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HOME OF PELICAN ISLAND
Certificate No. 2712
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:
Millennium Cremation
RE: Debra Ann Coburn
800 8"' Street
Vero Beach, FL 32962
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 12, Lot 2
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 9th day of September, 2020.
CITY OF SEBASTIAN, FLORIDA ATTEST:
Paul E. Carlisle
City Manager
D#anette Williams, MMC
City Clerk
07111Of
171A
HOME Of PEUCAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser and person for whom lot is intended for interment
must be provided at time of purchase.
hIIIIE,,rrvltA(h 000itA,McAj
Name(s) �`/
80o d�R,�'d Ve2c &,nctl-, FL, 3a9roa
Address 7�a p,n�53�FI -17�7 - S 7
Area Code & Phone Number
JEb2u �� ('o(�tc2n1
Name & Residence Address of Intended Occupant K Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
.IWo `-Niait.Sra,,rn 44(1�d c'GhGO Dollars($ a,CCO o� 1
on this { day ofCJ�P�p
Cemetery Lot(s) and/or Niche(s).
Unit 4 , Block la , Lot(s)
, 20A0 for the purchase of the following described
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:
Corner Markers (set of 4 -$20) Opening & Closina/��• I w O H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
Temporary Marker Preparation & Installation
Signature of Purchaser
I:\W W.DATA\Ms-CemeteMRECEIPT.doc
TOTA $ d,l SC o0
�S
City of Seba I
The following documents were provided as Proof of
Residency:
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIANtd'�
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETEF'
SEBASTIgN
Ph (772) 389-2595 -
rww w r y
For information contact:
Kip Kelso - Cemetery Saxton M
Sebastian Municipal Cemetery \'l�
Ph. (772) 589-2545 y eax (772) 228-9s11 '\l
City Clerk's Office
City HAIL 1225 Main Street
Sebastian, FL 32958
Office (772)r138&9215 or 3e8-8214
FUNERAL HOME r Lid r (tVfJG, tA4 { e'' ^
ADDRESS: (-FD ^7t �`Iz7 Lrl�`i WVU ��I.J-d( H%I I,I vJ c
PHONEM — - / %- .7 Z4t— 11 jp. __ __ _ _• -_— r
(Che 'a O
PEN BURII L LOT Lot Gam- SloCk _jUnit
_OPEN CRE AINS LOT Lot Bloat Unit
—_OPEN COLMBARIUM NICHE Niches —Block —unit
BURIAL DATE ANIIQ SERVICE TIME: / PVA - —11= ��� e7
FOR 6ECEASED:I kJ �Ip 19,A_ A J,3
wame
)DAME AND SIGN URE OF LOT OWNER OR REPRESENTATIV
(Mustprovide propTd`oqumenlafion of owner Ip)
! RAC 'I�IA,1. % /II( \�cyf�S-2-blb
Name ) - Signat re / I 1731e
1 certify that I have elermined the ownership of the above described site that all site east and
administrative fees ave been paid and authorize opening of same
NAME AND SIGNA URE OF LICENSED FUN ECTOR.
Name SignatU 1 0Ile
Cemetery Sexton CGrUficalion:
I certify that I have checked the ownership information by viewing the owner's deed a d confirming
with Clerk's office and that all fees have been paid
Cemetery Sexton I Dale
This form 10 be proviged to Clerk's Office by Sexton for permanent record upon comp) Ilion.
Ld LZ�69ZZZLL re)awao uensegeR 7041'1 dcrin•m
CITY OF SEBASTIAN 12540
ADMINISTRATIVE SERVICES RECEIPT
NameAIIc-N.V/um /Cotbi<eAl ❑Cash
Date glglo10.AO @'CheckR /C. 33
/❑''Credit
Amount Paid
001501 362150 Nan -Taxable Rent
001001 220000 Security Deposit
001501 362100 Taxable Rent
001001208001 Sales Tax
450010369900 Airport Badge
001001 218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 220030 PD SHOP
001501 366602 PD SAFE
001501 366603 PD COPE I
oroty 34390c) /1T_r
(01501 3 43 2os L
I)timµ (31k 3 Lrra �.
�^ Total P t
While - Dept. of Origin - Yellow - Admin. Svcs. - Pink -Applicant