HomeMy WebLinkAbout3-48-10j� r I i t t,., O �"► v-�c.. ,�� 1
Name v L�ll�fi}� C1�- ! L. CIA —
Unit `
Block / 1Y
Lot /
Date of Mark -out 7— / 6 — 2,15'
Date of Burial ` — lit— --5—
Name of Furneral Home v C(j
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
ctesta0citvofsebastian.orp,
Funeral Home: Strunk Funeral Home
Address:1623 N Central Ave, Sebastian, FDL 32958
Phone:772-589-1000
(Check)
n Open Burial Lot
Open Cremains Lot
Open Columbarium Niche
Burial Date and Service Time: 7/19 1 pm
Deceased Name: Barbara Patricia Lohman
Unit3 Block48 Lot 10
Unit Block Lot
Unit Block Niche
Name and Signature of Lot Owner or Representative:
(Must provide proper documentation of ownership)
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 F 'recto
Sandy Mastrando 7/14/2025
Print Name iE 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:
Cp- etery / 0 Date
This form is to be provided to Clerk's Office for permanent record upon completion.