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HomeMy WebLinkAbout3-COL-20SnName Unit Block lim F. Lot .1Y.1 � -SIA( ' Date of Mark -out Date of Burial ,tZ er �' Time o� , Name of Funeral Home Authorized by ANA GONZALEZ Sunday, August 24th, 1924 - Sunday, August 2nd, 2015 crnmor HOME OF PELICAN ISLAND Certificate No. 2452 CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Carlos & Ana Ramon 534 Ponoka Street Sebastian, Fl. 32958 In and for consideration of the sum of $3,200.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following niches: Unit 3, Columbarium, Niches 7dnb & 20sn 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 18th day of February, 2015. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: 61411- �v Sally A. io, MMC City Clerk FUNERAL H ADDRESS! PHONE M FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SE84-T N wnra ntKurnwa 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 i (Check One) _nPEN BURIAL LOT OPEN CREMAINS LOT _X nPEN COLUM9ARIUM NICHE Lot Block Unit Lot Block Unit NicherI Block _ Unit N BURIAL DATE AND SERVICE TIME: FOR DECEASED: 4&/,*' J,o Z l g rvame NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership �K� rum h 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. rvame /✓ 14 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 Cemel ry SeAon Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion from SEAWINDS CREMATORY Sebastian, Florida. IiAr 735 Fleming Street • Sebastian, Florida 32958 www.seawindsfh.com (772) 589-1933 We hereby certify that these are the remains of ANA GONZALEZ #©5 31 SEAWINDS FUNERAL HOME & CREMATORY Cremation Permit No. 15-73380-5181 Date of Death AUGUST 2, 2015 The remains were received Issued at INDIAN RIVER COUNTY Date of Cremation I Bykc'' Cremator CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT ; 932 Name m r d- m rs 0 ✓1 ❑ Cash Date --S---1-1— " L atCheck # 13 % in ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit - 001501 362100 Taxable Rent - 001501 362150 Non -Taxable Rent - 450010 369900 Airport Badge 001501 329500 Alarm Permits 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 00 i5a i 34 Vas (51 156. 0 /ala ,oizc�eL 4"-d � Total Paid /.sa. 00 Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant orr or SFD T, . HOME Of vPELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. CaLrIUS 4 Ana karnvn 53y Pvnoka Yy-reat, Sebastian F& 32958 Address Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of Dollars ($ ) on this day of 20_ for the purchase of the following described Cemetery Lot(s) and/or Ni Niche(s). C'%yin 6 2000. 00 Unit Block Co I , Lot(s) Niches) 2 0 shD, 00 for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. Additional Fees paid at time of purchase: Corner Markers (set of 4 - $20) Vase and Ring for Niches (cost) Opening & Closing Intermen�gC'W&o 0. Temporary Marker Preparation Installa ion n I i-¢ /�� Signature of Purchaser I:1W W-DATA\Ms-Cemetery\RECEIPT.doc of /W O H Circle One Disinterment ,oma-w�ce� TOTAL $ The following documents were provided as Proof of Residency: CRY OF SEBASTIAN CRY CLERK'S OFFICE RECEIPT ❑ Cash [3 -Check# No. 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 CopiesfBid Specs. 001501 341910 LDC/Code of Ordinances COMM 341930 Election Qualifying Fees 601010343800 Cemetery Lots Vn6 Lot/NicheM , Block Unit 001501 343805 Cemetery Fees 4994 Amount Paid Total P Id L? rials White - Dept. of Origin • Yellow - Finance • Pink - Applicant DECEASED NAME: DATE OF =tile, (First) PLEASE PRINT n-24 le -2 (Middle) (Last) 9 DATE OF DEATH: (Month) (Day) (Year) SIGNATURE: ✓�/'l� 2{ PRINT SIGNATURE: DATE: � g -f l mvn FOR OFFICE USE ONLY Unit 3 Singles / N COLUMBERIUM: NICH