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Certificate No. 2007
Cf OF SEEBA- TIAN`1
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Yelda Clark
(name)
517 Fleming Street, Sebastian, Fl 32958
(address)
in and for consideration of the sum of $1,400.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit—4— Block 17 Lot—5 & 6
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 1st day of March, 2005.
CITY OF SEBASTIAN, FLORIDA
James A. "Davis —
Interim City Manager
ATTEST.
Sa1YA. Maio, MMC
City Clerk
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
.1„
NOME OF PE4CAN ISIANO
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
FUNERAL HOME: 7:S7,r~.,,-vzLs /-/o-H6
ADDRESS: 7,55' 5ae/7y fZ—coW.-V✓d: S�- 052-'6;9Sr/MN FG.
PHONE* 772-589-z37"
(Check One)
OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TIME:
FOR DECEASED:
Lot Block Unit
Lot Block Unit
Niche Block Unit
F�iD,vN S.ov�.r6E.rWs� zf��
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
Name
a
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 th all fees have been paid:
4 <�s
Cemet ry S xton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT V941
Name M i Sbj Sande-rS ❑ Cash
Date q-1— ' S (gtheck #70-7
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501 362100 Taxable Rent -
001501 362150 Non -Taxable Rent -
450010 369900 Airport Badge
001501 329500 Alarm Permits
001001 218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 369900 Miscellaneous Revenue
001501 359000 Other Fines/Forfeitures
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 344 WO -5 O/G 150.0
fvr VUda C(cu-L
Total Paid 150.0O
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
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