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HOME OF PELICAN ISLAND
Certificate # 1923
CITY OF SUBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Kathy Fetkenher
(name)
(name)
3300 74th Lane, Vero Beach, F1 32967
(address)
(address)
in and for consideration of the sum of $1,725.00 , has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery for the following plot:
Unit 3 , Block COL , Lot(s) 19DS
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 7th day o f November ) 2003
C OF S ASTIAN, FLORIDA L�
Terrence gore
City Manager
O O
Name X,21 nil) u� f'C C"4 Ae e • /11 5
Unit 3
Block v o ry '
Lot iy,
Date of Mark -out
Date of Burial / ' �) Time
r
Name of Funeral Home / /✓ D 5
Authorized by �
SEAWINDS CREMATORY
Sebastian, Florida
735 Fleming Stree Sebastian, Florida 32958
w".::, indsfh.com
(772) 589 -1933
We hereby certify that these are the remains of
ROLAND W. FETKENHER, JR
CRAWTHDS FUNERAL HOKL
The remains were received
uvIII -
Cremation Permit No.03- 2617 -145 Issued atIMPAIN RIVER COUNTY
Date of Death NOVEMBER 17, 2003
atl NOV. 19, 2003 By JAMES W. YOUNG
Date 01 Crem on Cremator
��z' 2 e�/
CITY OF SEBASTM
CITY CLERK'S OFFICE 2326,
RECEIPT
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Initials
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Garage Sales
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LDC /Code of Ordinances
Election Qualifying Fees
Cemetery Lots
LofMiche . Block
. Unit _
Cemetery Fees
AV - :A—d",
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HOW Of PIU"N ISLAND Oo
November 12, 2003
Kathy Fetkenher
3300 74th Lane
Vero Beach, Fl 32967
Dear Ms. Fetkenher:
Enclosed is City of Sebastian Certificate Number 1923 for the purchase of Cemetery Niche
19DS, Columbarium, Unit 3. Also enclosed is a copy of the Rules and Regulations governing
the Sebastian Municipal Cemetery.
If you have any questions, please contact our office.
Sincerely,
Sally A. Maio, CMC
City Clerk
SAM:ar
enclosure
affOf
SEISAST.IM / y�
HOAR OF PELICAN MU ND
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
k
Name(s)
YA
Address
7 '7 a - 17' 1 q - q (0
Area Code & Phone Number
Residence Address of Intended Occupant if Other Than Purchaser
Office Use Only
. Receipt is acknowledged in the sum of:
on this day of,
described Cemetery Lot(s)
Niche(s).
.7
lars ($ =-r, 00)
for the purchase of the following
Unit _, Block &nZ , Lot(s) Niche(s) /�c17S
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) • Oa Interment
4gna of Purchaser y of Seb
2
W O H
Circle One
Disinterment
Service fees are to be paid at time of need only
I:1W W- DATA\Ms- Cemetery\RECEIPT.doc
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 2266
RECEIPT
Name
0 Cash
oo-
Wdhack #L=—
Date
No.
Amount Paid
001001 208001
Sales Tax
001501322900
Garage Sales
001501341920
Copies/Bid Specs.
001501341910
LDC /Code of Ordinances
001501341930
Election Qualifying Fees
d�
601010 343800
Cemetery Lots
LotlN'iche Bbde—," . unites
001501343805
Cemetery Fees
a
ZV
as
8 sarrc�
&� z �/ a
Total Pad f � .
Initials
White - Dept. of Origin • Mellow - Finance a Pink • Applicant
DECEASED
NAME:
(First)
PLEASE PRINT
w.
(Middle)
-kfN
(Lag)
DATE OF BIRTH: 01-4 09 9 3 0
(Month) (Day) (Year) --
DATE OF DEATH:
(Month) (Day) (Year)
SIGNATURE
PRINT
SIGNATURE:
DATE:
FOR OFFICE USE ONLY
Unit 3
Doubles / South
COLUM BERIUM:
(South)
NICH
NUMBER:
e Ti(c.
00n,
16k
IN
- - ml
fjw.,f ON
DECEASED
NAME:
(First)
0
0
PLEASE PRINT
Fe4ke�
(Middle) (Lag)
DATE OF BIRTH: O_ G S?
(Month) (Day) (Year)
DATE OF DEATH:
(Month) (Day) (Year)
SIGNATURE:
PRINT
SIGNATURE:
DATE: /1/7
14
FOR OFFICE USE ONLY
Unit 3
Doubles/ South
COLUAMRIUM:
(South)
NICH
NUMBER: