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HomeMy WebLinkAbout3-COL-21DsCm OF SEBBASTIAN] HOME OF PELICAN ISLAND Certificate No. 2535 CITY OF SE$AkSTtAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Felicia Mullins 1276 Bevan Drive Sebastian, FL 32958 In and for consideration of the sum of $2,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following niche: Unit 3, Bilk COL, Niche 21Ds of the Sebastian Municipal Cemetery, as maintained on file in the records of the City Clerk for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. CONVEYED THIS 2nd day of May, 2017. CITY OF SEBASTIAN, FLORIDA Joseph F. Griffin City Manager ATTEST: -n4 anette Williams, MMC City Clerk _ - MY Lf SEELASTIAN HOME OF PELICAN ISLAND 1225 Main Street Sebastian, FL 32958 (772) 589-5330 Phone (772) 589-5570 Fax May 4, 2017 Mrs. Felicia Mullins 1276 Bevan Drive Sebastian, FL 32958 RE., Interment Rights to Unit 3, Blk COL, Niche 21 Ds , Sebastian Municipal Cemetery. Dear Mrs. Mullins: Enclosed is City of Sebastian Certificate 2535 entitling you to full interment rights in Unit 3, Blk COL, Niche 21 Ds, in the name of Felicia Mullins If you have any questions, please contact our office at 388-8209. Sincerely, Cathy Testa Records Clerk Enclosure arr OF SEBASTIAN a s3 s HOME OF PELICAN ISLAND City of Sebastian Municipal Cemetery Purchase Receipt To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate regulations, proof of City residency of purchaser or person for whom lot is intended for interment must be provided at time of purchase. Name(s) Address 77a -3�?8 - 96i 3• Area Code & Phone Number Name & Residence Address of Intended Occupant if Other Than Purchaser OFFICE USE ONLY Receipt is acknowledged in the sum of: W o 'that--st+TVD Dollars ($ awo, Ob ) on this -N6 day of —,20/7 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit 3 Block COL , Lot(s) Niche(s) g�lp / b 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 OD Vase and Ring for Niches (cost) 9o• Interment Temporary Marker Preparation & Installation Signature of Purchaser /W O H Circle One Disinterment TOTAL $, A, O '!(D' Cab City The following documents were provided as Proof of Residency: I:\W W-DATA\Ms-Cemetery\RECEIPT.doc and PLEASE PRINT DECEASED LinD102- ,� L NAME: :ri m& S i%9UJ- L / /[/ S I U 54 ) (First) (Middle) (Last) \\\ V.5(o cg DATE OF BIRTH (Day) (Year) DATE OF DEATH: /.5 =Zd/y (Month) (Day) (Year) SIGNATURE: PRINT SIGNATURE: L/Z- / �s DATE: / Unit 3 Doubles ! South COLUMBERIUM: NIGH NUMBER. FOR OFFICE USE ONLY z/(So Ll III CITY OF SEBASTIAN 10440 ADMINISTRATIVE SERVICES RECEIPT Name khw,rjS -iCash Date `Y — A ' 7 I(Check # 9 fo U Credit Amount Paid 001001 208001 Sales Tax 001001 220000 Security Deposit 001501 362100 Taxable Rent 001501 362150 Non -Taxable Rent 450010 369900 Airport Badge 001001 218010 CobraServe 001501 354100 Code Enforcement Fines 001501 347557 Community Center Revenue 001501341920 Copies 001501 351140 Parking Citation 001501 342100 Police Security Services 001501 329200 Site Plan Review 001501 329300 SubdivisionMat Review 001501 329100 Zoning Fees /�,a3nNL a000.06 ©o is%t 3 1J�-Ubs- \rAse-tR1.6 A ia, U aa- Total Paid 090• tials Security Dep Held - Amount $ Check # White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant NAME:/ (First DATE OF BIRTH: SE, DATE OF DEATH: SIGNATURE: PLEASE PRINTp 2) ue �u 710 00 .-/ (Middle) (Last) 193 (Day) (Year) (Month) (Day) (Year) PRINT SIGNATURE: DATE: --2e / 7 FOR OFFICE USE ONLY Unit s Double. / South COLUMBERIUM: �A- (soull)) NICH O NUMBER: iZ Pur l A k u.NDa7L hog s t\f7km e