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Home My WebLink About3-COL-30DnBName C Unit 5 Block 104 Lot L13. Date of Mark -out Date of Burial�Time Name of Funeral Home Authorized by 01/17/2017 13:22 VERAL DIRIECTOR'S REQUEST TO BURIAL OPENING IN SEBASTIAN I Check #7442 i For Information contai 1 Kip Kelso. CemeteryS9 the amount Sebastian Municipal Cer, (772) 589.2545 $50.00 was pad City Clerk's Office on 5/20/201§ City Nall, 1225 Main SI authorize opening of same. Sebastian, FL 3295 NAME AND SIGNATUF E OF LICENSED FUNERAL DIRECTOR: Office (772) 388-8215 or 3 Tim Marvin Fax: (772) 589-55A FUNERAL HOME: Strunk Funeral Home and Crematory Central Avenue, Sebastian, Florida, 329: ADDRESS: 1623 Nort PHONE#' 772-589-1000 (Check One) OPEN BURIAL �OT OPEN CREMA1ARIUM LOT XXXXXOPEN COLUM NICHE OF BURIAL DATE AND S VICE TIME: 12:30 PM, January 19, 1017 Placem FOR DECEASED: C arles D. Roberts 4- h- pr- (c, e0f I NAME AND 51GNATU (Must provide proper d Rob Roberts E OF LOT OWNER OR REPRESENTATI cumentation of ownership) 1ZaTVR66e#1 Signature : L, Name I certify that I havedete fined the ownership of the above descri site that all fees have been paid an authorize opening of same. NAME AND SIGNATUF E OF LICENSED FUNERAL DIRECTOR: Tim Marvin 1"th q (n Name Signature Cemetery Sexton Certif tion_ I certify that I have checked the ownership information by viewing heownersd office and that all fees have been paid: Cemetery Sexton Date This form to be providel to Clerk's Office by Sexton for permanen cord upon #6364 P.001/001 D)Und 3 ;ONLY at Columbarium 5121)12016 Date fees and administrative 5/20/2016 Date end confirming with Clerk's QIY OF SEBASTIAN HOME OF PELICAN ISLAND Certificate No. 2460 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Charles Roberts 461 Citrus Avenue Sebastian, FL 32958 In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following niche: Unit 3, Columbarium, Niche 30dnb of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 5th day of May, 2015 CITY OF SEBASTIAN, FLORIDA ATTEST: Joseph F. Griffin Sally A. aioo,, MCMC City Manager City Clerk CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT 9890 Name %� {�. IC C7 b e Irk ❑ Cash Date 5' S — L] .heck # ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit - 001501 362100 Taxable Rent - 001501 362150 Non -Taxable Rent - 450010 369900 Airport Badge 001501 329500 Alarm Permits 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 60/olo 3y39-60 3 dol30d.17b 74000.00 Total Paid OWN). 00 Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant MY OF HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Cha-rteS Kober Name(s) LI(o 1 Cr Trus f}ve, Se hc�sfi� �� R- 3Z45S Address C-770-) 2ZR-9550 Area Code & Phond Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: ryW u . 6 (l/�Q✓>�{ ( 0-0 Dollars ($ 0 D O. 0 on this _day of Ma y 20 15 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 3_, Block Co I , Lot(s) Niche(s) '30 d h b 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 - $20) Opening & Closing / W O H Circle One Vase and Ring for Niches (cost) Interment Disinterment Temporary Marker Preparation & Installation Signature of Purchaser I:\W W-DATA\Ms-CemeteryURECEIPT.doc TOTAL$ o2U00• 60 eeji/t`NC � W j&'� of Sebastian The following documents were provided as Proof of Residency: 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) OPEN BURIAL LOT Lot—Block—Unit OPEN CREMAINS LOT Lot—Block—Unit XXXXXOPEN COLUMBARIUM NICHE Niche 30 DNB Block COL Unit 3 N S E W BURIAL DATE AND SERVICE TIME: j 6b FOR DECEASED: Charles D. Roberts Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Rob Roberts 1Zob-1Z&b #-tk 5/20/2016 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: Tim Marvin Name UUriAq qV. cJi akytA 5/20/2016 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: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SEBASTIAN 10088 ADMINISTRATIVE SERVICES RECEIPT Name� V� Q:!� ❑ Cash Date 1,heck #� YC ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees 001501 34-3965- 01c, 45-0 00 U 3 COL Lar :3obgb Total Paid In' ial Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant