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Burial rights in the S bastii4n Municipal Cemetery lots /niches purchased by me
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(Please print name and address of purchaser)
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(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. �/� (,� z'L
I have read and understand the terms of this agreement.
.Zs ti, Tpt94671 Am o-� s oati
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Signat at
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