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SIEBAST1131
HOME OF PELICAN ISLAND
Certificate No. 2365
CITY OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Rita G. Daley
139 Columbus Street
Sebastian, FL 32958
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots: l
Unit 4, Block 5, Lots 18 & 19
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian. I�
CONVEYED THIS 11th day of March, 2013.
CITY OF SEBASTIAN, FLORIDA ATTEST:
x,
A .14( f� T 1
I Minner Sally A . Maio, MMC
i y Manager City Clerk
,
011 OF
SEBASTIAN
HOME OF PELICAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
Dca
Name(s)
13q Col u buc Street, 5L.IQSflair\ fL 37958
Address
Area Code & Phone Number
Name & Residence Address o ntended •ccupant if 6 her Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
4-W-0 �4-6 d. av-cC h/o r-o ' Dollars ($ ) -
on this. / / day of , arch , 20 / 3 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit q , Block 5 , Lot(s) I F (7 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) (:;pening & Closing /W 0 H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
Temporary Marker Preparation & Installation
TOTAL $ ,,ZC10C , OO
Signature of Purchaser i of Sebastian
The following documents were provided as Proof of
Residency:
!_\Ww-DATA\Ms-Cemetery\RECEIPT.doc I i C Prop /prz ;s t
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