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Unit
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Lot
Date of Mark -out
Date of Burial �� 5 Time OD
Name of Funeral Home I/ e"jw&
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SEBASTIA
HOME OF PELICAN ISLAND
Certificate No. 2445
CITY OF SEBASTLAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Nikki Walker
3791 County Street, 2840
Rush Springs, OK 73082
In and for consideration of the sum of $2,400.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, Columbarium, Niche 3 s/n
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 12th day of January, 2015.
CITY OF SEBASTIAN, FLORIDA
Joseph F. GrIffin
City Manager
ATTEST:
Sally A. aio, MMC
City Clerk
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
For information contact:
Kip Kelso Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax: (772) 589-5570
FUNERAL HOME: Strunk Funeral Home and Crematory
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE#:
(Check One) --�( N U 1 f\ V ETE t�
OPEN BURIAL LOT Lot—Block Unit
OPEN CREMAINS LOT
XX OPEN COLUMBARIUM NICHE
Lot—Block—Unit
Niche 3 SN Block Unit 3 COL
N S E W
BURIAL DATE AND SERVICE TIME:
1:00 PM, Monday, January 12, 2015 �) �3\u-\L
FOR DECEASED: Jimmie Lyle Walker
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
William B. Whittaker 01112/2015
Name Signature Date
I certify that I have determined the ownership of the above described site that all site fees and administrative
fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR:
Nikki Walker
Name
Nikki'WaCker 01/12/2015
Signature Date
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's
office and that all fees have been paid:
Cemet Se on Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
STRUNK FUNERAL HOMES & CREMATORY CASH ADVANCE ACCOUNT - SEBASTIAN 7178
1/12/2015
$2400.00
City of Sebastian
1228-15025 Purchase of Niche U3 COL, 3 SN
Walker
SEB - HCB - Cash Advance
Nikki Walker (Deed to his daughter)
3791 County Street, 2840, Rush Springy Oklahoma 73082
405-999-0897
LMP98 M/P CHECK
CITY OF SEBASTIAN
CRY CLERK'S OFFICE
RECEIPT
4972
C
Name . ) Um L / Wct.l k err
❑ Cash
Date - Z ! 5 I
-/
VCheck A I
No.
Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501341910 LDC/Code of Ordinances
001501 341930 Election Qualifying Fees
601010 343800 Cemetery Lots
O -q U
< y� I� I
Lot/Niche Bbck
Unit
�,
001501 343805 Cemetery Fees
:/j 6C) tc,4141YOTotal Paid61 �R �U•�'
Initials
White - Dept. of Origin. Yellow -Finance ePink- Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
4973
Name CC �Jf-ru- k
❑ Cash
Date I
KCheck#
No.
Amount Pald
001001 208001 Sales Tax
001501322900 Garage Sales
001501341920 CoplesSid Specs.
001501341910 LDC/Code of Ordinances
001501341930 Election Qualifying Fees
601010343800 Cemetery Lots
Lot/Niche 3 s n Block I
Un0 3
001501 343805 Cemetery Fees
Total Paid
InlDak
White —Dept. of Origin • Yellow—Finance •Pink Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE - 4979
RECEIPT
Name /\) 1<k I V",�Zj k ❑ Cash
Date -23- Uheck
No. Amount Paid
001001 208001
Sales Tax
001501 322900
Garage Sales
001501341920
Copies/Bid Specs.
001501341910
LDC/Code of Ordinances
001501 341930
Election Qualifying Fees
601010 343800
Cemetery Lots
Lot/Niche Block Unit_
001501 343805
Cemetery Fees
Total Paid -7 5,
Initials
White - Dept. of Origin 0 Yellow - Finance • Pink • Applicant
,)uc;(j h fe r
A/ic/ju(e L/',/dzi /<cr
(5S6) y76 - �y90