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HOME OF PELICAN ISLAND
Certificate No. 2459
CtT x QF SEBBASTUN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Joan T. Norman
434 Royal Tern Drive
Barefoot Bay, FL 32976
In and for consideration of the sum of $2,400.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, Columbarium, Niche 10sn
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 15` day of May, 2015.
CITY OF SEBASTIAN, FLORIDA ATTEST:
KWa
Joseph F. Griffin Sally A. MYo, MMC
City Manager City Clerk
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HOME OF PELICAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
lg � i . N" a(ykR 4
Name(s)
4
3q Rowl4LleOnly2 �PkEl-orrAgV FC 3xct74,
Address
Area
Iq;z — 6l z — v//
& Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
Receipt is acknowledged in the sum of.-
OFFICE USE ONLY
CL
41-4✓e o
r ($ 210U � UO
on this ) 5� day of 20J-6 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit 3 , Block e,0 I , LOt(s) Niches) / , n
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 - $20) Opening & Closing
Vase and Ring for Niches (cost) 0 q, Z.5 Interment
Temporary Marker Preparation & Installation
Signature of Purchaser
I:1WW-DATA\Ms-Cemetery\ RECEIPT.doc
/W O H
Circle One
Disinterment
TOT/A.L,$�pZ��Lf ,
60Ity of Sebastian
The following documents were provided as Proof of
Residency:
PLEASE PRINT
NAME: �OF1N
DATE OF
DATE OF DEATH:
(Month)
SIGNA
1
(Middle)
1 �
(Day)
(Day)
77 x
PRINT
SIGNATURE: _j o R N (, �(
DATE:� / d
FOR OFFICE USE ONLY
Unit 3
Singles / N
COLUMBERIUM:
NICH
1� 6 2 (Y1 R IJ
(Last— )
/932
(Year)
(Year)
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT , 895
Name W1 cNorm 0-f1 L3 Cash
Date - / —/J Url5heck # 3y 2
❑ 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
Co0/0/0 3y3koo n/te,he- 2400.00
vO1501 3y.>fo5 ,We -t r"In y.Z
Total Paid Z'Yt*2.5
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant