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HomeMy WebLinkAbout3-COL-23Snc CRY OF HOME OF PELICAN ISLAND Certificate No. 2303 CITV OF SEBASTI i1 Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Cathy Smiarowski 1306 Schumann Drive Sebastian, FL 32958 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 23sn 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 5t" day of August, 2011. CITY OF SEJBASTIAN, FLORIDA rm Al Minner ty Manager ATTEST: Sally Maio, MMC City Clerk CITY OF SEBASTIAN CITY CLERK'S OFFICE 4313 RECEIPT Name &-h q Y I&Y- 0&A6 V-Cash �i Date O — 6' — / I ❑ Check A No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDCICode of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots �1 /.ZOO Lot/Niche 3sn .Blocks, 1 Unit 001501 343805 Cemetery Fees yo-St ri na 70.00 Total Paid 13,Z0.0 Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant a t I C� d P� U 1 Name Unit Block Lot Z l/Y Date of Mark -out !� Date of Burial_ Time Name of Funeral Home Authorized by FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY . SEW1V nt�E a rttKN+ntN+o 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 -6,215 or 388 -8214 Fax: (772)'589 -5570 FUNERAL HOME: ADDRESS: PHONE #: (Check One) N BURIAL LOT Lot Block Unit PEN CREMAINS LOT Lot -Block Unit jk:� OPEN COLUMBARIUM NICHE Niche _V11 Block�v,� , Unit W BURIAL DATE AND SERVICE TIME: dap FOR DECEASED: ! Name IJAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) C""" 7i� � a� z•J! Name Signature Date 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 Signature Date ------------------------------------------------------------------------------------------------------------------------------ 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 8 s- <i cernfleryfiext6h Date This fonTi to be provided to Clerk's Office by Sexton for permanent record upon completion. 0 3 N OJ N l-) o ar. 7 ?2 S o ( 7 70� II D n n 0 c z -a 0 v` O --i m m m o z 0� 4' 1 \10 F-) �ry • \ `w 0 Q � d l-) o ar. 7 ?2 S o ( 7 70� II D n n 0 c z -a 0 v` O --i m m m o z 0� 4' 1 \10 F-)