HomeMy WebLinkAbout4-11-25CITY Of
HOME OF PELICAN ISLAND
CITY OF SEB STUN
Certificate No. 2230
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Harry E. /or Donna Brock Post Office Box 87, Roseland, FL 32957
(name) (address)
In and for consideration of the sum of $6,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following Tots:
Unit 4, Blk 11, Lots 25, 26, 27
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 14 day of July, 2009.
CITY OF S BASTIAN, FLORIDA ATTE T:
Al Minner
City Manager
Sall A. Maio, MMC
City Clerk
Iii
Name ,e/i At
Unit 1
Block /1
Lot .g6
Date of Mark -out 2//r///
Date of Burial x/i7
Name of Funeral Home
Authorized by
1/1-1:2
(et'es.,,p,.r) 4 ix
n
3
CD
Time 1 /s
0 8
8 8 8 8
A A A Cal
c.., N O
cg 8 (D (0 O CO O O 8
0 m 0 d m
co
N
g 0 -4
m
c
1
3
0
a
n
n 0
m r
mT
m m
y N CO
-I O H
T H
T s
m z
m
CO
f
WARREN HENRY WEAVER
WARREN HENRY WEAVER
(January 22, 1937 January 22, 2011)
Mr. Warren Henry Weaver, 74, died January 22, 2011 at his residence in
Roseland.
He was born in Albany, New York and lived in Roseland for 34 years coming
from his birthplace.
He worked as a Lineman in the Electrical Industry prior to retirement.
He served in the U.S. Air Force.
Survivors include his wife of 53 years, Dorothy (Dot) Weaver of Roseland; sons,
Terry Weaver of East Schodack, NY, Mark Weaver of Pendleton, SC; daughters,
Lynn Weaver of Roseland, Donna Brock of Roseland; brothers, Don Weaver of
Colonie, NY, Billie Weaver of Saratoga Springs, NY; sisters, Claire Dwyer of
Schenectady, NY, Jackie Weaver of New York, Marsha Kowalski of Palm Bay; 7
grandchildren, 2 great grandchildren. He was preceded in death by a baby
brother, his sister, Eileen and grandson, Justin Brock.
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEBAs
HOW Oa PELICAN ISLAND
For information contact:
Kip Kelso Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
FOR DECEASED: w p,ek.otGir ,e/4
Name
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: )1T-el L. /gM, e,>,t.
ADDRE SS:
PHONE S87— /odo-
/le Ti✓ .r 7 ,:r9usT.v 4it f PAI7?z J_o 7
(Check One) 'lir fbo
OPEN BURIAL LOT Lot Block Unit 7
_OPEN CREMAINS LOT Lot Block Unit
_OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME: 4/j77, /,o /574.
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
W
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
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR.
Name 'Signature Date
Cemetery Sexton Certification:
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
e ete on
Ce et Sexton
/7//
Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
Area Code Phone Number
../4.19-6(4etnict Q v iv /6-0
Vase and Ring for Niches (cost)
Signature of Purchaser
I \VWV- DATA \Ms Cemetery\RECE I PT. doc
SLDASTIAN
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.
Ferro 6ufvcyo Dohna- Brock
Name(s)
p. g9 g
Address
g.ose,)aro4 FL 3
Name Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
on this `t +1 day of N fa.(y 20 Q for the purchase of the following described
Cemetery and /or Niche(s).
Unit `1" Block 1 Lot(s) c 5 5 071p, 017 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 0 H
Circle One
Interment c)_60,00 Disinterment
Temporary Marker Preparation Installation
Dollars (o000. w
11 L4 4
The following documents were provided as Proof of
Residency:
A and
ty of Sebastian
TOTAL CU oZJJO 0 O
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
4569
Name 5 7-13-05 L .n'f. Cash
Date Check# 4742
No. Amount Paid
001001208001 Sales Tax
001501 322900 Garage Sales
001501 341920 Copies/Bid Specs.
001501 341910 LDC/Code of Ordinances
001501 341930 Election Qualifying Fees
601010 343800 Cemetery Lots 13 r oc i 6000 QQ
Lot/Nie5 424. a 7 Block 1 Unit
001501 343805 Cemetery Fees
Initials
White Dept. of Origin Yellow Finance Pink Applicant
Total Paid 6256,120