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Home My WebLink About3-COL-01DsU — -- - - - -- �VJ NNOMY CM Of S HOME OF PELICAN ISLAND CITY OF E B— STIA J Certificate # 1878 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: James Lewis 731 Mulberry Street, Sebastian, F1 32958 (name) (address) Anna Lewis 731 Mulberry Street, Sebastian, F1 32958 (name) (address) (name) (address) in and for consideration of the sum of $1,350.00 , has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plot: Unit 3 , Block COL , Lot(s) 1Ds 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 3rd day of March OF SE$1ASTIAN, FLORIDA Terrence t> City Manager 2003 ATTEST: �' %za - - Sally A. M44, CMC City Clerk S EAWINDS CREMATORY Sebastian, Florida 735 Fleming Street • Sebastian, Florida 32958 wwwseawindsth.com (772) 589 -1933 We hereby certify that these are the remains of CHRI STINF. T.FWT S Y� �2 7/ . The remains were received from SEAWINDS FUNERAL HOME & CREMATOR Cremation Permit No. 13- 41682 -5015 Issued at INDIAN RTVF.R COTTNTY Date of Death _JANUARY 21, 2 Date of Cremation / -' Z / By Cremator Name_ Unit �? Block Lot Date of Mark-out Date of Burial l /28� Z/,3 Ti meID'a'U/f /f7 1! —� Name of Funeral Home Authorized by CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT Name Zqn a a /, e L4_) / S Date I—)—k- / No. 001001 208001 Sales Tax 001501 322900 Garage Sales 4783 ❑ Cash Check # 10-7 Amount Paid 001501 341920 Copies/Bid Specs. _ 001501 341910 LDC /Code of Ordinances _ 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche ds Block l,(J t Unit 001501 343805 Cemetery Fees _ W 0 ® Total Paid � i): Q Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant CHRISTINE LEWIS DORIAN Christine Lewis Dorian, 56, died Jan. 21, 2013, at Sebastian River Medical Center, Sebastian. She was born in New York, N.Y., and had been a resident of Sebastian for 19 years, coming from South Toms River, N.J. She was a CNA in the medical industry. Survivors include her husband of 19 years, Dwayne Dorian, Sebastian; mother; Anna Lewis, of Sebastian; brother, Michael Dashosh, of Vero Beach; and sister; Amy Grasso, of Toms River, N.J. She was preceded in death by her father, James Lewis. FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY BAST_ "Zf vi CftK�N iSUiD For information contact: Kip Kelso - Cemetery Sexton Sebastian Manlcipal 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: ADDRESS: PHONE #: (Check One) OPEN BURIAL LOT Lot Block Unit PEN CREMAINS LOT Lot _ _Block Unit PEN COLUMBARIUM NICHE. Niche4a /S Block_ _Unit _s3 �- W BURIAL DATE AND SERVICE TIME: 1,1 a %0, - FOR DECEASED: rvame NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) ,IVJ A 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 NAIr1E AND SIGNATURE OF LICENSED FUNERAL DIRECTOR. !,a Name Signature Date Cemetery Sexton Certificalion: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid Ce tery Sex on Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Unit -2 Block Cow w/ Lot / I Date of Mark -out Time/ SOD Date of Burial l /* , /�dC✓ `'s Name of Funeral Home Authorized by JAMES LEWIS Born — Tuesday April 4th 1933 Passed Away — Tuesday December 27th 2011 James Lewis, 78, of Sebastian, passed away on Tuesday, December 27, 2011, at Indian River Medical Center in Vero Beach, FL. He was born April 22, 1933 in New York, NY, and moved to Sebastian 32 years ago from Toms River, NJ. James was a USMC Korean War veteran. He worked as a Mechanic for the Vero Beach city government, and was a Civil Defense Director. He was a member of the Moose lodge, and the Boy Scouts of America. He actively volunteered with the Indian River Sheriff's Dept., the Tom's River Fire Department, and South Tom's River First Aid and Reserve. Survivors include his wife of 57 years Anna Lewis of Sebastian, son Michael Dashosh of Summer Place, FL, daughters Amy Grasso of Toms River, NJ and Christine Lewis of Roseland, FL, 2 grandchildren, 1 great grandchild, and a sister Johanna George of Lake Wales, FL. N N T-4 L0 / 0 N oj va r ay aNi L �b aO US& CoTly O ru O IT O O Q' r41 ru r" cc O L%- cA ru s w "o Name I-eal S Date 3-3-63 CITY OF SEBASTIAN CITY CLERK'S OFFICE 153-( RECEIPT ❑ Cash Check #__ AmountPaid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501 341910 LDC /Code of Ordinances 001501 362100 Community Center Rent 001501 362100 Yacht Club Rent 001501 362150 Non Taxable Rent 001501 343800 Cemetery Lots / 601010 343800 Cemetery Lots Lot/Niche , Block Unit 3 001501 369400 Interment Fee �Dy 001501 369400 Weekaad Service 680800 220681 Yacht Club Security Deposit 680800 220682 Community Center Security Deposit 680800 220683 Riverview Park Security Deposit v'GZS ( { {// /yy�A ( / / /' / / /J/ r; �1 Ot 3 Total Paid r � � l—, Initials White - Dept. of Origin a Yellow - Finance • Pink • Applicant The Sebastian Cemetery �6 City of Sebastian, Florida Receipt is acknowledged in the sum of: Dollars ($ 1350. 0. ° O ) From: 1A/''l d` i '!&'P H ��`U ✓�S ^/ T.3/ ex" iii ` SG`l�.s' ( Vii'- :z ph o o e : on this 3_ day of 20 () 3 for the purchase of the following described Cemetery Lot(s)/Niche(s) upon the terms and conditions as stated herein: Description of Property. Cemetery Lot(s)/Niche(s) % Block Unit 3 Purchase Price: ,i0m Ii of ars ($ 1350, no Terms and Condition of Sale: This contract shall be binding upon both parties, the seller and the purchaser, when approved by the owner of the property above described: I, or we, agree to purchase the above described property on the terms and conditions stated in the foregoing instrument: >141aser signature Purchaser signature The City of Sebastian agrees to sell the above mentioned property to the above named purchaser(s) on the terms and conditions stated in the above instrument. z n '-�[YOA I)IJ qlk� ity of Sebastian itness