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HomeMy WebLinkAbout3-COL-17DS - Pending_. _ - - -- __ _ - __ U ~ ~~ QIY OF SEB~T~V _4 HOME OF VPELICAN ISWVD Certificate # 1928 C QTY 0~~ ~ E B ,~T1 ~c Certificate of In~rment R ~ht~ ~~ a IN ACCORDANCE with provisions oft it is hereby certified that: George F. & Jeatn1 B. Wagner n 620 N. Mi~ror (name) i ' , (addres `~ "' Y (name) i (address) r~ in and for considerati n o h su $1,350 interment rights in the unicipal Cem¢te fo. of the City of Sebastian, Dr., Sebastian, F1 32958 s ur~thased and is entitled to full wing plot: Unit ,Block co , Ldt(s) s of the Se astian Mu ici al Cemete , ,." as maintained,6n file in the r cords of the C Cl rk for use in ordance with e nditi~n , ordinances, resol 'o s, es and regulations prescribed therefore by the C' y of S astian. CONVEYED THIS 17th day of No ember 2003 0 CITY OF SEB STIAN, FLORIDA ATTEST: i " ~~ / ~~ ~` ~- ce oo ~ Sally A. aio, CMC City Manager City Clerk " ~\ I O _ -_ _ - - - - - - - - -- O PLEASE PRINT DECEASED I,' NAME: c-r i ~ (d Cr ~ ~ ~ ~l/ (3 G ~ (First) (Middle) (bast) DATE OF BIRTH: ~ I I 1 `~ ~, 3 (Month) (Day) (Year) DATE OF DEATH: (Month) (Day) {Year) SIGNA YKiPI~I SIGNATURE: DATE: FOR OFFICE USE ONLY Unit s Doubles /South COLUMBERIUM: (South) NICH NUMBER: ~qCT o ~ o OQ ®q gsrro o. ~~,~ CITY OF SEBASTIAN CHECK REQUEST Accounting Use Only Input Date 7/3/2007 Fiscal Period Document # Entered By Document Amount # of Lines Total HC Hash To Be Completed By Department Due Date 7/6/2007 Single Check Y / N Y Vendor Number LN TC Reference Organization Code Object Code Project Code Amount 601011 534959 $1,350.00 Number of Lines Amount $1,350.00 Description Bu back interment ri hts of cemete lot described as Unit 3, Block COL. Lot 17DS. Cop of Certificate # 1928 attached. ISSUE CHECK TO NAME George E. & Jean B. Wagner ADDRESS 620 N. Mirror Lake Drive CITY Sebastian State FL ZIP CODE 32958 DRAW CHECK FROM SEE BELOW APPROVED BY DATE 7/3/2007 BUDGET APP 0 MAIL ATTACHED DOCUMENATION (Except for remit slips, requesting department should attach a copy of documentation along with the original) © OTHER INSTRUCTIONS Please make copy of check for clerk files -Thanks ITY OE 63-643 ': r ~ ~~` ~~°,~J I] ITY OFSEBASTIAN i cH~cK rlo ~ ~ s~o `f~` ~~ wACxovrA 065.273 1225 MAIN STREET ~° 6 S ~ 7 3 ~..~; "'_~~ ~ SEBASTIAN,FL32958 '"~ ~'`"` ' GENERALACCOUNT HOME OF PELICAN ISLA i). VEfJDOR' CHECKDATE CHECKAMOl3NT ?3s~~~ o~/oc/2oo~ $1,350.0 ***~**1, 350 D3I~~RS ,FSJD NO CEI~ITS ,.~,,-~~~ r-. ,~.. I . -P~f,,,-,~STJ~, 31. ~_ PAY ` George ~ . ~ & Jean B . Wagner ID IF'NOT PalDwiTHIN sobavs 520 N. Mirror. Lake Drive TOT+~1= Sebastian- FL 395.8 ORDER` --c~,~~~ ~"" ~Yv~+~,..-, --- -- - ___ ror ~TiJG slCriAXtiRESREC~uI~ED II'06527311' ~:067006432~:20000 2 7 3 1 6 2 9 611' S~ _ - ___ 65273 - -- - _ .. - CITY OF SEBASTIAN SEBASTIAN, FL 32958 0.70607 0 6 5 2 7 3 ~ ~ ~'~ ~ ~~~ ~~~ '~~ irvvvn t uts(;HIPTID~, ~ NET~IP~JVOICE~AMOU<~1T~.~ ' ~~' 07/03/07 Cert---1928 buy back lot cemetery 1,350.00 235741 George E. & Jean B. Wagner 1,350.00 _. - . - - _ ACP4GL 65273 ~~ SE~~T~°~1 __ ~:.~ HOME OF PELICAN ISLAND Certificate # 1928 C' ~ ~ ~ ~ 0~~' ~~~$~~~''f Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: George E. & Jean B. Wagner 620 N. Mirror Lake Dr., Sebastian, F1 32958 (name) (address) (name) (address) in and for consideration of the sum of $1,350.00 ,has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 3 ,Block coL . ,Lot(s) 17Ds of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 17th day of November 2003 CITY OF SEB STIAN, FLORIDA ATTEST: t`~ F ` _ 1.~ ` Z ce oo Sally A. aio, CMC City Manage City Clerk 0 Ur-.. _..._ ~J CITY 4F ~ ti ~r ~,~a.3tUsu. ~~ _... ~ .. ~~~ ~~ P~I.1 0~~~tfi~~ November 18, 2003 George E. & Jean B. Wagner 620 N. Mirror Lake Drive Sebastian, F132958 Dear Mr. & Mrs. Wagner: Enclosed is City of Sebastian Certificate Number 1928 for the purchase of Cemetery Niche 17DS , Columbarium, Unit 3. Also enclosed is a copy of the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sincerely, ~_ n n~yn/ i v "/ ~_~. ~. Sally A. Maio, CMC City Clerk SAM:ar enclosure rnra ~'~ FIOME OF PELICAN ~ISIAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase E ~ rQ ~ ~ . -~- ~C' Q `1 g f InIQ~ ~1 e r Name(s) -~ `-~ ~~~. D ~ o . /1/l i r ro r fake ~b ~, ~G~aS ~i Qn ~ L 3a-~ 5 ~ Ad ress -t~~)~~~-9~3g7 Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: /~ Dollars ($ r/~. ~ ~ ) k}I~ u v ~ on this j ~ day of N~ U ~ , 203 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit ~_, Block ~, Lot(s) Niche(s) ~ 7 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 Vase and Ring for Niches (cost) Interment W O H Circle One Disinterment TOTAL $ ~~ ~ ~~ ~j n ~ ~Q f ~ ,c Signature of Purchaser t of Sebastian Service fees are to be paid at time of need only I:1W W-DATA\Ms-CemeterylRECEIPT.doc PLEASE PRINT ~Op~y DECEASED NAME: ~~ A ~ ~ . ~,'U 1q'~ E I~ (First) (Middle) (Last) DATE OF BIRTH: 'y- ~ g 1 ~ .~ 11- (Month) (Day) (Year) DATE OF DEATH: SIGNATURE: (Month) (Day) (Year) PRINT SIGNATURE: DATE: FOR OFFICE USE ONLY Unit 3 Doubles /South COLUMBERIIJM: (Suuth) ,+ ~' NICH '' 4., NUMBER: 1 ~ C~~p~ PLEASE PRINT DECEASED NAME: CY~~(~G-~ ~. ~(3G~L'r'1 (First) (Middle) (Last) DATE OF BIRTH: ~ I I l ~ ~, 3 (Month) (Day) (Year) DATE OF DEATH: (Month) (DaY) (Y~) SIGNA PR[N"1' SIGNATURE: DATE: FOR OFFICE USE ONLY Unit 3 Doubles /South COLUMBERIUM: (South) ~ _.. NICH NUMBER: t a "~ , ~ e ~ a C, i~FiL~~ R~~ q ` v EORGE E. WAGNER ~~-as JEAN B. WAGNER 620 NORTH MIRROR LAKE DR PH. 561-388-9397 SEBASTIAN, FL 32978-1534 2456 l ^ 63-8419/2670 {~~ ~ ! ~ 3 DATE BRANCH 008 ~ . p-o 8 B.<u r;,y Feeluras Ds~ule on Beck. FOR t,[ ~; ~I k ~~5, Na ~ ~ .~ ~~ ~. x:267084 L99~:2 2 30000 7 366 L II^ 2456 ®HAgIANU 2000 nHntsvn t,~ud Sebastian, PL 32958