HomeMy WebLinkAbout4-13-30bName 46 Q Zw/
Unit
Block
Lot 3 D
Date of Mark -out
Date of Burial ` If Time��'00
Name of Funeral Home
s
Authorized by
a1Y OF
HOME OF PELICAN ISLAND
Certificate No. 2107
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:
Regina Petlowany
(name)
521 Balboa Street, Sebastian, FL 32958
(address)
in and for consideration of the sum of $350.00 is entitled to full interment rights in the
Sebastian Municipal Cemetery for the following plot:
Unit —4— Block 13 Lots-30b-
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 20th day of December, 2006.
ATTE
Sall A. Maio, MMC
City Clerk
03/26/2013 09:58 3212598690 EAST COAST M
ti MIY. ^"
( ll y of Sebastian
1'()'` l r)l l I(J 111)x 7TW127 1) Sl iln':IIAN. I'l()Ii1DA :W'9711
IFE.F')'llt)?)[- (401) r,89 !',;YN) it l AX (4117) 5119 !;S70
PAGE 01102
NOTE: 1111S JS FOR INr0RMA'i'1()NAf, i'U1tf't.liE;i 1lf:t;Afit)1tit; MONUMENTS AT
SFnASTIAN C:EMrl'F.RV:
1 I,EASE fil;'11WN 1'0 f':XTY OF SrUASTIAN
SEHA S't'1AN cTTY 1iAi,i.
1725 MA T N
SRIIA STTAN, f't.. :321i 511
t!
SIZE:
HIS NAME:
D.O.B. . D.O -D -_ -
HER NAME: �� (oV • 1 -
D.O.B. G.-.`J
LEGAL DESCRIPTION:
UNIT;
BLOCK:
LOT:
SQUARE FEET:
APPROVED:
CHECKED BY:
A.
DATE:
BY:
SUBMITTED BY: EAST COAST MONUMENT COMPANY PHONE: 1 -800-274 -1949
EXAMPLE OR
PICTURE
OF MONUMENT IN
QUESTION ATTACHED
°(
-7-72--
Z 2
,�d Total Paid
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4291
RECEIPT
Name �eQ i n a tb u1 Q n v ❑ Cash
Date �' q
r heck# 1.400
No.
Amount Paid
001001208001
Sales Tax
001501322900
Garage Sales
001501341920
Copies/Bid Specs.
001501341910
LDCICode of Ordinances
001501341930
Election Qualifying Fees
601010 343800
Cemetery Lots
LotlNiche�, Block 1.3 Unit
001501343805
Cemetery Fees oo
,�d Total Paid
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
C f IF
SEISAST_"
HOME OF PEUCAN IAAND
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
.��. �.... 7 13 -,3!2 d
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Recei t is acknowledged in the sum of:
. Lk�" " ea ,x Dollars ($350a00 )
on this — day of , 20D((0 for the purchase of the following
described Cemetery Lot(s) and /or Niche(s).
Unit, Block , Lot(s) Niches) 00h
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)
SibrMure of Purchaser
Interment
Disinterment
W O H
Circle One
TOTAL
CI Sebastian
Service fees are to be paid at time of need only
I: \W W- DATA \Ms - Cemetery\RECEI PT.doc
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3696
RECEIPT
c
Name ❑ Cash �1
Date Check #�51
No. Amount Paid
i
001001208001 Sales Tax
�j
001501322900 Garage Sales
001501341920 CopieslBid Specs.
001501341910 LDCICode of Ordinances
001501341930 Election Qualifying Fees
601010 343800 Cemetery Lots LoVNiche Lo -o J Block /m J Unit 11
001501343805 Cemetery Fees
I
C�
Total Paid
'als
White - Dept. of Origin • Yellow - Finance • Pink • Applicant
REGINA PETLOWANY 04 -06
521 BALBOA STREET
SEBASTIAN, FL 32958
63- 1383/670 1005
1100475
O�
1$36a.4Fb
$eEesllen� 3ride 32858
1:0670 L3836i: L L0047 ' L005