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Certificate # 1901
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SEBAST_" COP
HOME OF PELICAN ISLAND
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Adrian Scheeres 9849 Oak Trail, Micco, Fl 32976
(name) (address)
Betty Scheeres 9849 Oak Trail, Micco, F1 32976
(name) (address)
in and for consideration of the sum of $2,025.00 , has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 3 , Block COL 'Lot(s) 2Ds
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 22nd day of May , 2003 .
CITY OF SEBASTIAN, FLORIDA AT ST:
1
terKence Rk Moore Sally A. aio, CMC
City Manager City Clerk
CITY or
SEIIAST_"
HOME OF PELICAN ISLAND
City of Sebastian Municipal Cemetery
Purchase Receipt •
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
Warne(s) v _
Address
7-72—
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
Dollars
on this arz_,_� y of , 20 -3 for the purchase of the following
described Cemetery Lot(s) and/or iche(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)
Signature of Purchaser
Interment
Disinterment
W O H
Circle One
Service fees are to be paid at time of need only
I: \W W- DATA \Ms - Cemetery\RECEIPT.doc
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CITY OF SEBASTIAN p
CITY CLERK'S OFFICE U
orr`Rs"
0 Cash
eck # 4.1 !�z
Amount Paid
001001 208001
Sales Tax
2002
001501 322900
Garage Sales
'71 cz g>
001501 341920
Copies /Bid Specs.
■ ■
0
001501 341910
LDC /Code of Ordinances
p. `e
°so
001501 362100
Community Center Rent
001501 362100
Yacht Club Rent
001501 362150
Non Taxable Rent
0
001501 343800
Cemetery Lots
601010 343800
Cemetery Lots
a
Lot/Nichla f , Block c Unit
001501 369400
Interment Fee
001501 369400
Weekend Service
680800 220681
Yacht Club Security Deposit
�
680800 220682
Community Center Security Deposit
680800 220683
Riverview Park Security Deposit
)/-
Total
Initials
�.
White - Dept. of Origin a Yellow - Finance • Pink • Applicant
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PLEASE PRINT
DECEASED �
NAME: D (" IAN 6,
trirst)
Copy
C (:2Pr F P,
(Middle) (bast)
DATE OF BIRTH: 0 C T /9 l
(Month) (Day) (Year)
DATE OF DEATH:
(Month)
SIGNATURE:
(Day) (Year)
PRINT n
SIGNATURE: /q D R r lgN
DATE: P11 11 2 2 - 2 oc, �3
FOR OFFICE USE ONLY
Unit 4
COLUM BERIUM:
In
NICH
NUMBER:
DECEASED
NAME:
(First)
DATE OF BIRTH:
PLEASE PRINT
�\ - So-
(Middle)
5 q
cop �
(Last)
33
(Month) (Day) (Year)
DATE OF DEATH:
(Month)
SIGNATURE:
a.
(Day) (Year)
PRINT Q _
SIGNATURE:
DATE: IS _
FOR OFFICE USE ONLY
Unit 4
COLUMBERIUM:
)
e!
NICH
NUMBER:
(WEST)