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Burial rights in the Sebastian Municipal Cemetery lots /niches purchased by me
ouIIa f,'r (.X,)n� k!0 KirKe- Au asfi6�IQ, 32G5�
(Please print name and address of purchaser)
(Lot/niche, block, unit description)
are intended for interment of the following individuals:
Please print name(s):
n n y J-oe BrvwIn - l of (6 - hasb0- 0cF (
canna brown - f of _5b - se1F
interred
Interment lots /niches are not to be transferred without written approval of the City of
Sebastian. Interment lots /niches in the Sebastian Municipal Cemetery are allowed to be
passed on to heirs but the City requires a certified copy of relevant probate or other
court documents.
I have read and understand the terms of this agreement.
Signature Date
and worn to before me this da of 1 by
'�� who is p a y known me, or has produced
r. as identification.
VI I"', MICHELLE W GRIFFIN
Notary Public] Sta�Florida ?r�+ �� Notary Public - State of Florida
. •; My Comm. Expires Feb 29, 2016
Commission # EE 174753
Names of Interred form •.'�F «.�NJ'
Bonded Through National Notary Assn.
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HOME OF PELtCAN ISWVD
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Certificate # 1942
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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:
Donna & Danny Brown 810 Kirke Avenue, Sebastian, Fl 32958
(name) (address)
in and for consideration of the sum of 700.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 4_, Block 13 , Lot(s)_5B & 6B _
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,;
OF SEB STL
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enence �.lY�e�o E
City Manager
' day of January, 2004.
, FLORIDA
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Sall� Maio, C1VIC
City Clerk
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January 21, 2004
Donna & Danny Brown
810 Kirke Avenue
Sebastian, F132958
Dear Mr. & Mrs. Brown:
Enclosed is City of Sebastian Certificate Number 1942 for the purchase of Niche Numbers SB &
6B, Block 13, Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations
governing the Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
S' rely,
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,
Sally A. aio, CMC
City Clerk
SAM:az
enclosure
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S��ST�AN
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HOME OF PELIUN ISWVD
City of 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
provided at time of purchase
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Name(s) /
C� , ��rlt� � �e. S� .�i� � 3�.�s�
Address
7 7� s�� �$��
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Recei 's acknowledged in the sum lo�f.�
� Dollars ($ D O. o a�
on this day o , 20� for the purchase of the following
described Cemetery Lot and/or Nic (s).
Unit , Block /,� , Lot(���� _Niche(s)
for use in accordance with the conditions, ordinances, resolutions, rules and regutations
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)
�
'2��`'y''1
S ature of Purchaser ity of Sebastian
Disinterment
Service fees are to be paid at time of need only
I:\W W-DATA\Ms-Cemetery�RECEI PT.doc
W O H
Circle One
$ d0 0�