HomeMy WebLinkAbout4-06-05Certificate No. 2385
CITY OF SSEEB SSTIA
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Kevin & Lucy Lovely
Paul & Samantha Gautier
740 Barker Street
Sebastian, FL 32958
In and for consideration of the sum of $5,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Block 6, Lots 4, 51 6, 7, & 8
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 21St day of June, 2013.
CITY OF SEBASTIAN, FLORIDA
� Al Minner
City Manager
ATTEST:
Sally Maio, MMC
qty Clerk
Total Paid W -00
Initials
White - Dept. of Origin • Yellow - Finance • Pink . Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
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Name k-e y I ri L y y P l
❑ Cash
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Date
r
❑ Check #
No.
Amount Paid
001001 208001
Sales Tax
001501 322900
Garage Sales
001501341920
Copies /Bid Specs.
001501 341910
LDC /Code of Ordinances
001501 341930
Election Qualifying Fees
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(1 00-00
601010 343800
Cemetery Lots
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LbfflicTi� 7' Block
Unit
001501 343805
Cemetery Fees
Total Paid W -00
Initials
White - Dept. of Origin • Yellow - Finance • Pink . Applicant
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SfOASTI
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HOME Of PELICAN ISLAND
1! 1 IN •' �'� li •
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
K ► v 4
Name(s)
uu '? 1 c 1 C \
A,ddre s
(17 -Q 3 G 0 05q
Area Code & Phone Number
IA O V'
Name & Residence Address of Intended Occupant if Other Than Purchaser
Receipt is acknowledged in the sum of:
on this. day of
Cemetery Lot(s) and /or Niche(s).
Unit , Block , Lot(s)
Dollars ($ )
20 for the purchase of the following described
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)
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installation
Signature of Purchaser
Opening & Closing
Interment
/W O H
Circle One
Disinterme
TlIT A t
1 V hL
City of Sebastian
The following documents were provided as Proof of
Residency:
!: \WW- DATA \Ms - Cemetery\RECEIPT.doc.. j and
CULT
n
HOME OF PELICAN ISLAND
Burial rights in the Sebastian Municipal Cemetery lots /niches purchased by me
(Please print name and address of purchaser)
`l
(Lot/niche, block, unit description)
are intended for interment of the following individuals:
Please print name(s):
Interment lots /niches are not to be transferred without written approval of the City of
Sebastian. Interment lots /niches in the Sebastian Municipal Cemetery are allowed to be
passed on to heirs but the City requires a certified copy of relevant probate or other
court documents.
I have read and understand the terms of this agreement.
Signature Date
Subscribed and sworn to before me this day of by
who is personally known to me, or has produced
as identification.
Notary Public, State of Florida
Names of Interred form
Point & Pay - Create Order
Thank you for your payment!
This service has been provided by City of Sebastian, FL and Point & Pay. We value your business.
Please keep this receipt for future reference.
You have made a payment to City of Sebastian, FL . The City of Sebastian thanks you for your
payment. For questions about your account, please call 772 - 589 -5330
Name: KEVIN LOVELY
Address: 740 Barker St, Sebastian FL, US, 32958
Contact: 7724735808
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