HomeMy WebLinkAbout3-COL-27SnName
Unit
Block
Lot
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Date of Mark-out—
Date of Burial Time
Name of Funeral Home
Authorized
CcJ
CITY OF SEBASTIAN 4376
CITY CLERK'S OFFICE
RECEIPT
Name ke—n I° e' ' �� Cash
cc
Date— Check#
Amount Paid
No.
001001208001
Sales Tax
001501322900
Garage Sales
001501341920
Copies/Bid Specs.
00150134`1910
LDC/Code of Ordinances
001501341930
Election Qualifying Fees
oC,VO•(JV
601010 343800
Cemetery Lots n ,�
5h%Block w
Unit...._
Lot[Nichea
_
Fees
olc
001501343805
Cemetery
Total Paid I d
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
Certificate No. 2371
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:
Renee M. Hazien
568 S. Easy Street
Sebastian, FL 32958
In and for consideration of the sum of $1,200.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 31 Columbarium, Niche 27sn
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 8th day of May, 2013.
CITY OF SEBASTIAN, FLORIDA
' `JkI Minner
City Manager
ATTEST:
-
Sally A. aio, MMC
itv Clerk
099040
Date a'7
TO /11/14 Ap-
TERMS
IN ACCOUNT WITH
�4, Z4.4 G�/ 1l t./ (id_
sroCK form zbtllz
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fb�
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fes•
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sroCK form zbtllz
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
sE,BAS_"
ItOW Vi PILICOIN ISLAND
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Ha/l. 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax: (772) 589-5570
FUNERAL HOME:
ADDRESS:
PHONE #:
(Check One)
OPEN BURIAL LOT Lot Block Unit
CREMAINS LOT Lot _Block Unit
__
PEN COLUMBARIUM NICHE Niche,2 Block Unit
W
BURIAL DATE AND SERVICE TIME: 5-1"641,3 C?a°,�✓LS�i�.�)
FOR DECEASED:17
ivame i
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
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.
Name Al /A Signature
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 tthhhat all fees have been paid
Ceme ry S xt Dal
le
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
City of Sebastian
Schaslian C rmetrry
Ph. tt 1(772) t84. 2545
Fa c N 1 ( 772) 229 - 9927
Vulc This Is for informational purpose~ reguarding Monuments at Sehnstian Cenialrr%
'
We ' This is for a Dooble 'Marker under 2 ft. & over 2 ft. ( over 2 ft, is a poured foundation )
Plrasr return In i'01 Of sehastlan
Sebastian Cenwery
1921 North t`Cntral Ave. 1"011"daliun puurril
32458 bs : everlasting/ jamie
Attention ('emeteri Setknt date - 5/5/1W' 13
--h- i+)st:tiltd
Si'fr Base: 4 - 0 x 1-2 x o - 4 b' : everlasting / jamie
Die : date : 6/6/13
'iamrS& llates
Itis hazien Hers
messina
--
D.O.1).D.O.D. —`
t nit 4
Block OAK PLANTER
lot*** Legs: 3o" -H/ 18"w@bottom/ 21/2"w top
squarr trot
%pproved K.G.K.
c herked ai K.G.K.
Dstc 5/9/13
It, : everlasting monument co.
h:X,illt'I.F ( Picture A/O Mimulnent in tntestiuu t i
1-2"
16" a _ 4 __
May 10 13 11:16a Quality Monument Sales I
7062837152 p.1
I
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