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Certificate No. 2319
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
John &/or Laura Cannon
1504 Eagles Circle
Sebastian, FL 32958
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, Columbarium, Niche iidsa
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 30th day of January, 2012.
CITY OF,SEBASTIAN, FLORIDA
AI Minner
ity Manager
ATTEST:
Ily
Maio, MMC
Clerk
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City of Sebastian Municipai Cemetery Purchase Receipt
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To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
,� h h Q-c��v r�Ci u.r� C C� n v� o�
Name(s) �
1�v`-f Ec��(�S L'tr�l� S2b�s�i��, FL 3ZS5�
Address
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Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
„�.(,�� �✓L� CUnl� ��D�p Dollars ($o�OV• ��
on this. � �� day of �0.� ��-� U , 20� for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit � � , Block Co � , Lot(s)
Niche(s) ! � � 5 0.
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
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
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Interment
/W O H
Circle One
Disinterment
TCT ^ L $
(�-�
ity of Sebastian
The following documents were provided as Proof of
Residency:
��_ � r� ve.v-s C� 1(., and V Q. ��2.�ij I S.
DECEASED
NAME:
DATE OF BIRTH:
Q � /�
(First)
(Month)
DATE OF DEATH:
(Month)
SIGNATURE:
PLEASE PRINT
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(Middle)
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(Day)
r, (Day) _
1 ��,
(Last)
ear)
(Year)
PRINTED NAME`�N' /
SIGNATURE: "` � �N �� �� �N�~�
DATE: � — �� — ��
FOR OFFICE USE ONLY
Unit 3
Columbarium:
Niche No.:
PLEASE PRINT
DECEASED l,�
NAME: �.�i �J /2F}� � }�/V �-f� �/Cf/l1 C� /J
(First) (Middle) (Last)
DATE OF BIRTH: �14��- � -Z.S� � � � �
(Month) (Day) (Year)
DATE OF DEATH:
SIGNATURE:
(Month)
� ,
(Day)
�
(Year)
PRINTED NAME OF
SIGNATURE: ��v/� %� �- ' C� N/v ° �
DATE: �' 3 �' � � / �
FOR OFFICE USE ONLY
Unit 3
Columbarium:
Niche No.:
CITY OF SEBASTIAN 4 4 3 8
CITY CLERK'S OFFICE
RECEIPT
Name � Y'�" %� rS �C�-�1 r► o vl ❑ Cash
Date �— 7 i� ° 1 Z �Check #
No.
001001208001
001501 322900
001501 341920
001501 341910
001501 341930
601010 343800
001501343805
Amount Paid
Sales Tax
Garage Sales
CopiesBid Specs.
LDC/Code of Ordinances
Elec6on Qualifying Fees
Cemetery Lots ��O,U 0
LoUNiche � dSQ Block liW 1 , Unit�
Cemetery Fees
W Total Paid C_tJw•d �
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant