HomeMy WebLinkAbout4-15-30Name .5 g v
Unit 9
Block—
Lot
Date of Mark -out
Date of Burial_
x
C,
-4-0
Name of Funeral Home
Authorized by
14 x
Time i_ i i9l)
QIY OF
~ .
,-
l~fl1VtE ®F FELtCAIV ISLAMd3
Certificate # 1914
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Sahak & Silva Davidian 826 Gilbert Street, Sebastian, F1 32958
(name)
(name)
(address)
(address)
in and for consideration of the sum of $ 7 0 0 . o o ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 15 ,hot(s) 3 0
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 3rd ~y p f September 2 0 0 3
ATT
r
S yA.M ' ,CMC
City Cl
City Manager
.~.~~_.
~~~
~
HOME Of
PELiGN 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
~~ ~ ~ eJ. ~if c1~.9Ut~.:9.y
Name(s)
Address
77z-3BB--28z~
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
rI~'"' ~ -
ars ($ Gov. o o )
-..
on this day of , 20d~ for the purchase of the following
described Cemetery Lots a d/or Niche(s).
Unit ~, Block ~, Lot(s) .a? 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 - $20) Opening & Closing;/a5 y ~ W O H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
Signature of Purchaser
Service fees are to be paid at time of need only
~~~ UQ
I:\W W-DATA1Ms-Cemetery\RECE IPT.doc
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HOME OF FELIGIN ~ISUIND
September 5, 2003
Sahak & Silva Davidian
826 Gilbert Street
Sebastian, Fl 32958
Dear Mr. & Mrs. Davidian:
Enclosed is City of Sebastian Certificate Number 1914 for the purchase of Cemetery Lot 30,
Block 15, Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations
governing the Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
Sincerely,
Sally A. Maio, CMC
City Clerk
SAM:ar
enclosure
C~~p~(
~9103I2003 1@:15
F1 nRiL~ADEPARTTTtvt81'17UF `t
Ju~
A.
. tJ" artte cf
Deceased
g, Plaora of ]:TeBth
County
r~enn
3. Name of fNedtoal
CeRifiEr r}R ,,~
4. Name of Fun~ra! tic
E6tabilshrrtent
B9V L15
5. Check
Approp+fate
Bax
8503t;o35'r9
REVIS FUIJERAL HOME
slats tsf Florisila, Depfslrtlm~wnt of Health, Vital Sftatistlcs
APPLttwATlfylV POR BtJR1AL -TRANSIT PERAAIT
GAGE 0~{
D
r first Middle 1_rrst Date - ~!orsmi ~ySr
as
Sevag Davidian [teeth Sa~mbe~_
City. Town ar Location NAmta of (H neither. give street address}
Hosp. or
Ta1lKhas~ee inst. '~allaktassf3e Memorial EIr3aJ.t:hcar~
_""'~ Address Phant Number
ephaaal Sg ,'1899 Eidex Court _a _
~dicaf Examiner Physioign 1~- xlahas e F :~ 0$
i¢JDirect Disp4sted Address Pta. Ua NoJR~. No. Prone No. (Area Cade}
27'i 0 N. MotYrorg Strout:
Faneral How Ta~lahasseu, Fly. 32303 237 854-385-Zi 93
~, ~Thle medics{ Cereifi~;ation rtes been campletgd and sign6d- A canlpleted certit!cata cif death 8cccxnparliss this
epp!lir:atkm.
b,
c.
wps Mntacted an
Ne/she verified that this death tYas from natural causes, that theta wss no aceldpni nor t~'!er external cause C+f death,
sr+d that wli complete and s!gn the medical
ceRiflcatton at cause of death within 72 hours.
DR. 5.r@~n,_~r~~~ vursacorttactedon 09-0 - . Me/shevarMsdthat
,_ _ _, Medw'81 Ettaminer, Wili Complete and sign the
m@ddcsl certification of causo of dill#h within 72 h urb.
~i 9tuf F.E. Ivra.IR68. No. Q~ Slgnrad
g, Funeral Direa#ar/ ~ ~ ~ _ ~ 3 _ ~ ~
Dirw;.tDispaser 'I`t~du Wr~!'slq'ua.~t: "57
~ --- ~~~ t~EJptAL -TRANSIT PERMIT
Rermissian is hereby grarried to cifapoae of {11iR body. Ft',rmit Na. ? 3'15- D 3 - y 63
A flue {5} Coy extension of time far filing the death csfifioste (exclusive at ;rraakends} has been requested amt granted since the physpicia.rr hAlB
pin contat:ted iav the tunerai director sand will net be Able to romplete the medical Cer'.Ification Of cause-of-tfeetn saotiort of file death re~Rificate within
72 itaurs.
~No eXtbn9ioN1 of ttme f r tiling death Ceftifi rate tt~ b requested
Registrar or ~ Dat9 Date Cartficate
gUbreaistrar SignaG4,r4e issuratl~ Ct 9- 0 3- 0 3 YDue: Q 9-1 8- d 3
~. .__..~ AitTHUR12ATtC~Nt 4or CRIst111ATiOht, ptBS@CT6C1N, ar BURIAI.-AT SEA
Apprc+val !~iu!rbsr. ___~ gate ,~_ -- ----
lrted,cal icxaminer, -~' gave auttrartraGnn by telephone to
~Funerai r3irectarlDirectDrspaser. f3ate`~ _
T'rre IVledical Examiner's epprov'al must be obtained before disposal by any of the at;uve ra~etha.~s. Awaiting period of A9 hours aff.Pr death is
raquirt:,7 far sl1 c^ematiors.
c _ -- ---.- -- c~n+lETiuRr u~ f:FiEMATCyRY
M1flsth~t of 17lSposifiat: Place pi' UlsposRian Sul~astian_ CetretQry -
Septemb~x~ 5, ZQ03
~liURI.AL ~~ 8T(}RAGE N7ato of Cipposition
~CftBhtAT1UN ~~~TI'ttrH I$pACify}
8t:lnature u` $etctnn ~ ~~~~~/~;"~'-"''
ar Persendn~Charge
"h'ss ~tt~rm'~t m-~t be ertdor
Wltnln tt: days t0 thra iacRl
!~ :3P.XtOn or .rars+~an~in•charge (ur by the Funeral Director/urreCr ul~sor wnan
HiQatth Department in the county wnere disposition cwaurred.
is nor Sexton} and
r)IUV~Utbrt: wnRe: C6tttCtM{C~ CmmalO~'
Y~r'~nv: F'.InM'8! ~lrnctor tx DiroGl DfBPCYFi•
~H 326, W57 (UUBObk~N a@ !p~r*~++vlau^. ~~I;IPns,r r+inx: LU9i! n®AI!!iFr
;S7eek hkur,hor: 574U~fh1Wi13E~21
~ ~
_
~
Nam ~ °' ~•
,.
, ^ Cash.
~ ~'
'
Date ~ ~~
A
No. Arrwu~ Paid
00.1001208001. Sales Tax.
W1W132290Q CSales
001501341920 Copiel8id Specs.
.,:<
001501341910 LL)GCAde of Ordinenoes
001501341930 Election Qualifying Fees
~~~
601010343800 ~ Lots ~~
LotlNiche -'w,,,,_Bkxk~~; l3nit~
001501303805 Cemetery.Fees ~ ~?
~
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Total C~-~".~~~,~
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