HomeMy WebLinkAbout3-COL-44DnBPS
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Date of Mark -out
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Date of Burial /i// � / fo Time
Name of Funeral Ho
Authorized by
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FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
SEBA?tAN
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 #: t7 7'Z'� 7-8 9 -
(Check One)
OPEN BURIAL LOT Lot Block Unit
iOPEN CREMAINS LOT Lot Block Unit
X x nPEN COLUMBARIUM NICHE Niche 68lock E; Unit .
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BURIAL DATE AND SERVICE TIME: r,e.. E�
FOR DECEASED:SG?�/,d( ,e .-4.s-WO
rvame
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
,✓/k
Name ignature Dale
I certify that I have determined the ownership of the above described 4ile that all site fees and
administrative fees hake been paid and authorize opening of same
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR.
f+r 1
Name 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 that all fees have been paid
// r re
Cemoftery Sdxton Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
CITY OF SEBASTIAN 10396
MINIS-T_R/ATIVE SERVICES RECEIPT
Name d Li�i'ry 0 X.Cash
Date 11 (At 1I (C a Check #
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit
001501 362100 Taxable Rent
001501 362150 Non -Taxable Rent
450010 369900 Airport Badge
001001218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 329200 Site Plan Review
001501 329300 Subdivision/Plat Review
001501 329100 Zoning Fees
oo t ,i- o t - 343 X05- b LG -Eo.
Jtjrr -i 8L -K CAL Lot 44 bAsa
Total Paid'
nitials
Security Dep Held - Amount $ Check #
White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant
Sebastian, Florida
735 Fleming Street • Sebastian, Florida 32958
www.scawindsfh.com
(772) 589-1933
SW
This envelope contains certificate of
JOSEPHINE ROMANO
seawinds Crematory
735 South Fleming Street, Sebastian, Florida
(772)589-1933
For Seawinds Funeral Home
We certify this container contains the Cremated
Remains of
Josephine Romano
who died on November 15, 2016
in the City of Vero Beach, County of Indian River
and State of Florida.
Your loved one was cremated on
16-73380-5266 76?y
Permit # Tag#
Cremator
�l!
Date Of Cremation
Thank you for allowing us to serve your family.
Name
Unit
Block
Lot
Date of Mark -out
10
Date of Burial Time
Name of Funeral Home
Authorized by
Sam M. Romano
Date of Birth: Friday, February 9th, 1917
Date of Death: Thursday, January 2nd, 2014
SEAWINDS CREMATORY
Sebastian, Florida
735 Fleming Street • Sebastian, Florida 32958
www.seawindsfh.com
(772) 589-1933
We hereby certify that these are the remains of SAM M. ROMANO SR
The remains were received
from SEAWINDS FUNERAL HOME & CREMATORY
Cremation Permit No. 14-73380-5002 Issued at INDIAN RIVER COUNTY
Date of Death JANUARY 2, 2014
Date of Cremation 1 t �f Bye!/ w, 4�1�
Cremator
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4835
RECEIPT
Name %YI &r( IV ti l M i
nata ti
No.
001001 208001
Sales Tax
001501322900
Garage Sales
001501 341920
Copies/Bid Specs.
001501 341910
LDC/Code of Ordinances
001501 341930
Election Qualifying Fees
❑ Cash
Check #
Amount Paid
601010 343800 Cemetery Lots /e-t'WL4-4\-o
LotMiche Block 6o unit 3
001501 343805 Cemetery Fees
0 I 50.0o
41 j' tX-1 n4 Total Paid 5Q..on
Initials
White - Dept. of Origin • Yellow - Finance a Pink - Applicant
Certificate No. 2381
CITY OF SES SSTIA
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Sam M. & Josephine R. Romano
9735 61s' Parkway
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 niche:
Unit 3, Columbarium, Niche 44dnb
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 19th day of June, 2013.
CITY OF SEBASTIAN, FLORIDA
"Al Minner
City Manager
ATTEST:
Sally,ff Maio, MMC
`City Clerk
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4 9
RECEIPT /
Name S� m 003 I 1 e � ❑ Cash
Date CIJ 1 l (_3 VCheck#�-
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
601010 343800
Cemetery Lots
AA
LoMiche Block
, Unit
001501 343805
Cemetery Fees
a,s e r
-7 EQ
N Total Paid C26
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
103616
JTATEMENT
DATE
TERMS
TO -
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ADDRESS
IN ACCOUNT WITH
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