HomeMy WebLinkAbout4-13-39bCITY OF
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HOME OF PELICAN ISLAND
Certificate No. 2219
C
ITY OF SEE-BASSTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Ana T. Walter & /or Alicia Tovar P.O. Box 1389, Roseland, Fl. 32957
(name) (address)
In and for consideration of the sum of $500.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Blk 13, Lot 39b
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 11th day of May, 2009.
CITY)OF SFirBASTIAN, FLORIDA
" CAI Minner
City Manager
ATTEST:
Sall A. Maio, MMC
City Clerk
Name
I Init
Block
Lot
Date of Mark-out CA
y
Date of Burial 2 C L Time
Name of Funeral Home
Authorized by
CM Of
HOME Of PEUCAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
&6K E kkd-�er a4ldl-lor 411'c"a -FOva-r
Name(s)
�D fox 13F9 I°05e,(6LAd R, 32957
Address
Area Code &Phone Number
koher-t ,billa -hay lv� 11cv +( leun Jvl�e 5�(oasl-ia�, 3Zg5�
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY,
Receipt is acknowledged in the sum of:
t � A
Dollars ($ 250 Q v
on this day of j1/ a V , 20 Ci 9 for the purchase of the following described
Cemetery Lot(s) and /or Niches— ).
Unit �, Block 13 , Lot(s)
Niche(s) 31q b
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)
Temporary Marker Preparation & Installation
Signature of Purchaser
I: \W W- DATA \Ms - Cemetery\RECEIPT.doc
ob
Interment 0
/W O H
Circle One
Disinterment
TOTAL $ O , 0 0
it& jii&�r"
of Sebastian
The following documents were provided as Proof of
Residency:
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
4247
AI I Cia 1—v va.r
Name ❑ Cash
44 7s
Date Check# Z 3
5 -11 -0� ,�
No.
Amount Paid
001001208001 Sales Tax
001501 322900 Garage Sales
001501341920 Copies/Bid Specs.
001501 341910 LDCICode of Ordinances
001501341930 Election Qualifying Fees
601010 343800 Cemetery Lots D I Q' 1
500, 00
Loe lchjq b . Block 1, Unit
of
Fees
�/�� Q
50. 0 n
001501343805 Cemetery
d6j Total Paid 5a -o-'o
Initials
White – Dept. of Origin • Yellow – Finance • Pink - Applicant
C STATEMENT 094509
Date
To
-T(!:) Ua YZ--
IN ACCOUNT WITH
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TERMS