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Certificate # 1912
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S~BAST'IA,jV
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HOME OF PELIUN ISLAND
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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:
Lorraine Dacey
874 Carnation Drive, Sebastian, F1 32958
(name) (address)
(name) (address)
in and for consideration of the sum of $700.00 ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 15 ,Lot(s) 4
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore. by the City of Sebastian.
CONVEYED THIS 2nd day of September 2003
ATTEST:
Sally A. Mai , CMC
City Clerk
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HOME OF PEUUN ISLAND
City of Sebastian Municipal Cemetery
Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase -~
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Name(s)
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Address '
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Area Code & Phone Cumber
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Residence Address of Intended Occupant if Other Than Purchaser
OfiFice Use Only
Receipt-is acknowledcted in the sum of:
na
~~~- ~ a Dollars ($ ~00 , ~ )
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on this ~ day of , 20 G 3 for the purchase of the following
described Cemetery Lot(s) and/or chefs).
Unit ~ ,Block ~ S ,Lot(s)
7
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: N~~
Corner Markers (set of 4 - $20) Opening & Closing
Vase and Ring for Niches (cost) Interment
W O H
Circle One
Disinterment
_ TOTAL $ /~~
L, ~~~ ~ ~-
Signature of Purchaser City of Se stian
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Service fees are to be paid at time of need only
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HAROLD V DACEY 3~ O3'
,) LORRAIIVE DACEY
874 Carnation Drive 772-589-9623 ss-saa~s~o
Sebastian,FL: 32958. ~ - ~ f _ ~ ~ ewwcr+ooses>
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HOME OF PELiChN ISLh1VD
September 2, 2003
Lorraine Dacey
874 Carnation Drive
Sebastian, Fl 32958
Dear Mrs. Dacey:
Enclosed is City of Sebastian Certificate Number 1912 for the purchase of Cemetery Lot 4,
Block 15, 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.
Sincerely,
~ ~ ,~G(_
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Sally A. Maio, CMC
City Clerk
SAM:ar
enclosure