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HOME OF PELICAN ISLAND
Certificate No. 2102
CITY
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Mary W. Delisle 373 Columbus Street, Sebastian, FL 32958
(name) (address)
in and for consideration of the sum of $700.00 is entitled to full interment rights in the
Sebastian Municipal Cemetery for the following plot/niches:
Unit —4— Block 9 Lot —7
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 21st day of September, 2006.
IDA ATTE T:
Sal A. Maio, MMC
City Clerk
U.
rnY or
SEISASPAN
HOME OF PELICAN 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, residence of purchaser or person for whom lot is intended for interment must be
provided at time of urchase
mi R—sm
a
.. -
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
(] dC
SO-,, �.tl 9c p L � 5C'
on this c f day of ' 20p for the purchase of the following
described Cemetery Lot(s) and r Niche(s). .
Unit , Block l , Lot(s) r7 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 & Closing
Vase and Ring for Niches (cost)
Signature of Purchaser
Interment
Disinterment
W O H
Circle One
TOTAL $ 00
C'iHf Sebastian
Service fees are to be paid at time of need only
1: \W W- DATA \Ms - Cemetery\RECEI PT.doc
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STATEMENT 47149
f Date j ,
TO 141 f 5 /fi',,
AC7. TERMS
IN ACCOUNT WITH
Stock Form 25812
/fo
Z20
Stock Form 25812
Name irr,
Block
Lot
Date of Mark -out y 1'g! 0
6, �/
/'Ijc� >"
Date of Burial Time
Name of Funeral Home - /- 4.c..i ' A/ /D
Authorized by
Name W Y, ( J tl"JR12 1-6t o Cash
Date 4 —,2 — yR Check # 13053
No. Amount Paid
001001208001
001501 322900
001501 341920
001501 341910
001501 341930
601010 343800
I 001501 343805
Sales Tax
Garage Sales
Copies/Bid Specs.
LDCICode of Ordinances
Election Qualifying Fees n `
Cemetery Lots Dpi t S i e.
Lot(Niche , Block �_, Unit 4— -
Cemetery Fees O/C 150-00
Total Paid
Initials
White - Dept. o origin • Yellow - Finance a Pink • Applicant
day
ski
ly
fro]
low
at 1
ner,
FOF.
Ells;
EL
Marc
Sh
da a
year
BE
wort'
iffs
year.
Corm
Chur
was
churc
volur
Wbee
was
La.;
Mary N isle
may
ian-
;ocie-
Mary (Wright) Delisle, 77,
idian
died March, 31, 2008, at Palm
Ve-
Gardens of Vero Beach.
She was born in Buffalo,
sere
N.Y., and lived in Sebastian
t the
since 1990, coming from Tama -
.ach.
rac.
)mas
She was a retired nurse.
and
Survivors include her chil-
A
dren, Keith Delisle of Sebas-
d at
tian, Darlene Delisle of Holly-
h o -
wood, John Delisle Jr. and
Michigan.
Carol Thomas of Tennessee; 10
grandchildren; and six
great- grandchildren..
She was preceded in death'
by her husband, John - Delisle;
died
son, Douglas Delisle; and
erce
daughter, Michelle Ryder.
SERVICES: A graveside serv-
ice will be at 2 p.m. April 8 at
'esi-
Sebastian Cemetery, Sebas-
tian. Arrangements are by Sea -
Iriv-
winds Funeral Home & Crema-
tory, Sebastian. A guest book
)ns,
may be signed . at
rry
seawindsth.com/obit.php.
day
ski
ly
fro]
low
at 1
ner,
FOF.
Ells;
EL
Marc
Sh
da a
year
BE
wort'
iffs
year.
Corm
Chur
was
churc
volur
Wbee
was
La.;
River
ian-
PORT ST. LUCIE
Amer
rt
Rachel Emmert
EVE
S of
Rachel Emmert, 69, died
Sur
Q 00 and
April 2, 2008.
band,
Fort
She was born in Grandville,
Pierc
and
Mich., and lived in Port St. Lu-
Rowe
.
cie since 1973, coming from
and G
qrv-
Michigan.
Tenn.
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
M..
SESTL"
HOME OF PRKm SW O
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772) 589 -5570
FUNERAL HOME: - i9ut1a,0.F
ADDRESS: 7.3.5
PHONE #: 772- 5,69 --
(Check One)
✓ OPEN BURIAL LOT Lot *_ Block 9 Unit
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME:
FOR DECEASED: IjM
Name I
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Name Si nature 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 authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERA (RECTOR:
Name 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:
X -
O
Cemete Se ton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.