HomeMy WebLinkAbout3-COL-30DSACRY OF
HOME OF PELICAN ISLAND
Certificate No. 2190
CITY OF S BBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Richard R. Lewis 897 Haverhill Ave., Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, COL, Niche 30113SA
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 19th day of August, 2008.
CITY OF, SEBASTIAN, FLORIDA
Al Minner
ty Manager
ATTEST:
Sall . Maio, MMC
City Clerk
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 8 4 8 8
Police Security Services
001501 359000
4nrla
l ew\A-
Name
❑ Cash
Date 4' q` 13
❑ Check #
v-CM IT CA42D
Amount Paid
001001 208001
Sales Tax
001001 220000
Security Deposit -Com. Center
001001 220000
Security Deposit -Yacht Club
001501 322900
Garage Sale Permit
001501 329500
Alarm Citation
001501341920
Copies
001501 351140
Parking Citation
001501 354100
Code Enforcement Fines
001501 342100
Police Security Services
001501 359000
Other Fines /Forfeitures
001501 362100
Rent - Royalties/ Com. Center
001501 362100
Rent/Royalties/Yacht Club
001501 362150
Park Rent/Pavilion /Elect
001501 369900
Other Miscellaneous Revenue
00,1501393910�r
17 1
44N4, Total Paid
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE /• O
RECEIPT 4
Na me ui ❑ Cash
Date f Check #
No. / Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501341920 Copies/Bid Specs.
001501341910 LDC /Code of Ordinances
001501341930 Election Qualifying Fees
601010 343800 Cemetery Lots
LotlNiche 30", lock , Unit
001501343805 Ce ery Fees p
Total Paid �
White — Dept. of Origin • Yellow — Finance • Pink - Applicant
Katherine G. Lewis
Katherine G. Lewis, 70, died Aug. 19, 2008, at her home. She was born in the
Bronx, N.Y., and moved to Sebastian 22 years ago, coming from her birthplace.
She was a housewife. Survivors include her husband of 46 years, Richard R.
Lewis Sr. of Sebastian; sons, Richard R. Lewis Jr. of Sebastian, John Mott and
James Mott, both of the Bronx, Joseph Mott of New Windsor, N.Y.; daughter,
Theresa Mott of Sebastian; 12 grandchildren; and 12 great grandchildren.
SERVICES: A memorial service will be at 1 p.m. Aug. 22 at Seawinds Funeral
Home, Sebastian. Inurnment will follow at Sebastian Cemetery. A guest book
may be signed at Seawindsfh.com /obit.php.
U3 Coy AJ'Chc 30 0 ,5,q
Name r ' / A r f ( r._. " ( ` /
Unit
Block rC
Lot Z) A:
Date of Mark -out
Date of Burial' Time
J 1 ,J F /
Name of Funeral Home
Authorized byC
---- - - - - --
CITY CLERK'S OFFICE 416 7
RECEIPT
` s
`3
Name
Date
❑ Cash
No.
Amount Paid
001001 208001
Sales Tax
001501322900
Garage Sales
001501 341920
Copies/Bid Specs.
001501341910
UDC /Code of Ordinances
001501341930
Election Qualifying Fees
Lots
��y�y
�J. 49450—
601010 343800
Cemetery
Lot/Nich�, Block Unit
001501343805
Cemetery Fees
Q'� I Total Paid
Initials
White - Dept. 0 1 1 low - Finance • Pink . Applicant
Name /i/l�n��2t^/ rS \ <�2f r✓Ixlrhl to g
Un
Lot
Date of Mark -out
Date of Burial 7. � /�-7 - Time L ro 0 sl�.e /1 ✓/i 51 D L /
Name of Funeral Home
Authorized by lam
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEBAST AN
HOME O+ CEttC+N ISIAND
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772) 589 -5570
FUNERAL HOME:
ADDRESS'
PHONE #:
(Check One)
OPEN BURIAL LOT Lot Block Unit
OPEN CREMAINS LOT Lot _Block Unit
_7Z_SJPEN COLUMBARIUM NICHE NicheD 0 Block Unit
W
BURIAL DATE AND SERVICE TIME:
FOR DECEASED:
ivame
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Name Signature Date
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.
Name 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
Ceme ery S ton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
CM Of
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HOME Of PELICAN ISLAND
City of Sebastian Municipal Cemetery Purchase Re
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
b-N,>
Names)
Address �i \ r
Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt Js acknowledged in the sum of:
_7�4vj" "�� "' - tx'4
J/
y �0�v
Dollars ($
on this l 44- day of w . , 200r or the purchase of the following described
Cemetery Lot(s) and /or Niche(s).
Unit _3 , Block U� - , Lot(s
Niche(s)
3a J S./4
for use in accordance with the conditions, ordinances, resolutions, rules and regulations pres
therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Corner Markers (set of 4 - $20)
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
Signature of Purchaser
Opening & Closing 9l' / / W O H
irCie One
Interment
Disinterment
TOTAL $-
City of Sebastian
The following documents were provided as Proof of
Residency:
is \wW - DATA \nits - Cemetery \RECEIPT.(_ioc I and
OD"!