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HomeMy WebLinkAbout3-COL-19I Minner City Manager CHYOF HOME OF PELICAN ISLAND CITY o)f SEBASTI Certificate of Interment Rights Certificate No. 2277 IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Robert Dolan 1350 Damask Lane, 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: Unit 3, Columbarium, Niche 19DSA 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 23rd day of November, 2010. CITY OF S :ASTIAN, FLORIDA ATT Sally Maio, MMC c ity Clerk Name LQIi 7 /�rL 77fl. 2 L4/,(- :•ei: )1/q/' Unit 3 Block G©/ Lot Date of Mark -out Date of Burial il/ 2 il Name of Funeral HomI' 17/7 Authorized by Time tv,".+6 A, 64‘414,f,br,) s F AWINDS CREMATORY Sebastian, Florida 735 Fleming Street Sebastian, Florida 32958 www.seawindsfh.com (772) 589 -1933 We hereby certify that these are the remains of ANTOINETTE DOLAN C (1 2, The remains were received from Cremation Permit No. 10 41682 203 Issued at INDIAN RIVER COUNTY Date of Death 11/22/2010 2_5 2 O (o By '44,1 Date of Cremation SEAWINDS FUNERAL HOME Cremator Name(s) Address Area Code Phone Number Receipt is acknowledged in the sum of: 1 ,Q Ak Irt t! on this n( 0 day of Vase and Ring for Niches (cost) I: \WW- DATA \Ms Cemetery\RECEIPT.doc J Cemetery Lot(s) and /or Niche(s). Unit Block CALQ Lot(s) Additional Fees paid at time of purchase: Temporary Marker Preparation Installation 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. 1 saAk 0 fzukS Seletdit&A 1 AutkE Name Residence Address of Intended Occupant if Other Than Purchaser Corner Markers (set of 4 $20) Opening Closing 4t OFFICE USE ONLY ea Dollars C 20/0 for the purchase of the following described Niche(s) 9 L3 for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed therefore by the City of Sebastian. /W 0 H Circle One Interment Disinterment Signature of Purchaser City of Sebastian TOTAL J/ S 0 The following documents were provided as Proof of Residenc P_ F and c og 00000 00Q CD 0 CD A CO A CO N O CO N.) CO CO (D (D (D (D O O O O O O 0 a co 0 -c n m0 T m y N W T ?t 5 m 2 m seoueu!INOI 9 P 0 0/001 909CtE 1.051,00 Pled pinowy i LL N ACCOUNT WITH 3.e_n4 7 1174 ri)e Les ADDRESS A9 I s o/c iz ,14‘G /2_1)%% A- eol• DATE //4 3 6 TERMS N. I 000, 8 c og 00000 00Q CD 0 CD A CO A CO N O CO N.) CO CO (D (D (D (D O O O O O O 0 a co 0 -c n m0 T m y N W T ?t 5 m 2 m seoueu!INOI 9 P 0 0/001 909CtE 1.051,00 Pled pinowy Indian River County, Florida Property Appraiser Property Data Page 1 of 1 Data For Parcel 31382400001279000008.0 Base Data Parcel: 31382400001279000008.0 Owner: ROBERT F ANTOINETTE DOLAN Site Address: Photos [11 Click to enlarge. Notes Notes: 1350 DAMASK LN, SEBASTIAN, FL 32958 Mailing Address Address: 1350 DAMASK LN City State Zip: SEBASTIAN, FL 32958 -6140 SEBASTIAN HIGHLANDS SUB UNIT NO 10 BLK 279 LOTS 8 9 PBI 6 -37G Report Discrepancy Map Property Information Tax Code: 2 Property Use: Neighborhood: his property. Legal Description Click here for full legal Secondary Owners description Real Appraiser CW CHARLES WILLIAMS Date: 3/2/2004 No additional owners found. Click here to view oblique imagery through Microsoft Live Maps. 0100 SINGLE FAMILY IMPROVED 140018.20 SEB HLS SEC 13/24/25 AREA GIS pace/ shapefi /e /ast updated 11/23/201012:17 ::06 AM. CAMA database /ast updated 11/19/2010 12:32: 05 AM. http://www.ircpa.org/Data.aspx?ParcelID=31382400001279000008.0 11/23/2010 FUNERAL HOME: ADDRESS: PHONE FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY (Check One) __OPEN BURIAL LOT Lot _OPEN CREMAINS LOT Lot X OPEN COLUMBARIUM NICHE Niche/ BURIAL DATE AND SERVICE TIME: FOR DECEASED: A ,y/oi.✓f.� /Jr��4.✓ Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of owner f Name I Signatu 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 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 Cerrdetery!Se tk on SE TI AN NOW a PELKAN ISLAND 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 sew C., ../D S /i <i,Gle.44 /7 A C Ifft Date Block Block Block G Unit Unit Unit 3 w 9>I,l l23 /id Date Signature Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion.