HomeMy WebLinkAbout4-08-11bFuneral Director's Request to City of Sebastian for Burial Opening In Sebastian
Municipal Cemetery
Contact Information:
Kip Kelso, Cemetery Sexton
Sebastian Municipal Cemetery
1'flOna (TTL) 000-2r4;
Fax (772) 228.9927
City Clerk's Office
Cathy Testa
City Hall, 1225 Main Street
Sebastian, FL 32958
Phone (772) 388-8209
ctesta(Mcitvofsebastian.ora,
Funeral Home: /.6M . Y
Address: /
Phone: -V 2& Y.i.
(Check)
Open Burial Lot
r. Opan Cremains Lot
Open Columberium Niche
Lot_ Block_ Unit_
Lot". Block$ Unit
Nlche Block Unit
(Circlet N S E W
Burial Date and Service Time: 3/�,� / [,#,b ,I
Deceased Nam -*
—
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:
Print Name'/A Signature Dale
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 Cent ation:
;6mdfely5kxtsh'
/
Dat/
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.