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Certificate No. 2254
(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:
Renee M. Hazien 568 S. Easy Street, Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $1,200.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, Columbarium, Niche 26Sn
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 21St day of April, 2010.
CITY FSEB STIAN, FLORIDA ATTEST:
Y
A Minner Sally aio, MMC
City Manager City Clerk
Name /4P A
Unit
Block
Lot
Date of Mark -out
Date of Burial / -0 (0 Time
Name of Funeral Home
Authorized by p � [s[�cr1
. Mon 1;,ew x 5 a
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SE"
HOME Oi DEEtUN WND
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
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:
ADDRESS:
PHONE #:
(Check One)
OPEN BURIAL LOT Lot Block Unit
--,OPEN CREMAINS LOT Lot Block Unit
PEN COLUMBARIUM NICHE NicheZBlock Unit
IA/ _ W
BURIAL DATE AND SERVICE TIME: a ;oa
FOR DECEASED:Al
ivame
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Name Signature Date
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 inforn-iation by viewing the owner's deed and confirming
with Clerk's office and that all fees have been paid
- /.0 e - 14��4 - / / O.
Cem ery Sext6n Date
This forlTI to be provided to Clerk's Office by Sexton for permanent record upon completion.
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City of Sebastian
ScI)J%(iarl (Cr►,CtCtY
Ph. N 11772) 589 - 2545
Vet R 1(772 ) 229 9927
tiutr Thi% h for Informational purpows regwrdirlg %lunument. 2t Sel,ostlan t'c>flcicr�
Note ' This is for a F)onhle Marker under 2 ft. & over 2 ft. ( over 2 ft. is a poured foundation )
Ncaw return io Cit} Of wha,tl2n
Sebastian Uenleler%
)921 North ('entral Alt.
32458
Attention ('euleterY Schon
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date 5/5/121, 13
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everlasting / jamie
date : 6/6/13
Block OAK PLANTER
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Uxtr 5/9/13
everlasting monument co.
EX%N i.r ( Victure AA) Monument in nuestion 1 i
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May 10 13 11:16a Quality Monument Sales I
7062837152 p.1
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