HomeMy WebLinkAbout4-31-53wAl Minner
City Manager
HOME OF PELICAN ISLAND
Certificate No. 2285
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:
Steven Bennis 350 Somerset Lane, Marietta, GA 30067
(name) (address)
In and for consideration of the sum of $1,200.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 4, Blk 31, Niche 53w
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 9 day of February, 2011.
CITY OF EBASTIAN, FLORIDA ATTEST:
Sally A. aio, MMC
Ci Clerk
FUNERAL HOME:
ADDRESS:
PHONE
Name
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEBASTENN
HoME OI PF ICAN ISLAND
D
For information contact:
Kip Kelso Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
('►7R) 3 too t
City Clerk's Office
City Halt, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772) 589 -5570
(Check One)
__OPEN BURIAL LOT Lot Block Unit
X OPEN CREMAINS LOT Lot 5 &"J. Block 3 Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME: /it 40/f C L# 7)
FOR DECEASED: fio.'tlrc�; ,ee1V JJ
Name
NAME AND SIGNATURE OF LOT OWNER OR REPR SENTATIVE:
(Must provide p roper documentation of ownership
-tp s i
'1•
Name Signature Date
I certify that 1 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.
Signature Date
Cemetery Sexton Certification:
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
Cerhete(v Sexton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
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Name Sfieu en 23 eh n I S Cash
Date c1-61-11 Check 503 7
No.
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC /Code of Ordinances
001501 341930 Election Qualifying Fees
601010 343800 Cemetery Lots
Lot/Nic 5316/ Block 3 1 Unit 4
001501 343805 Cemetery Fees
Initials
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
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White Dept. of Origin Yellow Finance Pink Applicant
4281
Amount Paid
aoo 00
5 0.v(-)
10
Total Paid 1320.6v
Cf1Y OF
HOME OF PELICAN ISLAND
Certificate No. 2285
CITY OF SEB ST'/ N
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Steven Bennis 350 Somerset Lane, Marietta, GA 30067
(name) (address)
In and for consideration of the sum of $1,200.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
CITY OF SEBASTIAN, FLORIDA
Al Minner
City Manager
Unit 4, Blk 31, Niche 53w
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 9 day of February, 2011.
ATTEST:
Sall Maio, MMC
City Clerk