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Home My WebLink About2-07-06Name Unit_ Block Lot Date of Mark -out /;—/iso)/(& Date of Burial �/;/�/� i� Time %'00,0• L-tf�4�OL�.' Name of Funeral Home Authorized by I4 seawinds Cremator 735 South Fleming Street, Sebastian, Florida (772)589-1933 For Seak.-inds F unepm' Home We certify this container contains the Cremated Remains of MARY ELIZABETH HEINICKE who died on December L7_,2016 in the City of Sebastian, County of Indian River, and State of Florida. Your loved one was cremated on 16-73380-5294 Permit # Tag# /a -"-dl - 1 & Date Of Cremation Thank you for allowing us to serve your family. Funeral Director's Request to City of Sebastian for Burial Opening in Sebastian Municipal Cemetery Funeral (Check) Open Burial Lot _60pen Cremains Lot Contact Information: Kip Kelso, Cemetery Sexton Sebastian Municipal Cemetery Phone (772) 589-2545 Fax (772) 228-9927 City Clerk's Office Cathy Testa City Hall, 1225 Main Street Sebastian, FL 32958 Phone (772) 388-8209 ctesta 0)citvofse ba sti a n. o rp „VA" FU�✓E�fIL Lot_ Lot (c 4Fdasvio.✓ Block_ Unit_ Block '7 Unit a Open Columbarium Niche Niche_ Block_ Unit_ (Circle) N S E W Burial Date and Service Time: 2 Z/ Zc/ 6 -S R Deceased Name: /yWA6 AIE4-✓eI 4-4r Name and Signature of Lot Ow prese tative: (Must provide proper docum ation f ner Swviow. wArl4t /.;)- - Zz-/G Print Name Signatur 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 authorized opening of same. Name and Signature of Licensed Funeral Director: Print Name Signature Date 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: Cemetery Sexton Certification: Cemetery Sexton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SEBASTIAN 10401 ADMINISTRATIVE SERVICES RECEIPT Name wb - c KE U Cash Date la.Wal 116 a/Check#aa�d�o ❑ 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 ob 15 o i 3437c,5 � • ° � t a �k -7 L -0-T,(0 464V Total Paid 6L_- I6als Security Dep Held - Amount $ Check # White - Dept. of Origin • Yellow - Admin. Svcs. • Pink - Applicant FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 11 SEBASTtgfN Ph (772) 589-2545 NOME Ji PELON ISEANO For information contact: Kip Kelso - Cemetery Sexton Sebastian Municipal Cemetery Ph. (772) 589-2545 / fax (772) 228-9927 City Clerk's Office City Hall, 1225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 FUNERAL HOME: 5 e,4 w f),5 ADDRESS: PHONE #: (Check One) OPEN BURIAL LOT Lot (/a Block _Unit XXX OPEN CREMAINS LOT Lot Block Unit _OPEN COLUMBARIUM NICHE Niche Block Unit ti W _ BURIAL DATE AND SERVICE TIME: 244-f 6 ��%ooR�C &;;a Z FOR DECEASED: . ivame NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) W �A - 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. A41' L /Q Date Names Signature - -- ------------------------------- Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with �i / Q. Clerk's office Lind that all fees have been paid 4 /Z'"'521 Ceme ry xton Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. Paid by General Receipt No. 176 3/14 80 DEED #387 p ••••- ••••••.. .... Dated...... � ......... Ronald O. Heinicke List Price $ *. *400.00 ** Maximum No. Burial Cleveland Street ........ spaces .4.......... Discount $ ............. � Fl 32958 ••••• Total area in square feet ............ Sebastian, Net Paid '"400.00 ** $ • • • • • • • • • • • • Monument permitted ......... fZa:t....... Catherine: interred Mar 80 R &R attached (Data above this line for City Record only) Lots 6.7,10 &11 BLK 7 Un #2 i _ I r a I 00 • D A t � d D j ;n M i 11