dad of
~1'~WJ'1 19~, personally appeared
who being duly sworn, deposes a sa
ACHES A.- 80LLA
1. THAT Affiant along with ~.ffiant's spouse,/obtained title to
the following described property on
2. THAT Affiant was married to the above Healed spouse prior to
the date of acquisition of the aforesaid property, and they re-
main dcontinuou~ly married from that date up to and including
f~.t.G ~ ~ / Q 7 to 19 ,the date of death of said
spouse . ~ 7j7 rte,
3. THAT Affis~n''t00's spouse died of natural causes in
(County) ,~,er,/ccG?M.. ~ i'l'l pia. (State) , intestate .
4. THAT all Federal and State taxes on the Estate of the decedent
have been paid 3n full.
• 5. THAT a certified copy of the death certificate is attached hereto.
' 6. THAT Affiant has not since remarried.
FURTHER THE AFFIANT SAYETH NOT.
i
Dated this ~ day of ~T~~ , 19~.
Address: •
IG~o D 1 y OIi t~_~
,'s~~~`,'.t~~i OA~QRf p
; • Si~IQRI~; .,AND SUBSCRIBED ~T~c~ Y• A.
.'phis CLERK gltgllT
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~ ~COIlO VER1f1E0
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,~s~ - . , . 458334
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~ . otary ublic My coannission expire
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Note to office personnel: ~ a'~
If title was held in an estate by the entireties the entire form is to rr,, `9
be completed. w`
If title was held as joint tenancq it is only necessary that 3, 4, and 5
be completed.
Form Fla-6117 90pK J1~ PIGS ~7eJ~7 _