HomeMy WebLinkAbout3-COL-01SNBAl Minner
City Manager
HOME OF PELICAN ISLAND
CITY OF SEB STI
Certificate No. 2257
r
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Elizabeth Emmett Brophy 537 Cavern Terrace, Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $3,200.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niches:
Unit 3, Columbarium, Niches 1SNB 2DNB
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 10 day of May, 2010.
CITY 0 SEBASTIAN, FLORIDA ATTEST:
Sally Maio, MMC
City Clerk
Corner Markers (set of 4 $20)
I: \WVV- DATA \Ms Cemetery\REC EI PT.doc
HOME Of PELICAN ISLAND
Area Code Phone Number ctk) a
0,vae as _boy
l ,k 1. (6 ,v) Fry1 m CA
Name Residence Address of Intended Occupant if Other Than Purchaser
Vase and Ring for Niches (cost) (.P 0 0 Interment 50
Temporary Marker Preparation Installation
Opening Closing W 0 H
Circle One
ty of Sebastian
Disinterment
TOTAL 302.50, UD
1A)26COAY1
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.
17f,A)QA ko9 F- 4
Name(s)
(Z4r;
0 U e- r c s �--�n
Address
tai oc2Q1
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
\IMP th.e 40 ro Jac d d,
on this day of 20
Cemetery Lot(s) and /or Niche(s).
Unit 3 Block Lot(s) Niche(s) 1 3/\) Jvb N Q
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:
%Dollars 0) v p/ rnse-
for the purchase of the following described
The following documents were provided as Proof of
Residency:
and
Name
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
Emmett Fain,
Date 540
Cash
Initials
White Dept. of Origin Yellow Finance Pink Applicant
4695
[YCheck
No. Amount Paid
001001 208001 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 3200. 4)
Lot/Niche Block Unit
001501 343805 Cemetery Fees 50- 0 0
Vase avid r 'n j 6a6.00
Total Paid 331& 00
May 10 2010 1: 9PM COS CEMETERY
I)ECEA, ;ED 2
NAME:
(First)
DATE 0 F BIRTH:
DATE 0 .DEATH:
(Month)
SIONAT 1RE:
PRINT
SIGNATI TRE:
DATE:
Unit 3
S/ N 'B
COLUMf EIHLJM:
NICE'
NUMBER:
/b 0
PLEASE PRINT
(Middle) (Last)
(J)ay)
FOR OFFICE USE ONLY
7722289927 p.1
gro