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HOME OF PElICAN ISIAND
Certi�cate # 1968
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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:
Nancy A. Wolaver and/or
Donald J. Perrier
(name)
3429 Heatherway Lane, Sebastian, FZ 32958
(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 plots:
Unit 4 Block 13 Lots 20a & 20b
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 24nd day of June, 2004
Y OF SEBA TIAN, FLORIDA
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Terr nc . Moore
City Manager
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Sa� A. Maio, CMC
City Clerk
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HO1WE QF PELiCAN iSUyND
June 29, 2004
Ms. Nancy A. Wolaver & Mr. Donald J. Perrier
3429 Heatherway Lane
Sebastian, Fl 32958
Dear Ms. Wolaver & Mr. Perrier:
Enclosed is City of Sebastian Certificate Number 1968 for the purchase of Cemetery Lots 20a &
20b, 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.
Sin er y,
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Sally A. aio, CMC
City Clerk
SAM:ar
enclosure
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HOME OF PEUCAN �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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Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Dollars ($�,�,(�� )
on this � day of , 20Q�-� for the purchase of the following
described Cemetery Lot(s) and/ r Niche(s).
Unit �, Block � _, 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) Interrnent
Disinterment
TOTAL $
C�.C�:�T�-cr-e%�
Sign e of Purchaser '�y�vf Sebastian
Service fees are to be paid at time of need only
I:1W W-DATA1Ms-Cernetery\RECEIPT.doc
W O H
Circle One
CITY OF SEBASTIAN
CITY C RERK' POFFICE 2 9 2 7
Name � � - ❑ Cash
Date �U Check # CQ g(o
No. Amount Paid
001001208001 Sales Tax I
001501 322900 Garage Sales
° 001501341920 CopieslBid Specs.
001501341910 LDC/Code of Ordinances
001501341930 Election Qualifying Fees ��
601010 343800 Cemetery Lots ��� '�
LotlNiche �, Block �_, Unit �
001501 343805 Cemetery Fees
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Total Paid���
tials
White — Dept. af Origin • Yeliaw — Finance • Pink • Applicant
NANCY A: WOLAVER
3429 HEATHERWAY LN �HEi
`SEBASTIAN;':FL .32958
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