HomeMy WebLinkAbout4-15-06
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HOME OF PELICAN ISLAND
Certificate # 1925
Certificate of interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Glen G. Rohm 1614 Coral Reef Street, Sebastian, Fl 32958
(name)
(name)
(address)
(address)
in and for consideration of the sum of ~ 2 , 800.00 ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 15 ,Lot(s) 6 , 7 , 8 & 10
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 13th day of November 2003
OF SE STIAN, FLORIDA ATTEST:
~~ .~cC. ~~.~'-a~~- min
ry
Te nce R. ]~GI e'''~ ~1 f Sally A. Maio, CMC
City Manager City Clerk
O O,
®HARLANG PRESTIGE
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CITY OF SEBASTIAN
tTY CLERK'S OFFICE 2 2 ~ ~
RECEIPT
Name
Date ^ Cash
~ heck # ~~
No. Amount Paid
0010 208001 Sales Tax
001501 322900 Garage Sales
001501 341920 CopieslBid Specs.
001501 341910 LDC1Code of Ordinances
001501 341930 Election Qualifying Fees
601010 343800 Cemetery Lots
001501 343805 p ~
LotlNiche Block ~, Unit ,
Ce ~~ Fee/ ~ ~7D0.00 .qe~. ,
Total Pa~/'-O-o-B~~
nitials •
White -Dept. of Origin • Yellow -Finance • Pink • Applicant
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HOME OF PELICAN ISLANA
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) ~7 ~~ ' . ~
~~v / o .9~ ~E 7 .3oZ S'~
Addr ss
'77 z _ .~8/ _ ,3a 6 a
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
i ~ Dollars ( de , o d )
on this /3~ day of ~v (JEi,~,~`c/L , 20 a,~ for the purchase of the following
described Cemetery Lot(s) and/or Niche(s).
Unit ~, Block /.~ , Lot(s) T ~ 9` /d 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
Vase and Ring for Niches (cost)
Signature of Purchaser
W O H
Circle One
Interment Disinterment
T L $o~_ ~d y. o p
Citv of Sebastian
Service fees are to be paid at time of need only
!:\W W-DATA\Ms-Cemetery\RECEIPT.doc