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Certificate No. 2169
CITE 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:
Joseph Vicari 743 Horizon Terrace
/or Gloria Dimeo Vicars Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $3,200.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niches:
Unit 3 Block COL_Niches_14 /S /S /A 15 /D /S /A_
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 12 day of March, 2008.
BASTIAN, FLORIDA ATT
Al Minner
C y Manager
Sally Maio, MMC
City Clerk
Name J o 'Q 11-
Unit
Block C o
Lot
ALL COUNTY FUNERAL
Home Crematory
Treasure Coast Chapel
1010 NW Federal Hwy.
Stuart, FL 34994
Joseph Viciari
axe5)
Date of Mark -out �y
Date of Burial 7n /1 Time 1 00 CIA(Z51T>g;
Name of Funeral Home PP/ 1.
Authorized by 1k 1J t i �A..( 1� v►'
S1160707
ALL COUNTY FUNERAL
Home Crematory
Palm Beach Chapel
1107 Lake Avenue
Lake Worth, FL 33460
We hereby certify that these are the cremated remains of:
Cremation Permit No. 412434160707 Issued at Indian River
Date of Death April 25, 2011
Cremation No. 11 37545
Date of Cremation It 1 By
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FUNERAL HOME:
ADDRESS:
PHONE
(Check One)
__OPEN BURIAL LOT Lot Block Unit
E�N CREMAINS LOT Lot rBlock Unit
PEN COLUMBARIUM NICHE Niche /Block Unit 3
W
BURIAL DATE AND SERVICE TIME: S� e /jy g 'oo�j
FOR DECEASED: 5,t J 4
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Name
AV
I certify that I have determined the ownership of the above described site that all site fees and
administrative fees have been paid and authorize opening of same
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR.
4
N ame
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
HOME a rItKum rump
For information contact:
Kip Kelso Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, F L 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772)'589 -5570
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Signature Date
Signature Date
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming
with Clerk's office and that all fees have been paid
1-/tv„
e ex on Date f
Cem ry,�
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.