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HOME OF PELICAN ISLAND
CITY OF' SEB (4 STIAN
Certificate of Interment Rights
Certificate No. 2265
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Nils /or Jean Wedin 12 Bimini Circle, Sebastian, FL 32958
(name) (address)
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
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 2 day of August, 2010.
CITY OF SE:ASTIAN, FLORIDA
Minner
y Manager
Unit 3, Columbarium, Niche 27dsa
ATTEST:
Sal A. Maio, MMC
City Clerk
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.
I1/1 r. d- h'Lrs N i I S (AI
Name(s)
Address
IZ 131miv- C■rctt, SehaSflco FL 32q3
(77 z) i 7 oa
Area Code Phone Number
Vase and Ring for Niches (cost)
Temporary Marker Preparation Installation
1:\WW- DATA \Ms Cemetery\RECEIPT doc
HOME OF PELICAN ISLAND
kI1Sd- Tear\
Name Residence Address of tended Occupan Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
hA9- .0-11cc alLe r9-6 Dollars o LO(1 00
on this J-- (A-C( day of J4 (AS 20 (0 for the purchase of the following described
Cemetery Lot(s) and /or Niche(s).
Unit 3 Block b Lot(s) Niche(s) c 7 GS a
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 W 0 H
Circle One
Interment Disinterment
Signature of Purchaser i ity of Sebastian
TOTAL $‘7Z0 00. 0
WiltucLA.n/a-
The following documents were provided as Proof of
Residency:
and
DECEASED
NAME:
DATE OF DEATH:
DATE:
NICH
NUMBER.
(First)
Unit 3
Double South A
COLUMBERIUM: eZ 7
PLEASE PRINT
DATE OF BIRTH: A =0 (ti 'gag
(Month) (Day) (Year)
(Month) (Day) (Year)
SIGNATURE: Ct
PRINT f�N (it)
SIGNATURE:
FOR OFFICE USE ONLY
A
(Middle)
7 ,,1/,l/ht
WiJ/v
(Last)
DECEASED t
NAME: V
(First)
DATE OF BIRTH: N 1 4 \Q
DATE OF DEATH:
SIGNATURE:
PRINT
SIGNATURE:
DATE:
Unit 3
Double South A
COLUMBERIUM:
NICH
NUMBER
PLEASE PRINT
(Month) (Day) (Year)
(Month) (Day)
`h.a S li
FOR OFFICE USE ONLY
T
(Middle)
a 7 l> /s
WE DIN)
(Last)
(Year)
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
4708
Name LA-J LA I r1 Cash
Date 0 1 0 DeCheck q 0 C
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 J ?,UfJ(.}_ r.00
Lot/Niche o2 74 O. Block o I Unit 3
001501 343805 Cemetery Fees
4.g (...,0;ilipiliVa"
Initials
White Dept. of Origin Yellow Finance Pink Applicant
Total Paid ;2_0‘.20.(-141)