HomeMy WebLinkAbout4-05-38Name tr- aArez �l
Unit y
Block 5�
Lot v
Date of Mark -out
Date of Burial 3 /,5—// ` Time ` : on A'
e_�
Name of Funeral Home 15 / A Vht
Authorized by
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
For information contact:
Kip Kelso .Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772) 589 -5570
FUNERAL HOME: Strunk Funeral Home and Crematory
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE #: 772- 589 -1000
Check One
OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
Lot7jgBlock �5' Unit_
Lot Block Unit,
Niche Block Unit
N S E W
BURIAL DATE AND SERVICE TIME: L�� — `� %lA-m
FOR DECEASED
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
644:A d a %J
Name
• - 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.
Tfi rvin
AAgC,1tk)
Na a Signature v 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 and that all fees have been paid:
1�2 a, zle,� �� -
e eter Sexton Date
This form to be provided t Clerk's Office by Sexton for permanent record upon completion.
Certificate No. 2342
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Richard Svatek
4435 Sunset Cay Circle
Boynton Beach, FL 33436
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 5, Lot 38
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 6th day of August, 2012.
CITY OF SEBASTIAN, FLORIDA
ATTEST:
Sally A._ aio, MMC
City Clerk
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
4858
Name alln 9 / 5 V6J64 ❑ Cash
Date i1 q, [(Check #
No. Amount Paid
001001
208001
Sales Tax
001501
322900
Garage Sales
001501341920
Copies /Bid Specs.
001501
341910
LDCICode of Ordinances
001501341930
Election Qualifying Fees
601010
343800
Cemetery Lots
Lot/Niche . > J �/
Block _, Unit
001501
343805
Cemetery Fees
0/c 5�o
Total Paid �• Q
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
f]lY Of
SJESAST
'mac,
HOME Of PELICAN 151-AND
\1
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
(Chard S VQfe k
Name(s)
41435 ScKrIset Cau C.t rC(e 30 nto n 13ea-Ck F 33 3(
Address
61 ) 73 5 _ u
Area Code & Phon Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the
d�sum
� of:
Dollars ($ 00(), 0o
on this. day of ALk0I u.S + , 20 U for the purchase of the following described
Cemetery Lot(s) and /or Niche(s).
Unit L , Block rJ , Lot(s) 38 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)
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
J
Signature of Purchaser
Opening & Closing
Interment
/W O H
Circle One
Disinterment
TOTAL $ cw () U , 00
of Sebastian
The following documents were provided as Proof of
Residency:
I:\WW- DATA \Ms- Cemeterv\RECEIPT.dor_. I
I and
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4484
RECEIPT
Name M K4- m rs. IA/e l ch ❑ Cash
Date —/2- Check# :33
No. Amount Paid
001001 208001 Sales Tax
001501 322900 Garage Sales
001501341920 Copies/Bid Specs.
001501 341910 LDC /Code of Ordinances
001501341930 Election Qualifying Fees
601010 343800 Cemetery Lots
LoMiche3 _3�,gabck , Unit
001501 343805 Cemetery Fees
ecc c� c rll� t JJXA
t� cC t Ko,� (,JLC.c.ti-.
41-el W' Total Paid VIJCJ.�
Initials
White – Dept. of Origin • Yellow – Finance a Pink - Applicant