Loading...
HomeMy WebLinkAbout4-11-31Name —&/ ���lf�i� �i�Dts�� / /sx�Y l GJ�G�/✓2/�iNS �Lz�S Unit Block Lot 3 Date of Mark -out 0 // A, I. Date of Burial /;t! // ` ' Name of Funeral Home 5144 )1 4)1.0:5 Authorized by Time i'�/� ' CITY OF SEBASTIAN 10408 ADMINISTRATIVE SERVICES RECEIPT Name tA`^'"NM S I9f-6wN ❑Cash Date I I i l 11-7 'A Check #a `Z 9 a ❑ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees o©1 so t - 34-3 805 `�� U-4 G -n L- 31A Total Paitl , nitials Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Contact Information: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone (772) 589-2545 Fax (772) 228-9927 City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctesta(a)cityofsebastian.org Funeral Home:yEflGtJ/NCpS F,OW -44 110A7E (Check) Open Burial Lot Lot_ Block_ Unit_ `pen Cremains Lot LoLVA Block// Unit &i Open Columbanum Niche Niche_ Block_ Unit_ `/'� (Circle) N S E W V Burial Date and Service Time: 'r4,4zw.*' -A;, /.,y A --4&Y Deceased Name: &Ii�'ZI9/79 C'•`ati?au/.,V/ Se' 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 F r r Director: 'DAYi d W w4twe C & PL L- -Z-, 7x 7 Print Name —awiatuK 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. Silver Sapphire Finish - Silver Velvet- Charpente interior- Removable Life Silver Sapphire Batesville Symbol Corner Pieces $6,655.00 Non -Rusting Copper -32 ounce Cashmere Beige Batesville Champagne Velvet Interior $7,995.00 Steel Blue -20 gauge Aires Blue New Point Light Blue Crepe Interior $3,695.00 18 gauge steel- Brushed red exterior finish with Ivory Velvet Interior - memory safe Silver Claret Batesville drawer $6,655.00 -Solid Oak Goldenridge Oak Batesville Rosetan Crepe $5,495.00 18 gauge steel- Polished Black Exterior- Gasketed —Crepe Interior with swing bar Black Onyx Batesville fixtures $4,495.00 18 gauge steel -White Exterior- Moss Pink Primrose Batesville { Crepe Interior — Gasketed $4,495.00 18 gauge steel- Brushed violet exterior - Violet Bouquet velvet interior with swing bar fixtures $4,895.00 18 gauge steel -Blue Exterior- Light Blue Virgo Blue New Pointe Crepe Interior—Gasketed $3,995.00 Silver Exterior — White Crepe Interior 20 Aries Silver New Pointe gauge carbon steel- Gasketed $3,655.00 Light Purple Exterior— Moss Pink Crepe Aries Orchid New Pointe Interior 20 gauge carbon steel- Gasketed $3,655.00 CITY OF SEEN HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax December 29, 2016 Mr. William Brown, Jr. 841 SW Monica St Port St. Lucie, FL 34953 RE: Interment Rights to Unit 4, Blk-11, Lot 31 Sebastian Municipal Cemetery Dear Mr. Brown Enclosed is City of Sebastian Certificate 2523 entitling you to full interment rights in Unit 4, Blk-11, Lot 31 in the name of William Brown, Jr. If you have any questions, please contact our office at 388-8209. Sincerely, I Cathy TeS Records Clerk Enclosure