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HomeMy WebLinkAbout3-COL-05DnBCITY L -r SE�T�N HOME OF PELICAN ISLAND Certificate No. 2531 CITY OF SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Debora Grillo 6106 Graysen Square Vero Beach, FL 32967 In and for consideration of the sum of $4,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following niche: Unit 3, Blk COL, Niche SDnB of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 14th day of April, 2017. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: 4 aw L__ ' anette William,% MMC City Clerk Name �/ j e.fTh Unit Block G P Lot /,V/i� Date of Mark -out Date of Burial ! /l y / Time Name of Fune Authorized by Vero Beach Crematory, LLC 1830 Wilbur Avenue Vero Beach, Florida 32960 We hereby certify that these are the cremated human remains of: Richard Girard Sansoucie April 10, 2017 (Date of Death) Strunk Funeral Home and Crematory (Funeral Home in Charge) 5044 (Cremation ID Number) April, 14 2017 (Date of Cremation) Sebastian, Florida (City and State) CITY OF SEBASTIAN 10433 ADMINISTRATIVE SERVICES RECEIPT Names +/R,fl O r SRNSOUCIE a Cash DateI�I % heck # 73C- ❑ Credit 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent Amount Paid 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 ?1561 3'%3 lS 9015 VAT6 �iW3" Total Pal • �� kj Initials Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. - Pink - Applicant DEBORA J GRILLO 736 ROBERT J GRILLO BAREFOOT BAY FL 32976 Date Pay to the T!</�t% / 2 w Order of L (✓N �..—P ///fes/C> Dollars © Bank "6,fUs Mat Corr Wdbnka For 04/14/2017 13:06 FUNERAL DIRECT R'S REQUEST TO C' FOR BURIAL OPENING IN SEBASTIAN ML For information contact: Ki Kelso,Cemetery Sex Set astian Municipal Come Phone: (772) 589-2545 Fax: (772) 228-9927 CityClerk's Office -- Cathy City Hall, 1225 Main Stre Sebastian, FL 32958 Office (772) 388-82 5 or 388-8214 ctesta c FUNERAL HOME: atrunK runerai ADDRESS: 1623 North Central Avenui PHONE#: 772-589-1000 (Check One) OPEN BURIAL LOT OPEN CREMAINS LOT XXX- OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME;-` / 6rGJ1'' FOR DECEASED: Richard irardSaLucie Lot Block Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATI (Must provide proper documentation of ownership) Debora Grillo Debora !G611D Name Signature 6106 Graysen Square, Vero SGach,Florida, 32967 1 certify that I have determined the owners ip of the above desorit fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Tim Marvin Name Cemetery Sexton Certification: I certify that I have checked the owner: office and that all fees have been paid: TK Mca u 46696 P.001/001 C that all silty fees and administrative nformation by viewing tljo owner's This form to be provided1to Clerk's Office �y Sexton for permanent [ecord upon and confirming with Clerk's FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, .Cemetery Sexton Sebastian Municipal Cemetery Phone: (772) 589-2545 I Fax: (772) 228-9927 IND �411k City Clerk's Office —Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(a cityofsebastian.or4 FUNERAL HOME: Strunk Funeral Home and Cremator — SEBASTIAN ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) OPEN BURIAL LOT OPEN CREMAINS LOT XXXX OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TI Lot Block Lot Block Unit Niche D/N/B Block--5--Unit 3 N S E W 4/18/2017, Tuesday Time TBD FOR DECEASED: Richard Girard Sansoucie Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Debora Grillo Debora C-v%LLo 4/14/2017 Name Signature Date 6106 Graysen Square, Vero Beach, Florida, 32967 1 certify that I have determined the ownership of the above described site that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Tim Marvin Name TjWL MOJI.Lft Signature 4/14/2017 Date Cemetery Sexton Certification: formation by viewing the owner's deed and confirming with Clerk's I certify that I have checked the ownership in office and that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. rul IV i 1 9 mr I'LL'ASE PRINT IWCEASW NAME: RICHARD GIRARD SANSOUCIE DATE OFMR111: JULY 03 1986 (Month) (Day) (YuLr) DAME U 01- DFA III: APRIL 10 2017 (Month) J)"i} SIGNATURE: PRINT SIGNATURE: l)A'l E: lol — FOR OFFICE USE ONLY i nit 3 DOUble I North I B COLUMBF.R111W (NORTH) array HOME OF FELWAN K AND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. 1110 Name(s) %lUl C�2/a /S�r`{ � t� \juo ;�;zc1CIN FL 32\ IG -7 Address Area code & Nhone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: -- tars ($ +occ>.) on this I + day of t'�' 201'7 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit .3 , Block aL- , Lot(s)--Niche(s) �S'bn Q 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: �o Corner Markers (set of 4 - $20) Opening & Closing. /W O H Circle One Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser I:\W W-DATA\Ms-Cem etery\R E CE I PT.doc Interment Disinterment TOTAL $ 0 �n , o0 City of Sebasti The following documents were provided as Proof of Residency: and goto m oE mgJ 7 7 j DI 41— >18 OW¢e mmm¢ LUO MMU H �i h � 0 0 c � CITY OF SEBASTIAN 10431 ADMINISTRATIVE SERVICES RECEIPT Name( -jt u.l..0 rSi�M(G-, .t IE UCash Date 4ji-t'I7 )CCheck# 731 1 1 n U Credit d4rr .3 S I% 1. OL Lc7r 5a„$ 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 Cho «©I 343g0:5 01c, (DVIDIb �3 WlE Total Paid On tials Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant