HomeMy WebLinkAbout3-COL-12SnCRY OF
HOME OF PELICAN ISLAND
Certificate No 2244
CITY OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that
Patricia Kushin 11315 Woodbrook Lane, Reston, VA 20194
(name) (address)
In and for consideration of the sum of $2,400.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, Columbarium, Niche 12sn
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 26 day of January, 2010.
CITY OF SEBASTIAN FLORIDA ATTEST:
I Minner
ity Manager
Sally ,!Maio, MMC
City Clerk
Name d4ller Z. ,"AA 1 qg
Unit
Block d•e•h•
Lot
Date of Mark -out
Date of Burial
de 1
At /A s
Name of Funeral Horne
Authorized by
/3 1 D/i 0
/16 API;
We hereby certify that these are the remains of
10 -0119
Cremation Permit
Self
Atlas Crematory
2111 S. US Hwy 1
Rockledge, Florida 32955
(321) 635 -1973
Mary Malone
The remains were received from
Seawinds Funeral Home
Funeral Home
Sebastian, Florida
City and State
Date of Death: January 24, 2010
Date of Cremation: January 29, 2010
Dave Reid
By:
Cremator
Time 0 e
29593
Chip ID
2 ryes
In Memory of
Mary Lou Malone
January 24, 1931 January 24, 2010
Mary Lou Malone, 79 of Barefoot Bay, Fl passed away Sunday, January 24,
2010 at Sebastian River Medical Center.
She was born January 24, 1931 in Fulton, MS and was a resident of Barefoot
Bay for 14 years, coming from Miami Lakes, FL.
Mrs. Malone was a homemaker and retired as a certified dietetic aide.
Survivors includes her daughters Barbara M. Sherman of Charlotte, NC, Patricia
G. Kushin of Reston, VA, Roxanne Malone Winarski of Valkaria, FL; son Jack D.
Malone of Palm Bay, FL; significant other J. Russell Hengst of Barefoot Bay, FL;
two sisters Catherine Steele of Salinas, CA, Murrel Thomas of Fulton, MS; half
brothers and sisters Joyce Miller, Gerald Wallace, Ted Wallace, Billy Ray
Wallace, Bobby Joe Wallace, Peggy Whitt, Shirley Marie Guntharp; step- brother
Dewey Cowart; six grandchildren and one great granddaughter.
Memorial contributions may be made to the Autism Society Treasure Coast
Chapter, 3253 Southeast Bonita St., Stuart, FL 34997.
A memorial service will be held at 1:00 PM, Saturday, January 30, 2010 at
Seawinds Funeral Home Chapel in Sebastian, Florida. Inurnment will be private.
DECEASED n
NAME: a ry
(First)
DATE OF BIRTH: vanaar
(Month
DATE OF DEATH: 3G
n u at
(Month)
SIGNATURE:
PRINT
SIGNATURE:
DATE: O/ J2b
Unit 3
S /N /B
COLUMBERIUM:
NICH
NUMBER:
�c1U UCG(. n7 afhrr
PLEASE PRINT
Ok )1 A.
Lau,
(Middle)
and Gran /ne /A
(Day)
(Day)
FOR OFFICE USE ONLY
1131
(Year)
020)
(Year)
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all of
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HOME OF PELICAN 1
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LAND
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.
e i `'cc.$)i ;'/1
Name(s)
I i' 3 I5 &oodtorook La." e. 12es ab/
Address
Ce(I (5 7/ Zyy /303 home- 703)78' 7- O(o3
Area Code Phone Number
Name Residence Address of Intended Occupant if Other Than Purchaser
Receipt is acknowledged in the sum of:
i��l ((46/..61. Z 0 Dollars c 2 0 0 1-1
on this day of 20 for the purchase of the following described
Cemetery Lot(s) and /or Niche(s).
Unit 3 Block CO Lot(s) Niche(s) f 02.5 h
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 07_50. O D C 0 H
Circle One
Vase and Ring for Niches (cost) 66, 00 Interment Disinterment
Temporary Marker Preparation Installation
Signature of Purchaser
I: \W N- DATA\Ms- Cemetery\RECEIPT.doc
of Sebastian
OFFICE USE ONLY
TOTAL 02 7 I 0Q
tiJ,LleiLaryw,
The following documents were provided as Proof of
Residency:
and
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