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HomeMy WebLinkAbout3-COL-15SnName d� ,e5,4 C4e,414, LneA6 Unit Block (/0/-, Lot Date of Mark -out 0 Date of Burial � ' Time y 5 fp Name of Funeral Home Authorized by Certificate No. 2373 CITY OF SS' E:B A ST I A N Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Angel Becerra 68 S. Elm Street Fellsmere, FL 32948 -6104 In and for consideration of the sum of $2,400.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following niche: Unit 3, Columbarium, Niche 15sn 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 15th day of May, 2013. CITY OF SEBASTIAN, FLORIDA ATTEST: Al Minner City Manager Sally A. M /o, MMC Citv-'Clerk FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY tOM( o rEUC +.r iSUnD 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: ADDRESS' PHONE #: (Check One) OPEN BURIAL LOT Lot Block Unit __Op.EN CREMAINS LOT Lot _Block Unit PEN COLUMBARIUM NICHE Niche Block pz Unit sti W BURIAL DATE AND SERVICE TIME: j-' FOR DECEASED: name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentatio +i 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 DIREC70R, 4 / - — Date Name Signature Cemetery Sexton Certification: I certify that I have checked the ownership inforniahon by viewing the owner's deed and confirming with Clerk's office ,end that all fees have been paid Ce etery xl n Dat This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SEBASTIAN CITY CLERK'S OFFICE /, '] n RECEIPT 4 J 7 Name / �/ [ ❑ Cash Date �Gheck # 0 L No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies /Bid Specs. 001501341910 LDC /Code of Ordinances 001501 341930 Election Qualifying Fees 1 601010 343800 Cemetery Lots Lot/Niche S , Block �' Unit 001501 343805 Cemetery Fees D/c. '50.0 �J Total Paid o2g50.00 Initials White - Dept. of Origin • Yellow - Finance • Pink • Applicant I 1 bTATEMENT DATE / S^ TERMS TO L v ADDRESS IN ACCOUNT WITH " c p w V Ae ©d GG $°e ad— DC5812