HomeMy WebLinkAbout4-13-30aName
Unit 1,4
Block
Lot 3o -
Date of Mark -out �,6
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Date of Burial 1� -,? 7 03
Name of Funeral Home
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Authorized by
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CiiY OF
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HOME OF F'ELFUN ISWVD
Certificate No. 2015
CITY 0!~ 5,~ ~ ~z~S~T'~1~:
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 521 Balboa Street, Sebastian, Fl 32958
(name) (address)
in and for consideration of the sum of $350.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 Block 13 Lot 30a
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS 5th day of May, 2005.
CITY QF SEBASTIAN, FLORIDA
James A. Davis
Interim City Manager
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.Maio, MMC
City Clerk
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HOME OF 1'EUUN 6[NND
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
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Name(s) ~ ~
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Address
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Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
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Receipt is acknowledged in the surn of: ~~~o d d
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d c~.(Z ~~~~~C~Q(-' ~ ~ r~~i~~l ~~~ Dollars ($ ~ `" )
on this J:.~_day of , 206 -for the purchase of the following
described Cemetery Lot(s) and/ r ache(s).
Unit ~, Block . /~ ,Lot(s) _~O H 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 - $20) Opening & Closing ~.l . O O W O H
C:irr_le One
Vase and Ring for Niches (cost) Interment
/,j' d Disinterme
TOT~$ C1 ,. d d
Slgn ture of Purchaser
of
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-CemeterylRECEIPT.doc
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Date of Mark-out
Time
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Sebastian, Florida
735 Fleming Street • Sebastian, Florida 32958
www seawindsfh.com
(772) 589-1933
We hereby certify thpt these pre the remains of
THEODORE PETLOWANY
. The remains were received
from SEAWINDS FUNERAL HOME
Cremation Permit No. 05-2617-083 Issued at INDIAN RIVER COUTNTY
Date of Death APRIL 21 2005
Date of Cremation 5 / 2 6 / OS
By SAM COBURN
Cremator
CITY Ctf
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HOME OF PELICAN ISLAND
1225 Main Street, Sebastian, Fl 32958
Telephone (772) 589-5330 -Fax (772) 589-5570
May 5, 2005
Mrs. Regina Petlowany
521 Balboa Street
Sebastian, Fl 32958
Dear Mrs. Petlowany:
Enclosed is City of Sebastian Certificate 2015 for the purchase of Cemetery Lot 30a, Block 13,
Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations governing the
Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
Sin erel , -~
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Sally A. M ' , MMC
City Cler
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enclosure
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3 2 ~ 9
RECEIPT
Name ~'
7L~
~D Cash
®'Check T ~ to
Amount Paid
No. _
001001 208001
001501322900
001501 341920
001501341910
001501 341930
601010 343800
001501343805
Sales Tax
Garage Sales
Copies/Bid Specs.
LDC/Code of Ordinances
Election Qualifying Fees
Cemetery Lots D. O D
LoUNich l10-.., Block ~~ . Unit
Cemetery Fees D ~ D d
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Total Paid /~f~~~
Initials
Whita - Oept. of Origin • Yellow -Finance • Pink • Applicant