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HomeMy WebLinkAbout4-09-180 arroF ~' HOME OF PELICAN ISLAND Certificate No. 2105 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: John H. Brown (name) 626 Fleming Street, Sebastian, FL 32958 (address) in and for consideration of the sum of $2,100.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plots: Unit 4_ Block _9_ Lots_18,19, 20_ 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 30th day of November, 2006. OF ' A~ Minner City Manager FLORIDA ATTEST: --~--- Sally A. Maio, MMC itv Clerk .~J t l ~J v i `~ anrot "~; ` ~~' FY ~~,BAST~ ._ ,: v 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 purchase John H. Brown Names) 62 Fleming Street, Sebastian, FL 32958 Address Area Code & Phone Number Howard E. & Joan M. Brown, 1210 W. Hyacinth Circle, Barefoot Bay, FL 32976 Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: Two thousand, One hundred and no/100-----------------DOIIarS(~2, 100.00 ) on this 30th day of Nov • , 20 06 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit ,Block 9 ,Lot(s) 1s, 19, 20 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) Interment 75.00 Signature of Purchaser W O H Circle One TOTAL $ 2175.00 J,, I y of Sebastian Service fees are to be paid at time of need only Disinterment I :\W W-DATA\Ms-Cemetery\RECEI PT.doc RY OF SEBASTIAN CRY CLERK'S OFFICE 3 6 91 RECEIPT Name Brown ~_~„ Nov. 30, 2006 No. 001001 208001 001501 322900 001501 341920 001501 341910 001501 341930 601010343800 001501 343805 ^ Cash ~Check# 2274 Amount Paid Sales Tax Garage Sales CopieslBid Specs. LDCICode of Ordinances Electlon Qualifying Fees Cemetery Lots LotMiche 18,19,2pglock 9 .Unit 4 Cemetery Fees 2,100.00 Total Paid 2 ,100.00 Inkials White -Dept. Origin • Yellow -Finance • Pink -Applicant i v C! ~1-y ~9 t~c.~ _ M Lam. ~~ 1 IC ~..o T S i$ 1 cam, ~ ao _ t~n.,v~ mom, ~.~.. 19 l.l~q s c M a„~ ~ cl ~o ; ~-~, ~. I J a,.o.w _ ~ a ~ ~ ~~ ~. ~ol-..k ~_ JOHN H. BROWN 626 FLEMING STREET SEBASTIAN, FL 32958 The Order Of ~+ ~ r Y ~^ V /'~ R ~~ ~ ~~;~ Odv~ ~ ~~~ HARBOR, FEDERAL ~g INDIAN RIVER COUNTY DIVISION ss-eais-zs~o . 2 2 7 4 20 ~ ~ ~lD~, ~ ~,,~~~~ ,p ~~ 'K~ Dollars 8 ~„,..,, o For -- -~~~~-- ~ ;~: 267084 i99~: 208000 L4558601 2274 6