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Home My WebLink About3-52-03Name�e_ �o<✓ �� E v�/� Unit Block S-2, Lot 3 Date of Mark -out / / I & Date of Burial // �^� Name of Furneral Home Authorized by Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: Clerk's Office ` � 50oCity add 1 Bridget Eakins City Hall, 1225 Main Street s 0�u Sebastian FL 32958 Ph ne (772) 388-8216 ' 0 beakins(a dwofsebastian.org Funeral Home: Address: M -j em l C� achasiian, R 32-959 Phone: 5� G (Chec Open Burial Lot Unit-3— B1ock52. Lot Open Cremains Lot Unit Block Lot Open Columbarium Niche Unit Block Niche Burial Date and Scrvice Time: Deceased Name: V r9 t timos Ur Name and Signature of Lot Owner or Representative: (Must provide proper documentation of ownership) Q- j4LA1 I d gun= 5 ha5 int Name Signature Date 5� 5, (990 413 - Address Srner�, 82a48 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: Toro _ I I /2.5h r)- 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: /meterryy Date This form is to be provided to Clerk's Office for permanent record upon completion. QrTY0F MEAL 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. Initial Sod placement. Sod will be placed after the ground has settled following the burial to ensure a level surface and proper establishment of the grass. This process helps maintain the overall appearance and integrity of the cemetery grounds. ( -1 1 (01 Initial 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 Sebastian Parks and Recreation Director, 1225 Main Street, Sebastian, Florida 32958. C.R Initial Unlawful Conduct. Our Ordinance states that it shall be unlawful for any person to possess or consume any type of alcoholic beverage within the cemetery grounds. C Initial 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 cemetery of the city. Initial I acknowledge that I have read and understand the contents on this form. CnC'MC �tP\(`n P-Ctrnr1\A-ac,-LlS Signature Date MY OF SEB T- 14 HOME OF PELICAN ISLAND 1225 Main Street, Sebastian, FL 32958 772-388-8209 City of Sebastian Municipal Cemetery Purchase Order C`'c&-h P lca Q�rkcy-i , D Name(s) ��h 3��W1�5 Address 7`15�, 1AY2) 661 Area Code �& Phone Number c-i i5 S McU %NCG\:G 5A 0P I LS McYP F `� c'lLi Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of -�AtA�AC1Gl1C1 Dollars ($ C�() ) on this 2S, day of IV die m�e,,'' 20 J for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit J Block 50� Lot(s) 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 $ TOTAL $ 3 '266 , 6-0i Signature of Purchaser City of Sebastian CITY OF SEBASTIAN 17755 / FINANCE DEPARTMENT RECEIPT ame (.24- tw Cash ate 1(lasi a S ❑r6Check # �T O Credit Amount Paid 01501 362150 Non -Taxable Rent i01001 220000 Security Deposit 101501 362100 Taxable Rent )01001 208001 Sales Tax 150010 369900 Airport Badge t50010 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 Sales 001501343805 CemeteryFees tip_ 480010 341920 Bldg Dept Copies PD Shop with a Cop PD COPE PD Cadets PD SRT Infeals - - — - - Total Pa White - Dept. of Origin • Yellow - Finance opt. • Pink-Appficant