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HOME OF PELICAN ISLAND
Certificate No. 2116
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Joan Chatham 945 Louisiana Avenue, 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 lot:
Unit 4 Block 9 Lots 22 & 23
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 28thd day of February, 2007.
CITY OF SEB TIAN, FLORIDA ATT~
/ /
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inner Sall A. Maio, MMC
ity anager City Clerk
aIr a
SE~s~~AN
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NC-ME C+F 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 ~
Name(s)
5
Address
(~~ ~a
Area Code & Phone N
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tuber
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Interment
on this o~ b~ day of , 20~ for the purchase of the following
described Cemetery Lot(s) and/or Niche s
Unit ,Block _~, Lot(s) o~J 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 - $20) Opening & Closing
Vase and Ring for Niches (cost)
ature of Purchaser
Dollars ($ "~~~ • ~(7 )
W O H
Circle One
Disinterment
TOTAL $ a O
- f Sebastian
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-CemeterylRECEIPT.doc