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HomeMy WebLinkAbout3-76-05Name _� /G & Unit Block Lot %.J Date of Mark -out /0 13 Date of Burial %l/ �/ Time 2 ✓ Name of Funeral Home Authorized by CITY OF SEBASTIAN 10939 ADMINISTRATIVE SERVICES RECEIPT NamestRuNr_ / LU_LICW r Cash Date 1c Jo " 1�7 Check # % 7 5 ❑ 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 polSo► 34_3?C5 0/ C, >Sp,oa Ogrr 3 AIK'76 Ltr S L�— Total Pail ls- 1®C Initials White -Dept. of Origin -Yellow -Admin. Svcs. • Pink -Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(a)citvofsebastian.org FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) XXXX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TI FOR DECEASED: Name Lot-5—Block-76–Unit 3 Lot—Block—Unit Niche Block Unit N S E W 11/7/2017, TUESDAY, 2:00 PM Committal Service (graveside) NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Steve Lulich Steve L-Ldi,ch 10/30/2017 Name Signature Date P.O. Box 1390, Sebastian, Florida, 32978 1 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 TK Amu 10/30/2017 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. For information contact: Kip Kelso, Cemetery Sexton FGl1ji�� Sebastian Municipal Cemetery Phone: (772) 589-2545 Fax: (772) 228-9927 City Clerk's Office - Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(a)citvofsebastian.org FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) XXXX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TI FOR DECEASED: Name Lot-5—Block-76–Unit 3 Lot—Block—Unit Niche Block Unit N S E W 11/7/2017, TUESDAY, 2:00 PM Committal Service (graveside) NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Steve Lulich Steve L-Ldi,ch 10/30/2017 Name Signature Date P.O. Box 1390, Sebastian, Florida, 32978 1 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 TK Amu 10/30/2017 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. 10/30/2017 15:05 FUNI-RAL DI FOR BURIAL C Office (772) FUNERALI ADDRESS: PHONEM _ (Check One) XXXX OPEN BURIAL LOT S REQUEST TO C:" OF IN SEBASTIAN MLJNICIPI For Information contact: Ki P Kelso, .Cemetery Sean Se astian Municipal Came Phone: (772) 589-2545 Fax. (772) 228-9927 OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TI FOR DECEASED: NAME AND SIGNATURE OF LOT OW (Must provide proper documentation of Steve Lulich Name P.O. Box 1390, ,9oastian, Florida, 32978 1 certify that I have determined the own fees have been paid and authorize ope NAME AND SIGNATURE', OF LICENSE Tim Marvin Name 1 Cemetery Sexton Certification: I certify that I have checked the ownership office and that all fees have been paid: ark's Office — Cathy r Hall, 1225 Main Str Sebastian, FL 32958 or 388.8214 ctestai 32958 ,TUESDAY, OR REPRESENT, Signature ip of the above descrit i of same. UNERAL DIRECTOR: TM M=K Signature by viewing 97181 P.001/001 ETERY Service (graveside) that alllsld$ fees and administrative /O -PV//? Cemetery r4 xtbn Date This form to be provided to Clerk's Office ty Sexton for permanent rd upon confirming with Clerk's CRYOF HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772)589-5330 Phone (772)589-5570 Fax July 7, 2016 Steven Lulich 1069 Main Street Sebastian, FL 32958 RF: Interment Rights to Unit 3, Block 76, Lots 3, 4, 5, Sebastian Municipal Cemetery Dear Mr. Lulich, Enclosed is City of Sebastian Certificate 2509 entitling you to full interment rights in Unit 3, Block 76, Lots 3, 41 5, in the name of Steven Lulich. If you have any questions, please contact our office at 388-8209. Sincerely, Cathy Te Records Clerk Enclosure Certificate No. 2509 CPT)(SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Steven Lulich 1069 Main Street Sebastian, FL 32958 In and for consideration of the sum of $6,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 3, Block 76, Lots 3, 4, 5 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 6th day of July, 2016. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: anette Wi lianps, �Wl City Clerk • .moi i i E 9 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. Name(s) ,S ou L %.k Address 9 Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: l S,4-r�1� C o�1 Dollars( $ 6)10 00 } on this 6 "-� day of , 20 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 3 , Block r76 , Lot(s)3-4-S'- Niche(s) 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) Temporary Marker Preparation & Installation Signature of Purchaser I :1W W-DATAWs-Cem eterylRECE I PT.doc Interment /W O H Circle One Disinterment TOTAL $ City of Sebastian The following documents were provided as Proof of Residency: and CITY OF SEBASTIAN 10102 ADMINISTRATIVE SERVICES RECEIPT Name L—.l' " D Cash Date 7 KCheck #� 0 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 (4 a 1 © I(_) s- 343 Soo aov . °O Uarr AtX Ns LM - 4_0*0 (eo 00. d� Qq Total Paid 160 Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. - Pink - Applicant