HomeMy WebLinkAbout3-COL-43SnCITY OF SEBASTIAN 17750
FINANCE DEPARTMENT RECEIPT
Name ❑ Cash 7
Date kCheck#L 4a%3W-{
O Credit
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
601010 343800 Cemetery Lot Sells k
001501 343805 Cemetery Fees
480010 341920 Bldg Dept Copies
PD Shop with a Cop
PD COPE
PD Cadets
PD SRT
Amount Paid
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Initials' —
White - Dept. of Origin Yellow - Finance Dpf. • Pink -Applicant
Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian
Municipal Cemetery
Contact lnformation:
Sebastian Municipal Cemetery
Phone (772) 589-2545
Fax (772) 228-9927
City Clerk's Office
Cathy Testa
City Hall, 1225ltAain Street
Sebastian, FL 32958
Phone (772) 388-8209
ctesta@citvofsebastia n.orq
Funeral
Add
Pho
(Check)
Open Burial Lot
Open Cremains Lot
\/ open Cotumbarium Ntcnehd LW
Lot_
Ni
(Circle)
Unit_
unit 3EW
Block_Unit
Lot_ Block_
"n$'*,"""6
Burial Date and Service Time
Deceased Name
Name and Signature of Lot Owner or Representative
(Must provide proper documentation of ownership)
Print 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 authorized opening of same.
Name and Signature of Licensed Funeral Director:
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 Sexton Certification:
Cemetery Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion
Print Name U Sisnature ()