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Home My WebLink About3-70-04Name Y �!'"Y\ CO L Unit 13 Block 740 Lot I/ Date of Mark -out ,J 0 cs-- ;-07-5— Date of Burial S— / �7— -I_o Z_ Name of Furneral Home Authorized by Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 cI ctesta0ciwofsebastian.ore Funeral Home:(_)�G,�A lt)Q_S Fi)r) ml Home Address: ' I M J 1—L ► as-hN n o 11 Phone: I (Chec Open Burial Lot Unit Block Lot4_ 7_ Open Cremains Lot Unit_ Block, Lot_ = Open Columbarium Niche Unit Block Niche Burial Date and Service Time: Wrn IV ' Ido Masi Deceased Name: LN an a KA C (�rt t _ _ Name and Signature of Lot Owner or Representative: /��, ^ac 1 I^ e (Must provide proper documentation of ownership) U o� Print Name Signature Date Address Phone Number I certify that I have determined the ownership of the above -described site that all site fees and administrative fees have been paid and authorized opening of same. Name and Signature of Licensed Funeral Director: T(IM <S ZW I . q �_1U_ L v _ ,511 � 1207� Print Name `l Signature Date 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 Certification: Cemetery Date This form is to be provided to Clerk's Office for permanent record upon completion. crrY OF S]Fj5ASTj�N HOME OF PELICAN ISLAND Certificate No. 2984 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: Stephen J. Johnson 956 Riviera Ave Sebastian, Florida 32958 In and for consideration of the sum of $2,850.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 3, Block 70, Lot 4 of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 121h day of May, 2025. CITY OFFSSEBBASTIAN, FLORIDA G� Brian Benton l• City Manager ATTEST: nette Williams, MM� City Clerk — _ orvor AST!�N HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FL 32958 772-388-8209 City of Sebastian Municipal Cemetery Purchase Order Name(s) S-zba-b T�A1 3;z,70? Address 77A -aa2-got0- Area Code & Phone Number - LyQlsr& M • &2ET'ri Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt its acknowledged in the sum of: �Y Dollars ($ �?o on this day of 20 r-�5r for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit Block /6 Lot(s)Y_ 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: Opening & Closing fee for ceremony after hours or on holiday. $ Disinterment Fee $ Vase and Ring for Niches (current market price) $ TOTAL $ cZ 2 SO. o0 ignat a of Pu aser City of Seb is CITY OF SEBASTIAN 17 016 FINANCE DEPARTMENT RECEIPT Name Wow 11san p Cash Date �"Check # T� f7 7 Credit Amount Paid 001501 362150 Non -Taxable Rent 001001 220000 Security Deposit 001501 362100 Taxable Rent 001001 208001 Sales Tax 450010 369900 Airport Badge 450010 362521 AP Shade Hangar Rent 450001 208045 Airport Sales Tax 001501 347557 Community Center Revenue 001501 341920 General Fund Copies 001501 354100 Code Enforcement Fines Cemetery Lot Sales a, �� • 6l 601010 343800 001501 343805 Cemetery Fees 480010 341920 Bldg Dept Copies PD Shop with a Cop PD COPE PD Cadets PD SRT 3 (31 VC 70 L,61ric, Total , D 9• 00 Initials I White - Dept. of Origin - Yellow - Finance Dpt. - Pink - Applicant OTYLf SEBASTIAN u HOME OF PELICAN ISLAND Sebastian Municipal Cemetery Artificial and fresh flower, blankets. No more than two bouquets of artificial or fresh flowers will be allowed at any gravesite. Artificial flower arrangements will be permitted to remain until they become faded or unsightly. Fresh flowers will remain until unsightly. No glass or ceramic flower containers or ornaments shall be allowed, however, a plastic flower container no more than six inched deep, six inches wide and 24 inches long may remain in place unless broken or in decrepit condition. No wires shall be allowed to hold flower arrangements permanently in place at the interment site. Blankets are allowed to be placed prior to any holiday but must be removed within ten days following the holiday. min Permanent Markers. All markers shall be installed within 120 days after burial. Where this regulation renders a hardship or presents any special problems, such as an estate not settled, special consideration will be given. Request for special consideration should be make in writing to the Sebba4tian Leisure Services Director, 1225 Main Street, Sebastian, Florida 32958. In Unlawful Conduct. Our Ordinance states that it shall be unlawful for any person to possess or co a any type of alcoholic beverage within the cemetery grounds. Initia Violations of article; penalties. A violation of any of the rules and regulations contained in this article shall be considered a violation of the ordinances of the city, and any person adjudicated in violation of such rules and regulations shall, in addition to any penalty imposed by court not exceeding $500.00 fine and/or not exceeding 90 days imprisonment, be denied the right to do further business in the metery of the city. Initi I acknowledge that I have read and understand the contents on this form. Sign .5A '�)ao,- 5L Date , IFY OI SEBATN HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 388-8216 beakins@cityofsebastian.org May 13, 2025 Mr. Stephen J. Johnson 956 Riviera Avenue Sebastian, FL 32958 RE: Interment Rights in the Sebastian Municipal Cemetery Dear Mr. Johnson, Enclosed is City of Sebastian Certificate 2984 entitling you to full interment rights in Unit 3, Block 70, Lot 4. I have also enclosed a copy of the Sebastian Municipal Cemetery Rules and Regulations Booklet. If you have any questions, please do not hesitate to contact me at (772) 388-8216. Sincerely, Bridge Executive Assistant Enclosures