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Certificate # 1922
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Richard & Christine Nevor
(name)
(name)
P. 0. Box 780609, Sebastian, F1 32978
(address)
(address)
in and for consideration of the sum of $1. , 400 . oo , has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4 , Block 13 , Lot(s) 1B, 2B, 3B, 4B
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and regulations
prescribed therefore by the City of Sebastian.
CONVEYED THIS � th day of November
2003
ATT �T:
C�`�
Sally A. aio, CMC
City C erk
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HdME OF PEUGN ISIAND
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City o� Sebastian Municipal Cemetery
Purchase Receipt
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To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery
rate regulations, residence of purchaser or person for whom lot is intended for interment must be
at time of purchase
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Ad resd s � '
77Z - s'8j- /,�v��
Area Code & Phone Number
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Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Dollars ($ � e0 - a � }
on this aay of ,.�Q-rJ , 20� for the purchase of the foliowing
described Cemetery Lot(s nd/or Niche(s).
Unit �, Block /`� , Lot(s�, �_ 3�3 h�� Niche(s)
for use in accordance with the conditions, ordinances, resofutions, 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 ��-5` O a W O H
Circle One
Vase and Ring for Niches (cost) interment � a- d d Disinterment
7i'
�TpTqL $ / �S- a a
Signature of Purchaser �ty of Sebastian
Service fees are to be paid at time of need only
I:1W W-DATA\Ms-Cemetery\RECEIPT.doc
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Name �'
Unit !
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Block �` C "' ' ; .C.,
Lot �� "-�'
Date of Mark-out �! � °
Date of�Burial ���� � ' �����—Time �� ' �� ��
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Name of Funeral Home � � � �" ��
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Authorized by ' " "
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Ro�2111 U.S. #1 Sourh
kledge, Florida 32955
(321) �3�_4275
�'e hereby certify thqt these are the remains of r'
Ma ion Kuduk
F�om Seawinds Funeral
Home The rema�ns W
Funeral Firrp ef� received
Sebasti
an, FL
03-2617-pg4
Crerpp}�pn P City an
ermit No. d State
Indian Rive
�ate of Deafh JulY 12, �s5ued at r
2003
Date of Crerriation JulY 16 � 2003 �
Chad Fol -
ey lweiler
Crerriator
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No. �
001001 208001
001501 322900
001501341920
001501 341910
001501 341930
601010 343800
001501 343805
CITY OF SEBASTIAN
CITY CLERK'S OFFICE °� °Z � �
RECEIPT
/ ❑ Cash
� eck #—��
Amount Paid
Sales Tax
Garage Sales
Copies/Bid Specs.
LDC/Code of Ordinances
Election Qualifying Fees
Cemete � t�„ Z� � �• O
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LoUNiche,;��Tr'�'_' Block �, Unit
Cemetery Fees �" ' O v
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, � Total Paid �� �T_�
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant