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Certificate No. 2336
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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: -
Brian .7. &/or .7oan M. Clinton
772 Holden Avenue
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 lot:
Unit 4, Block 5, Lot 22
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 8t" day of )une, 2012.
CITY OF SEBASTIAN, FLORIDA
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AI Minner
ity Manager
ATTEST:
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Sally . Maio, MMC
City Clerk
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Date of Burial 'T/3.�I`L Time �l•� � ' �
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Name of Funeral Ho
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JOAN MARIE CLINTON
Joan Marie Clinton, 79 of Sebastian, FL died June 8, 2012 at Sebastian River
Medical Center.
She was born October 19, 1932 in Brooklyn, NY. She had been a resident of
Sebastian and Barefoot Bay since 1988, coming from North Merrick, NY.
Prior to retirement she was staff aide to the Principal of Lakeside School in
Merrick, NY. She was a long time member of St. Lukes Catholic Church and a
member of St. Lukes Ladies Guild.
Survivors include her husband of 57 years Brian J. Clinton of Sebastian, FL; sons
Kenneth Clinton of Ontario, WI, Gerard Clinton of Sayville, NY; daughter Joanne
Carbone of Bayside, NY; sister Francis Ricca of North Merrick, NY; two
grandsons and finro granddaughters. She was a loving and gentle lady.
Jun.29.2012 01:44 PM PAGE. 1/ 2
FUNERAL DIRECi�R`S REqUEST TD C17'Y O� S��ASTfAN
FOR �URtA1. QpENtNG IN SEBASTIAN MUNIClPAL C�M�TERY
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r�e a� Pe,crw �wwo
For informat�On contack:
K/p Kelso - Ceme,tery Se�cbn
5eb�stlan Muni�ipa! Cemetery
(772} 589-264�
FUNERAL HQM�:
ADDFtESS
F'HUNE #:
C/ty Gerk's Offf��
Clty Hall, 922b Maln Street
SeBastlan, FL 32958
Oflice (i72} 388..�295 or 3$8-82�4
Fax: (7�'2) fi89-557p
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(CheCk dne)
OPEN BURIAL �QT. Lo# Block Unit
�� ,OC'EN CREMAtNS I.+p`T Lat � gloCk � Unit �
�,OP�N CQLUMBARIUM NICHE Niche � $IocK Unit
N,�S�E�W
BURtA�. DATE AN� SERVICE TIM�: —
FQR DEC�AS�D: �Dr ri ` .
Name
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�/�C�t �i�i , -�7)
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NAME AND SIGNATU�tE QF LQT OWNER OR REpR�SENTATIVE:
(Must provfde prope� documentation of ownership}
, �� ��S �f�. f� ` � � R l � �.._.
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Name Si� a#ure D�te
I cErtify thet I have determined the ownershfp of the above descrlbed site, that all site f�es and
�dministratfve fees h�ve b�n paid and authorize opening af same,
NAME AND 81GNATURE O� LICENa�D �UN
Name
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[Ja#e
Gemetery Sextan CertFFicati�n: ' — --
! cerfify that I have cher,lced the �nrner�shfp information by viawing the owrter's dsed and cqr�firmin�
wifh C1erk's pjtia� a d at ell fees have besn paid:
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e te 5 � ps e
This fomn to be pravided to Cierk`s Office by Sexton for perrnanent rect�rd upon compl�tion.
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City of Sebastian Municipal Cemetery Purchase Receipt
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To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
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�V'��' C�c� C�c�ia � .J � �h !yl . � � � n �o r�
Name(s) -j 7 2 �o (G�e..c� �v�� �.5�(�S'�t-iC��� ��.. 3 Z g S8
Address
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Area Code & Phone umber
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
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?-D Dollars ($ %D � 0 , b Q )
on this. ��h day of �I,Z, h� , 20 � Z for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit _�, Block �_, Lot(s} Z z 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
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
Signature of Purchaser
Interment
/W O H
Circle One
Disinterment
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of Sebastian
The following documents were provided as Proof of
Residency:
!:\V�M�-DRTAWls-Cemetery\RFCF I PT. d oc
I and
CRY OF SEBASTIAN � � � �
CITY CLERK'S OFFICE -
RECEIPT
Name J'`� l.•l I�(1 ) b �i ❑ Cash
Date lY � ("1 � � � li(Check p�
No. Amount Paid
001001208001 Sales Tax
001501322900 Garage Sales
001501341920 CopiesBid Specs.
0015E11341910 LDCICode of O�dinances
001501341930 Eledion Qualirying Fees
601010 343800 Cemetery Lots ���
LotMiche Z Z , Block �, Unit �
001501343805 Cemetery Fees
TotalPaid �%dU ��
In'fials
White - Dept. of Oripin • Yellow - Finsnce • Pink • Applicant