HomeMy WebLinkAbout4-38-02AName
Unit 7
Block 3
Lot
Date of Mark -out Z�
*7*.14S
Date of Burial !� /� / �?� Time : oD �r •�
Name of Funeral Ho
Authorized by
from
Sebastian, Florida
735 Fleming Street • Sebastian, Florida 32958
www.seawindsfli.com
(772) 589-1933
We hereby certify that these are the remains of
SYLVIA D DOROTHY
y 1l The remains were received
SEAWINDS FUNERAL HOME & CREMATORY
Cremation Permit No. 17 — 7 3 3 8 0 — 51 91 Issued at INDIAN RIVER COUNTY
Date of Death SEPTEMBER 25, 2 01 7
Date of Cremation 2 By '
Cremator
Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian
Municipal Cemetery
Funeral Home:
Address:
Phone:
(Check)
Open Burial Lot
Open Cremains Lot
Open Columbarium Niche
Burial Date and Service Time:
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 a0cityofsebastian.org
Lot_ Block Unit—
Lot-:&(&) Block 39 Unit
Niche_ Block_ Unit_
(Circle) N S E W
Deceased Name: v 1✓: `/�0 20% ifY .
Name and Signature of Lot Ow or Representative:
Must providesproper document n of ownership) `O/f
4967-a
%-
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 Funeral Director:
'OV 14 .
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 Sexton Certification:
Cemetery Eexton � Date lz/,
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
an Cf
SERAsin,AN
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, FL 32958
(772) 589-5330 Phone
(772) 589-5570 Fax
October 4, 2017
Ms. Dianna Faye Grant
7945 96th Avenue
Vero Beach, FL 32967
RE: Interment Rights to Unit 4, Block 38, Lot 2a, Sebastian Municipal Cemetery
Dear Ms. Grant,
Enclosed is City of Sebastian Certificate 2548 entitling you to full interment rights in
Unit 4, Block 38, Lot 2a in the name of Dianna Faye Grant.
If you have any questions, please contact our office at 388-8209.
Sincerely,
Cathy T
Records Clerk
Enclosure
My OF
SEBASTIAN.
HOME OF PELICAN ISLAND
Certificate No. 2548
MY OF SEBA S- TI N
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Dianna Faye Grant
794596 th Avenue
Vero Beach, FL 32967
In and for consideration of the sum of $500.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 38, Lot 2a
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 25th day of September, 2017.
CITY OF SEBASTIAN, FLORIDA
Joseph F. Griffin"
City Manager
ATTEST:
d�tif4LHf �kkl- a
anette Williams,
City Clerk
CRY Or
SERASTIAN 6�54
HOME OF PEUCAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
r4a h4q e
Name(s)
Address
Area Code & Phone Number
Name & Residence Address of I
Receipt is acknowledged in the sum of:
W
Uther I han Purchaser
OFFICE USE ONLY
Jars ($ Soo. oa )
on this e2a_day oftSL—PT- 20 P-7 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit + Block 3g , Lot(s) C� A 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:
ov
Corner Markers (set of 4 - $20) Opening & Closing G •
Ci cle ne
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Instal
- 7
ignature of Purchaser
I:\W W-DATA\Ms-Cemetery\RECEIPT.doc
Interment
Disinterment
TOTAL
City of
The following documents were provided as Proof of
Residency:
CITY OF SEBASTIAN 10928
ADMINISTRATIVE SERVICES RECEIPT
Name G i6 -,4,j- — ❑ Cash �
Date `T -X5 - 1-7 Cp1
oheck # �
❑ 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
4�40 (ooto1c 313Qoo Ler SOC.as
no I � DI 3+f3 905' oI C,
11mrr 4 Ali< 3g L-&rAA
0_0 Total Paid
Initials
White - Dept. of Origin • Yellow - Admin. Svcs. • Pink -Applicant