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Certificate # 1947
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Nicholas M. & Carmen Jackson 1337 Scroll St., Sebastian, FI 32958
(name) (address)
in and for consideration of the sum of $2,100.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4_, Block 16 , Lot(s)_3, 4& 5_
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian. �
CONVEYED THIS 25th day of February, 2004.
OF .S�AJS „�TIAN, FLORIDA
�rreric�,,F� Moore
City Manager
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Sall� . Maio, C
City Clerk
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Name
No.
001001 208001
001501322900
001501 341920
001501 341910
001501341930
601010 343800
001501343805
CITY OF SEBASTIAN
CITY C R C6 pOFFICE 2 5 5�
❑ Cash
�[ Check #�_
i�
Amount Paid
Sales Tax
Garage Sales
CopieslBid Specs. �
LDC/Code of Ordinances
Election Qualifying �ees
Cemetery Lots ���C10
LoUNiche �� J , Blodc �, Unit.�
Cemetery Fees
Totai Paid C�(/��
nitials — �T—
Whits - D , Oripfn • Yellow - Fin�nce • Pink • Applicant
S�,BASTIAN
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HOME OF PELiCAN ISIAND
City of Sebastian Municipal Cemetery
Purchase Receipt
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To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase
Name(s
Address
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Area Code & Phone Number
5a wt,
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
on this "�` day of IrQ,lOY'UQI
described Cemetery Lot(s) and/or Nich
Dollars ($ oZ.iDO.� )
, 20� for the purchase of the following
Unit �_, Block �,(�, Lot(s)��,_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
W O H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
TOTAL $ o o � � d
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Signature of P haser f Sebastian
Service fees are to be paid at time of need only
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HOME OF PELICAN ISUIIVD
February 25, 2004
Nicholas M. and Carmen Jackson
1337 Scroll Street
Sebastian, Fl 32958
Dear Mr. & Mrs. Jackson:
Enclosed is City of Sebastian Certificate Number 1947 for the purchase of Lot Numbers 3, 4&
5, Block 16, Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations
governing the Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
�i erely,
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Sally A aio, CMC
City Clerk
SAM:ax
enclosure