HomeMy WebLinkAbout4-08-10aCtiY OF
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HOME OF PELICAN ISLAND
Certificate No. 2329
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Certificate of lnterment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Oscar &/or Aurelia Tiborczszeghi
3262 Sussex Way
Vero Beach, FL 32966
In and for consideration of the sum of $1,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 8, Lot 10a
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 2nd day Of April� 2012.
CITY OF SEBASTIAN, FLORIDA
� AI Minner
City Manager
ATTEST:
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Sally . Maio, MMC
City Clerk
Name v.7 c./� ic. �- e,R.:
Unit "I
Block �
Lot !Ci " %� •
Date of Mark-out�1�/��
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Date of Burial �/y��/� � Time �ti � oa ff�� 4��iYGS �,���
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Name of Funeral Home
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City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
r Q�I'��l'flY %�� �� � I
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Name(s) ' _..J
3 Z� 2 5 u�.� P u �a-u .��r� �� c`c,i� �� � Z� �O �
Address ,� _
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Area Code & Phone umber
Name & Residence Address of
cCC� r,f�YY�c�d F., o�; b r, r C�
nded Occupant if Other Than Pu
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
(�i� ��,�1� Q.YI�. ��. ��B-� Dollars ($ �UC�O, b o � .
on this. � day of /�(i� t' i( , 20� for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit �, Block O , Lot(s) � �4- Niche(s)
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 5�. 6� / W O H
Circle One
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
Signature of Purchaser
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Interment
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!:\�n!W-�ATA1Ms-Gemeter;�RFCEIPT.doc �� (�
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Disinterment
Tc�a� � /(JS�. °a
� y of Sebastian
The following documents were provided as Proof of
Residency:
and
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
an�
S��T�N
HOME OF PELICAN ISLAND .
For information contact:
Kip Ke/so - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
O�ce (772) 388-8215 or 388-8294
Fax: (772) 589-5570
FUNERAL HOME: ��i�
ADDRESS:
PHONE #:
(Check One)
OPEN BURIAL LOT
✓ OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TIME:
FOR DECEASED: USCCc.Y
Name
Lot Block Unit
Lot � Block � Unit �
Niche Block Unit
N S E W .
o ' o t� �
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
a
I 18�o�C z s��� HI � l � D�a � oz -���Z.
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:
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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 an th t all fees have been paid:
. Yz
Ceme ry exton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.