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HOME OF PELICAN ISLAND
Certificate No. 2109
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Donald & Mary Lou Whitney 233 Del Monte Road, Sebastian, FL 32958
(name) (address)
in and for consideration of the sum of $1,400.00 is entitled to full interment rights in
the Sebastian Municipal Cemetery for the following lots:
Unit 4_ Block 9_ Lots_15,16_
of the Sebastian Municipal Cemetery,
as maintained on file ~ the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS ls` day of February, 2007.
~v iviulner
City Manager
FLORIDA
ATT
Sally .Maio,
itv Clerk
Q1Y Of
S~,~AS1'iAj~
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HOME OF ~PEUCAN ISIAND
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
!~0 G1 Q ~ ~ ~- f~ It ~ ~ L-O l,C ~~/~l ~ ~ n E. ii
Name(s)
~ .3.3 ,D~ l i'yl o ~ ~te ~da~ ~S~IoQS f r a n : ~ c- 3 Zg 5~
Address
Receipt is acknowledged in the sum of:
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
_,~(, ~ Dollars ($ /`~~0. ~D )
on this ~ ~' day of ~Rv1, uQr , 20 ~ 7 for the purchase of the following
described Cemetery Lot(s) and/or Niche( ).
Unit y ,Block ~~ ,Lot(s) /J~, ~ ~ ~a Niches
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 W O H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
TOTAL $ / ~ 0 ~ , ~' ~
~~ h~ ~ ~ ~
Signature of Purchaser ' y of Sebastian
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-Cemetery\RECEIPT.doc
ONALD M. WHITNEY
MARY L. WHITNEY
233 DELMONTE ROAD
SEBASTIAN, FL 32958
Pay to the
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