HomeMy WebLinkAbout3-64-08Funeral 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 J
Phone (772) 388-8209
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Funeral Home:._1X 1 Nilh� '--
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Address:74/3S 5 J
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Phone:
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Open Burial Lot
F-1_ Open Cremains Lot
F_ Open Columbarium Niche
Unit Block Lot
Unit_ Block_ Lot_
Unit_ Block_ Niche_
Burial Date and Service Time: ' Y Ills 1 aq r v O IN 1 120Z5 1 I � m
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Deceased Name: _q_,L )Q l A De P-{)6,*
Name and Signature of Lot Owner or Representative:
(Must provide proper documentation of ownership
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r Print Name Signature Date
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Address Whone 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:
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-'Print Name 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.