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Burial rights in the Sebasti n Municipal Cemetery lots /niches purchased by me
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T An ers(-)n
(Please print name and address of purchaser)
LLni � ) � 81ock I R} Lffs 26, 2-7, Z ) 1 30 3Z
(Lot/niche, block, unit description)
are intended for interment of the following individuals:
Please print name(s):
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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.
/:
Signat�o bat6
Subscribed and swom to before me this _
who is
as identification.
Notary Public, State of Florida
Names of Interred form
day of by
personally known to me, or has produced