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HOME OF PELICAN ISLAND
Certificate No. 2099
CIn( 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:
Lynne Griswold
(name)
1281 George Street, Sebastian, FL 32958
(address)
in and for consideration of the sum of $1.400.00 is entitled to full intennent rights in
the Sebastian Municipal Cemetery for the following plot/niche:
Unit_4_Block_09_Lot_09,10_
of the Sebastian Municipal Cemetery,
as maintained on t1le in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 15th day of September, 2006.
BASTIAN, FLORIDA
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HOME OF PELICAN ISLAND
#: J097
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for intennent must be
provided at time of purchase
i . Jj
Name(s)
Address
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
OI\lQ ~~~, ~ tL'l-et ~'-----Dollars ($/400.00
. 'f-1l-
on this _I ~ day of
described Cemetery Lot(s) and or Niche(s).
Unit 1- ,Block-L, Lot(s) ~ ~ /0
)
, 20& for the purchase of the following
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 - $20) Opening & Closing ~ 75 I CO
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. ircle One
Vase and Ring for Niches (cost)
Interment
Disinterment
Signature of Purchaser
~ T:AL$/L/15.00
"Iy- f sebasti~
Service fees are to be paid at time of need only
I :\WW -DATA \Ms-Cemetery\RECEIPT .doc
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
3585
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No.
001001 208001
001501 322900
001501 341920
001501 341910
001501 341930
601010343800
001501 343805
~
o Cash
~chJJ~9S'3 7fJ06
Amount Paid
Sales Tax
Garage Sales
Copies/Bid Specs.
LOC/Code of Ordinances
Election Qualifying Fees
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Cemetery Lots . sJI..l.:lL!iL
LotlNiche f.i.La, Block~ Unit~
Cemetery Fees
O/G
$ ,6-tiJ
<t II L '1 c:-Cc
TotalPaid ~
White - Dept. of Drigin. Yellow - Finance . Pink. Applicant
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