The URL can be used to link to this page

Home My WebLink About4-14-29Name JAdz ,J Unit 7 Block Lot g - Date of Mark -out Date of Burial eb/ ki�-// T Time � -C'O . A sl D)C- Name of Fune Authorized by CITY OF SEBASTIAN 10938 ADMINISTRATIVE SERVICES RECEIPT Name\A7GUAle, 1 �/V�II S ❑ Cash Date io --.q `f- % Check # EJ Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 Subdivision/Plat Review 001501 329100 Zoning Fees mlacl 644 gcs `V IInuT * AIL j4 L.o7-,R/ .QP lip Initials Total Paid ` 0, 06 White - Dept. of Origin • Yellow -Admin. Svcs. • Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY For information contact: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery A O Phone: (772) 589-2545 Fax: (772) 228-9927 City Clerk's Office - Cathy Testa D I City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 ctesta(a)citvofsebastian.orp FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958 PHONE#: 772-589-1000 (Check One) XXXX OPEN BURIAL LOT OPEN CREMAINS LOT OPEN COLUMBARIUM NICHE Lot-29—Block-14—Unit 4 Lot—Block—Unit Niche Block Unit N S E W BURIAL DATE AND SERVICE TIME: Friday, 10/27/2017 @ 2:00 PM, Graveside Service FOR DECEASED: Janice Wright Innis Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) John A. Innis _lohw ft. Iwwis 10/24/2017 Name Signature Date 277 Eagle Drive, Blairsville, Georgia, 30512 1 certify that I have determined the ownership of the above described site that all site fees and administrative fees have been paid and authorize opening of same. NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR: Gary D. Evans Name Gcuy D. F-XKS 10/24/2017 Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. 10/24/2017 11:23 FUNERALI FOR BURIAL Offipe (772) FUNERAL' ADDRESS: PHONE#: _ (Check One) )0= OPEN BURIAL LOT OPEN CREMAINS LOT S REQUEST TO Cl IN SEBASTIAN MU 'or information contact: Kelso, .CemeterySex hone: (772) 589-2545 Fax: (772) 228-9927 City lerk's Office — Cathy C ty Nall, 1225 Main Styr Sebastian, FL 32958 3-82 5or388-8214 cfesta OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE FOR DECEASED; Janice Wright Innis Name NAME AND SIGNATURE OF LOT OWNS i OR REPRESENT. (Must provide proper documentation of ow iership) John A. Innis Name lohw.4. Iww%S Signature 277 Eagle Drive, Blairsville, Geprgia, 30512 1 certify that I have determined the owners lip of the above describe fees have been paid and authorize openin 1 of same. NAME AND SIGNATURE OF LICENSED UNERAL DIRECTOR: Gary D. Evans Gaay'D. srIlUBS Name Signature Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing t office and that all fees h ve been paid: -- 10 Cem tery exton Date This form to be provided to Clerk's Office oy Sexton for permanent rel aM= upon #7163 P.001/001 fees and administrative confirming with Clerk's EG MY OF SLISAL5T HOME OF PELICAN ISLAND Certificate # 1954 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Sherwood A. & Janice W. Innis 431 Copley Terrace ,Sebastian, Fl 32958 (name) (address) in and for consideration of the sum of $1,400.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit _ 4_ Block _14_, Lot(s)_ 28 & 29 _ of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 8th day of April 2004. Y OF SEB TIAN, FLORIDA A }T: zence:R: oore y A. Maio, CMC �y'l4anager City Clerk N • CnYa i9s SEBAST. IAN NOME OF PWCM ISLAND City of Sebastian Municipal Cemetery C04 Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase Area Code & Phone =Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: M ov on this day of , 20�0� described Cemetery Lot(s) d /or Niche(s). Dollars ($ for the purchase of the following Unit _, Block , Lot(s) .?S s,- a9 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 %S dd 6�:) 0 H Circle One Vase and Ring for Niches (cost) Interment Disinterment Signature of Purchaser ity of Sebastian TOTAL Service fees are to be paid at time of need only 1:1ww- DATA \Ms - Cemetery\RECEIPT.doc Georgia Department of Community Health I (1 -g°3 l I i► Vital Records Service PERMIT FOR THE DISPOSITION OF HUMAN REMAINS PERMIT NUMBER • Fefal Death? Place of Death (Hospital of Street No.) OR In ent (Cemetery) CItY 4 lao S-�CNe-1 e�g2- A&SIA3 Qr• 5. --Name of Cer6fylr Physlclan, Coroner, or Wedical Examiner (Not Used for Disinterment/Reinterment) 7. () Aga. 5anae.C5 Funeral Home Name and Address - 00Ca,t"' F'>nCirkA N � p ., Lt- % l..l, r l`. — M aAte, .5'',+ g lot �s 8. Date of Death A,. b z 1.0-.16-17 SVt Ile. 3. Yes ❑ N -X County of Death OR Interme s. l) rment) w Ile, GA 3os t . Funeral Home Llc No. ,0. 1153 Date of Disposiban OR Reinterment DlslrRennentlRefnferment Ll10-a4- ao�" , It Cremation 13Donabon ❑ Other El Removal Frem State Location of Disposloon OR Remtem,ent Site Vame and Address of Disposition OR Reinterment Site (County, City or State) Sel��.s � � rt wyapte GP-�Q Se L,4" rt , FL t3. elaii N• Ce 4w A� ,4. her person who first assumes custody of a dead body or 31-10-20.(a) The funeral director or person acting as such, or ot fetus shall obtain a disposition permit prior to cremation or removal from the state of the body or fetus. A disposition permit may be required within the state by local authorities. TDateigned ocal7,s. igned Sexton erson rge)— SigntrW I S//J t Is.to-a3- a�t7