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COUN TY OF j~v v~~ )
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STATE OF )
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_~~u\c~ x:~ .~'1C~n hr,1 ~ , being first duly sworn
ep ses an says:
1. That ~r~ ~'9laze4~~k, died on the ~~--~1
T
day of ,~v'l, , i9 (~,
,....~~~.t
2. That affiant and d'eceased were jointly nawed as pur-
chasers under the following contract(s):
,
CONTRACT N0. LOT(S) BLOCK SU6DIVISION
8ooq 3'~ t 3 t 4~ y SEc~'~on S~
. ~T ST ~-v~~
3. That this affidavit is being ~ade for the purpos,e of
transferring the above nua~bered contract(s) to the
survivor.
AND FURTHER DEPOHENT SAYETH NOT.
,
` ~~~1Ll~ll.,r~
gnature
Subscribed and sworn o before ~e
~"'~"'~"'~~A~ his day of , A.D., I9~
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RE~OORD & REI[J~I T0: Garirorywealth Iand Title,
422 Colorado Ave., Stuart, Fla. 33494.
(File No. G-U18-7685T).
- 5163~30
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~TGGER FGt i RA5
CLEFK CI4Cl'IT C~~
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Form #111
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