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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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Certificate # 1940
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Donna Brown
(name)
810 Kirke Avenue, Sebastian, Fl 32958
(address)
in and for consideration of the sum of 350.00 has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit _ 4_, Block _13 , Lot(s)_6a _
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 16"' day of January, 2004.
OF
Terrence �o
City Manager
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Sa11y . Maio, CMC
City Clerk
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HOME CaF PELiChN ISL.AND
January 19, 2004
Ms. Donna Brown
810 Kirke Avenue
Sebastian, F132958
Dear Ms. Brown:
.
0
Enclosed is City of Sebastian Certificate Number 1940 for the purchase of Lot Number 6a,
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.
Sincerely,
� ����f _"_.,_—
/
Sally A. M o, CMC
City Clerk
SAM: ar
enclosure
I Name
CITY OF SEBA;
CITY CLERK'S 0
RECEIPT
No.
001001 208001 Sales Tan
001501 322900 rage Sales
001501341920 Cop' id Specs.
001501341910 LDGC of Ordinar�ces
001501 341930 Electlon Qua ng Fees
601010 343800 Cemetery lots
LoUNiche Blodc
001501343805 Cemetery Fees
p c ,
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White – Dept of Oripin • Ydlow –
i Fa..wew —
SEAWINDS FUNERAL HOME
735 FLEMING STREET
SEBASTIAN, FL 32958
0 Cash
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Unit �
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P
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CITY OF SEBASTIAN ,
CfTY C ERK' POFFICE �/, � e
4 V
Name ��_� v� .lL�►ilT..s�.� 0 Cash / ��
.�cr
Date / / G a qeck�,�
No. � 7— AmouM Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501 341920• Copies/Bid Specs.
001501 341910 LDC/Code of Ordinanc�s
001501341930 Electlon Qualifying Fees
601010 343800 Cemetery Lois :��a.-oe
LotlNiche (� a� . Blodc �.� . Unit�
001501343805 Cametery Fees
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Total Pa •��O � Total Paid✓"�� �• ��
� . In�ials.
• Pink • Applic�nt White - Dept of Origin • Yellow - Fin�nca • Pink - Applic�nt
� PAY
i ORDER OF ��
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" 3696
63-843/870
DATE � ` � •Z_ 13 � � ewwcH e�e�e
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DOLLARS � `:��'�::
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� WA�CHOVIA
Wachovia Bank, N.A. �
ACH R/T067008432
FOR
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HOME OF VPEUGN �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
�o N �1 A �i tz-ow �
Name(s)
�i a �C►'e��t; �L 5�.��►S7�'A �► �'—j 32 9 S 8
Address
,, 2- s� q -�.-� �s�a
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
O�ce Use Only
Receipt is acknowledged in the sum of:
� �..µ a o� A�c�t ,
� Dollars ($ 35�• a� )
on this � day of �oJ , 20 03 for the purchase of the following
described Cemetery Lot(s) and/or Niche(s). /
4i�''''�
Unit � , Block I 3 , Lot(s) ` 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
Vase and Ring for Niches (cost)
Signature of Purchaser
Interment
W O H
Circle One
Disinterment
/� �T � � ..�'sa , o a
�
of Sebastia
Service fees are to be paid at time of need only
I:\W W-DATA1Ms-Cemetery\RECEIPT.doc