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HOME OF vFELTUN ISIAND
Certificate # 1916
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
John F. and Mary K. Kasper
(name)
(name)
599 Caravan Terrace, Sebastian, F1 32958
(address)
(address)
in and for consideration of the sum of ~ 3 , 500.00 ,has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 ,Block 15 ,Lot(s) 36, 37, 38, 39 & 40
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 THI5 12th~y pf September , 2003
Y OF S ASTIAN, FLORIDA ATTEST:
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Terrence R. oore Sally A. 'o, CMC
City Manager City Cl
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Name ~ ~ p~.r ^~, ,,,...,»-
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Block
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Lot _
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Date of Mark-out
Date of Burial
Name of Funeral Hom
Authorized by =' -- .-
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OX GIFFORD-SEAWINDS FUNERAL HOME - suNTausraAruc 2042
1950'20TH ST 83-607/670
VERO BEACH;. FL 32960
12/2/2004>
PAY TO THE
' ORDER OF C;lt~ ~f Sebastian ~ ~**~]5.00
_ seven -Five and 00/T00****************************************~*****~****~********** DOLLARS ~
City of Sebastian
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/ MEMO Sod & Marker for Kasper ~•
11'00204211' ~:067006076~:L000OL737776211
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 3 ~ q 3
RECEIPT
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Name ., - - 1 6 ^ Cash
Date ~ ~C,' .~ ''tr~~ ~ Check #~_
No. Amount Paid
001001208001 Sales Tax
001501322900 Garage Sales
001501341920 CopieslBid Specs.
001501341910 LDCICode of Ordinances
001501341930 Election Qualifying Fees
1101010343800 Cemetery Lots T ~11..J ~~~
LofIN(che,_, Bkrck (:J . Un(t~
001501343805 Cemetery Fees / ,fi,~~
Total Paid
InOials
White - ept. of Origin • Yellow -Finance • Pink • Applicant
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DH-PHS-BTP-89a ~~ .4 ~ VERMONT DEPARTMENT OF HEALTH
~ BURIAL-TRANSIT PERMIT Permit No.
Permit for Removal, Disinterment and Reinterment
1. Decedent's Name (f rst, iddte, I ) 2. Sex 3. Dat of De th
4. City/To ~} of e 5. to of Birth 6. Pla a of Birth
V1 ~'t / 1'~ L DYI
7. N ddre s o neral Dire or r Authorized erso
PERMISSION REQUESTED FOR: (Check only one box and complete appropriate section)
^ Temporary O Removal from - ^ Cremation urial or
Storage Temp. Storage or (Section C) Entombment
(Section A) Disinterment (Section D)
(Section B)
• ~ . •
Place of Storage (Name pf Ce tery or Vault) City/Town, State Date
PERMISSION IS GIVEN TO DISPOSE OF SAID ODY AS STATED ABOV . (Title 18, V.S.A. 5201)
Si ature of Clerk or Deputy., ~u City/Town Date
Cr erk aF b f' a n ~a - 3 -o
natur of Sexton/ me ry Official Date
j D
• .-.
Name of Cemetery or Vault from which body is being removed City/Town
Date
Name of Cemetery where body is being taken City/Town, State Date
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
Signature of Clerk or Deputy City/Town Date
Signature of Sexton/Cemetery Official Date
Name of Crematorium City/Town, State Date
.~-
PERMISSION IS GIVEN TO DISPOSE OF SAID BODY AS STATED ABOVE. (Title 18, V.S.A. 5201)
Signature of Clerk or Deputy CitylTown Date
Signature of Crematorium Official Container Number Date
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Name e~etery
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17'1 eC.~.~ ..
Citylfow ~ ~ R~~~
ate ~D
PERMISSI
O
S GIVEN T
Signatur C erk or t ISPOSE OF SAID BODY AS STATED. ABOVE. (Title 18, V.S.A. 5201)
r- Citylfow
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Dat
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Bod remains ere uried O Entombed Date
Name of Cemetery Section Lot Number Grave Number
City/Town, State Signature of Sexton/Cemetery Official
This
to.be filed with the City/Town C~lerk~y ~e,/10th day of the month following disposition. (Title 18, V.S.A. 5215)