HomeMy WebLinkAbout4-08-03aName
Unit Al
Block
r,*01
Lot 3 P-40
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Date of Mark -out
Date of Burial 14^d:4x wp - Time
Name of Funeral Ho
Authorized by
03/12/2012 10:30 7722287079 COS AIR BLDG PAGE 01/01
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
N
HOW OPP ucnH Hwm
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
FUNERAL HOME:
City Clarks Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax: (772) 589.5570
Fiv�,eA/ //c�rE
ADDRESS: %Ss S, ELE/!r/SVG ST .SE6.OST/SYN F,C4e9,��
PHONE#: %72—reTJ9—/5slj
(Check One) 9 A
OPEN BURIAL LOT Lot3fy Block 8 Unit
-j,�DPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME: Ay6US�—Zo/,y
FOR DECEASED: �J/ZEILq �` EaGC/�9�ZI� �i JLGgS
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
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 FUNE CTOR:
-a.oviD cu ul.oiigcr I. ?Y/G
Name gnature
Da
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:
$2 6.
O'e�tery eon Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion
CITY OF SEBASTIAN 10116
ADMINISTRATIVE SERVICES RECEIPT
NameVEA w /rrbs '84'114-S ' ❑ Cash
Date 1�5 1'� Check 441-575-
L)
4j5-❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit
001501 362100 Taxable Rent
001501 362150 Non -Taxable Rent
450010 369900 Airport Badge
001001218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 329200 Site Plan Review
001501 329300 Subdivision/Plat Review
001501 329100 Zoning Fees �p
00 t5 O t 343gos' C
tlnr 1T ,QIK $ 0girs 3,qt 4.4
Total Paikloo,
6nitia-Is
Security Dep Held - Amourit $ Check #
White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant
from
SEAWINDS CREMATORY
Sebastian, Florida
735 Fleming Street • Sebastian, Florida 32958
www.seawindsfh.com
(772) 589-1933
We hereby certify that these are the remains of EDWARD A BALLAS SR
`S . The remains were received
SEAWINDS FUNERAL HOME & CREMATORY
Cremation Permit No. 04-2617-117
Issued at INDIAN RIVER COUNTY
Date of Death MAY 28 , 2004
Date of Cremation JUNE 2 , 2004 BY
Cremator
CITY OF
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HONiE �OF PEUCAN ISLAND
Certificate No. 2327
��� �� � '��������
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Edward A. Ballas, �r.
1342 Starboard Street
Sebastian, FL 32958
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Block 8, Lots 3a & 4a
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 20th day of March, 2012.
CITY OF SEBASTIAN, FLORIDA
' 7AI Minner
City Manager
ATTEST:
,r �t.
C�''-�.__
�
Sally . Maio, MMC
City Clerk
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Oct 12 16 04:24p Eaglemonuments 17724657949 p.2
Varr' TAia6 fmlo
Now 'Mir is For 51
lgaatertlutnla :
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Name ADO(* r His :
A.O.B.
B.O.D.
Legal Qesoipi4en
Unit
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Lot
Squara FL
Approved By
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By
tixaunpto : NOTE
a'
City v/' Sebastian
som Ian Ccaxten
Pb. k It 5I{9 - 1545
(:at f 10721 228-992?
rmallenal purpalm rxyuxrdlap 1110410me015 rl Schartlan Cexicim .
le SIxti cm aadrt 2 ft. A awc 2 rt.( V" 2 h, iw a pained fnntalatlan )
City of Seh"rfau Dry MIX
Seb➢ltlaA (`OflKStYr
1921 Sarth i'enlral Ara- Faundalinp puurrrl
32v52 . By
Ctmiclerr Sexton dale;
t P,�P-�tv &
ILPZHER:
13, 19)2,1 o,o-e. 0x
nlatrrirt>L•tlltd
ira*1
a� : �n1�yy'f\
ddtc : 101-s ,2q
MARKER OVER 2 FT, L 4G REQUIRES A POURED CONCRETE FOUNDATION
INCLU DESA BASE.
MARKER SMALLER THAN 2 FT. LONG REQUIRES A DRY MfX
I INCLUDES A FLAT GRASS MARKER.
Oct 12 16 04:24p Eaglemonuments
17724657949 p.3
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