HomeMy WebLinkAbout4-13-38aCertificate No. 2237
crrY oF sEBAsTiAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
John Vor Lorraine Lacenere
650 Helicon Terrace
Sebastian, FL 32958
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Block 13, Lots 23b, 24b, 38a & 37a
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 23rd day of September, 2009.
CI OF BASTIAN, FLORIDA
'Al Minner
City Manager
ATT
Sally . Maio, MMC
City Clerk
Name
Unit I
p /
Block 13 �C.�LMA o y✓ �C7 �C /r
Lot
Date of Mark -out /O /�... /��
/y A Time
p : 06 .4-
Date of Burial 14✓
Name of Funeral Home .5-7 P" j L
Authorized by
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
�a
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax. (772) 589 -5570
FUNERAL HOME: STRUNK FUNERAL HOME b CREMATORY
1623 No. Ceintrat Ave.
ADDRESS: sEB Ac N F1
PHONE #: 02 589`1000
(Check One)
OPEN BURIAL LOT Lot Block Unit
OPEN CREMAINS LOT Lot Block ��- Unit t�qs
OPEN COLUMBARIUM NICHE Niche Block Unit
S E W
BURIAL DATE AND SERVICE TIME: SP I I (
FOR DECEASED�oug Ias Lacehefz ,
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownershi
Name Signature Date
I 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 FUNERA (RECTOR:
Name Signature D 2�e
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming
with Clerk's office a d that all fees have been paid:
Ceniete exton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion
AVAILABLE FOR SALE
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