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Certificate # 1932
CIWOF SE BASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian,
it is hereby certified that:
Florence T. Baer
(name)
(name)
349 Fordham Street, Sebastian, F1 32958
(address)
(address)
in and for consideration of the sum of $1, 3 5 0.0 0 , has purchased and is entitled to full
interment rights in the Sebastian Municipal Cemetery _ for. the following plot: -
Unit 3 , Block C 0 L , Lot(s) 2 3 D s
of the Sebastian Municipal Cemetery, kA
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 12 t h day o f December , 2003 .
OF
City Manager
FLORIDA
ATTEST:
Sally A. M #, , CMC
City Clerk
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Name
Unit
Block
—
Lot / C �l r
Date of Mark -out
Date of Burial :&
lS 7 , Time ff
Name of Funeral F{o e �� S
Authorized by
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Name /41 .f- h
Unit
Block C' o '
Lot�G
vale VI I -M vim• - -
Date of Burial WO i, Time �� ' DID '
Name of Funeral bCome
Authorized
aff OF
HOME OF PELICAN SISiAND
December 15, 2003
Florence T. Baer
349 Fordham Street
Sebastian, Fl 32958
Dear Mrs. Baer:
Enclosed is City of Sebastian Certificate Number 1932 for the purchase of Niche Number 23Ds,
Block Columbarium, Unit 3. 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.
Sinc y,
Sally tA.o, CMC
City Clerk
SAM:ar
enclosure
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SEBAS71AN
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HOME OF PELICAN LSIAND
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
Name(s)
Address
Area Code & Phone Number
Residence Address of intended Occupant if Other Than Purchaser
Office Use Only
is acknowledged in the sum of:
on this A01f day of
described Cemetery Lot(s) and /or Nich
Unit ..7 , Block, Lot(s).�
�_--r for the purchase of the following
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),.74p.oe Interment
Signature of Purchaser City /�&S _e�b a s t 2ia
Service fees are to be paid at time of need only
l: \W W- DATAWa- CemeterARECEIPT.doc
W O H
Circle One
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DECEASED
NAME:
(First)
COf��
PLEASE PRINT
(Middle) (Last) ( q S , y)
DATE OF BIRTH: 213 Z `f
(Month) (Day) (Year)
DATE OF DEATH: ll
SIGNATURE:
(Month)
(Day) (Year)
PRINT Q /
SIGNATURE: �� r
• ii / 6"
DATE. �
Unit 3
Doubles / South
COLUMBERIUM:
NICH
NUMBER:
FOR OFFICE USE ONLY
(South)
CITY OF SEBASTIAN
❑ Cash
No.
Amount Paid
001001208001
Sales Tax
001501322900
Garage Sales
001501341920
Copies/Bid Specs.
001501341910
LDC/Code of Ordinances
001501341930
Election (qualifying Fees
601010 343800
Cemetery Lots
LotMichvZACI7.S • Block 4L Unit
001501343805
Cemetery Fees
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(DgC'C—
Total Paid ' d d
In Is
White — Dept. of Origin • Yellow — Finance • Pink - Applicant
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