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HomeMy WebLinkAbout4-08-30aUnit Block Lot '10— Date of Mark -out // Date of Burial � / Time 4 Vi Name of Funeral Home Authorized by Certificate No. 2380 CITY OF -j� B STIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Bobby Roseman 519 Lanfair Avenue Sebastian, FL 32958 In and for consideration of the sum of $1,000.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lots: Unit 4, Block 8, Lots 30 a & b 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 22nd day of May, 2013. CITY OF SEBASTIAN, FLORIDA /Al Minner City Manager ATTEST: Sally A aio, MMC City Clerk CITY OF SEBASTIAN CITY CLERK'S OFFICE 4392 RECEIPT Name Date No. 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. ❑ Cash Ik Check # 02- FCO Amount Paid 001501 341910 LDC/Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots Lot/Niche 30a , Block_, LIMA- 001501343805 nitA-001501343805 Cemetery Fees /n tv 0.©� r iJ" ��"' "f-✓� '� Total Paid -50. V `' Initials White - Dept. of Origin 9 Yellow - Finance • Pink • Applicant 10)615 aft JTATEMENT I DATE TERMS TO J ADDRESS IN ACCOUNT WfTH lzE/f/7 O ' �A _g _ 3D CD a ade DC5812 CITY OF SEBASTIAN CITY CLERK'S OFFICE 4384 RECEIPT Name �1%"f_ ❑ Cash Date 5f/ 2Z/�� Wl(:heck# ?9y` �T No. Amount Paid 001001 208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots ti Lot/Niche iA ' , Block Unit 001501 343805 Cemetery Fees Total Paid 1606 o nitials White — Dept. of Origin 9 Yellow — Finance • Pink - Applicant 3 aly Of .Y 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. A i / ill ., Name(s) Address 331--5h32 Area Code & Phone Number Je � / 5 11M-4 (6a� IZ911M Name & Residence Address of Intended Occupant if Other Than Purchaser 1��e f .30,E f11 OFFICE USE ONLY Receipt is acknowledged in the sum of: Ute/ h a"j ?o Dollars ($ l00 0 �� ) ( -V 1 on this t7224 day of t&-, 20/:5 for the purchase of the following described Cemetery Lot(s) and/or Niche(s). f/ Unit 7 , Block , Lot(s) 364 '� 4-5 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 - $2 Vase and Ring for Niches (cost) Temporary Marker Preparation & Installation Signature of Purchaser Opening & Closing Interment /W O H Circle One Disinterment TOTAL $ City of Sebastian The following documents were provided as Proof of Residency: I:\WW-DATA\Ms-Cemetery\RECEIPT.doc and 103612 STATEMENT DATE 5 ! TERMS TO ADDRESS IN ACCOUNT WITH _ 5 Z j 9 W-4222�IZ ek-�11 4f V�L r T- 7 S' n - l' adm DC5812 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY 5EBASTtAN nomf Ci; PFUCAN 1"ND 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 OPEN CREMAINS LOT ___DPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE TIME Lot Block Unit Lof ,,,_Block ��Unil Niche Block Unit vv FOR DECEASED: ivame 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 NAIAE AND SIGNATURE OF LICENSED FUNERAL DIREC-TOR. /y, 1,4 Name ISignature Cemetery Sexton Certification: I certify that I have checked the ownership infornr)ahon by viewing with Clerk's office ,and that all fees have been paid - �! 3 - Ce eter Sex on Date Date the owner's deed and confirming This font to be provided to Clerk's Office by Sexton, for permanent record upon completion, 4 " deep I 12" w City of Sebastian Sebastian Cemetery Ph. # 1(772) 589 - 2545 Fax # 1(772) Note This is for informational purposes reguarding Monuments at Sebastian Cemetery . Note Please return to Dry Mix Sebastian Cemetery 1%21 North Central Ave. Foundation noured 32938 by : everlasting/ jamie Attention Cemetery Sexton date: 0/42 f1l stone installed by : everlastin /jamie Size : t- 0 x 2- 0 x 0- 4 standard grey granite flat grass marker date : �l 3 Names & Dates: / His: Her: L ©a i • D.O.B. D.O.B. D.O.D. D.O.D. Z)e Legal Description: Unit : Blk.: g Lot : O. Approved By: K. G. K. K G K. Checked By: • • Date : By everlasting stone works Example: 4 " deep I 12" Nf P P� L'd Z9 tL£8Z90L 6`S QCT C I seleg }uawnuon Al!lenp e8£:0L £L 6t -nr