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Certificate No. 2347
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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:
�onathan Keddy &/or David
12780 103rd Street
Fellsmere, FL 32948
R. Keddy
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 5, Lot 30
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 16t" day of October, 2012.
CITY OF SEBASTIAN, FLORIDA
i�"AI Minner
City Manager
ATTEST:
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Sally A aio, MMC
City Clerk
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City of Sebastian iVlunicip�l Cer�etery Purchase Receipt
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To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
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Name(s)
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Address
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Area Code & Phone Number
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Name & Residence Address of Intended Occupant if Other Than Purchaser
O�FICE USE ONLY
Receipt is acknowledged in the sum of:
..�'�u-o ���-c,� a� � �' < �
Dollars ($ �0(�. oQ )
on this. 1(J`� day of (� C�-t� � 2,Y , 20 �c�- for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit � , Block Jc , Lot(s) � v 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 & Installatio
Signature of Purchaser
Opening & Closing
Interment
/W O H
Circle One
Disinterme
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ty of Sebastian
The following documents were provided as Proof of
Residency:
l:1V�M1-DATA�Nls-Gemetery\RECElPT.doc � ana
CITY OF SEBASTIAN
CITY CLERK�S oFF��E . 4 4 81
RECEIPT
Name � �l� [.1.T1') �./'1 1` �-(J�C.� y
Date � � � � � —� Z
No.
001001208001
001501 322900
001501 341920
001501 341910
001501 341930
601010 343800
001501 343805
Sales Tax
Garage Sales
Copies/Bid Specs.
LDCICode of Ordinances
� Cash
�Check #�_
Amount Paid
Election Qualifying Fees
Cemetery Lots ��o
LoUNiche �V , Block�, Unit�
Cemetery Fees
Total Paid vV ��
Inkials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant