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Home My WebLink About4-03-37from Sebastian, Florida 735 Fleming Street • Sebastian, Florida 32958 www.seawindsfh.com (772) 589-1933 We hereby certify that these are the remains of 46501 FAY HALLENE KICIA SEAWINDS FUNERAL HOME & CREMATORY The remains were received Cremation Permit No. 17-73380-5082 Issued at BREVARD COUNTY Date of Death APRIL 3, 2016 Date of Cremation 4-6-2016 gy Cremator w Name rnd Unit Al Block 43 Lot 3 � Date of Mark -out Date of Burial / %� Time- Name ime Name of. Funeral Home. c� Authorized by FRIVE:rffualawc4ty"TA April 26, 1947 - April 3, 2016 CITY OF SEBASTIAN HOME OF PELICAN ISLAND Certificate No. 2495 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: Robert & Fay Kicia 1392 Thornhill Lane Sebastian, FL 32958 I In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Block 3, Lot 37 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and it regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 16th day of March, 2016. I CITY OF SEBASTIAN, FLORIDA ATTEST: I I� Joseph F. Griffin Sally A. M.io, MMC City Manager City Clerk CMIY of 1- HOME Of PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. P01)(2-i'l f 6, i Name(s) / 3q2._ norrth ( La4ne_ Se.bosti (An F 3zg58 Addres ( ITZ) 38$ — 693c/ Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: &" AB"444Glc A /010 J Dollars ($ /COO, U1) ) on this / fk day of el rc h , 20 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit L/ , Block 3 , Lot(s) 3 7 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 /W 0 H Circle One Vase and Ring for Niches (cost) Interment Disinterment Temporary Marker Preparation & Installation TOTAL $ I COO, /at„,/ ( /A-10,±6 Wid-h-OLVV-) Signature o 'urchaser y of Sebastian The following documents were provided as Proof of Residency: /� I:\WW-DATA\Ms-Cemetery\RECEIPT.doc Pap 14p p iui 5 p C.Q b CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT `, t Name Kicia Family ❑Cash Date 3-16-16 Check# U" (Z Li 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 _ 001501 341920 Copies 001501 369900 Miscellaneous Revenue 001501 359000 Other Fines/Forfeitures 001501 351140 Parking Citation 001501 342100 Police Security Services 601010 3 4 3 8 0 0 Cemetery Int _t,000-00 `➢"� Total Paid 1°�•� I ials White-Dept.of Origin • Yellow-Finance • Pink-Applicant CITY OF SEBASTIAN 10069 ADMINISTRATIVE SERVICES RECEIPT Name ❑ Cash Date heck It C Aa D 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 QO1501 - 3�-3505 0 C. jam- c� Total Paid Initials Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. - Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SERASTKN HOME OFPEOGNISUFdI For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery (772) 589-2545 City Clerk's Office City /iak 7225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax. (772) 589-5570 FUNERAL HOME: ADDRESS: PHONE#: 772 - /9.13 _i (Check One) OPEN BURIAL LOT PEN CREMAINS LOT OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME: FOR DECEASED: Name Lot Block Unit Lot Block Unit Niche—Block—Unit N_S E_W_ 7Z NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of pin 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 )aA Name (I /C Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confining with Clerk's office and that all fees have bee24- Q 121. C ete Se n Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion.