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NOME OF PELICAN ISLAND
Burial rights in the Sebastian Municipal Cemetery lots/niches purchased by me
C�e lJ�P S "&' e l Sl;�,s�_ `1�i �,8 Q-A '*fr j i?Rgc4, CL 3;-
t name and address of purchaser)
(Lot/niche, block, unit description)
are intended for interment of the following individuals:
Please print name(s):
(1)
(6)m
(2) (7)( uZA-G AS
(3)
(8) (13)
(4) (s)�C�lVI-S-1�f�sO'Cl (14)Sa S, �V,rbZ5
(5)
10)
(15) \NNe01,Q \
35) -Tewl 1j.
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.
�ml 3 —5, dztn nom»
lgnat ate �1 f
s bacdbed an sworn to before me this ��( Q0 1 f9, by
.L} \ who Is perso lay known o me, or has produced
t d as Idenlifitetlon.
KRISTIE KIRSTEIN
Notary Public - State of Florida
+ : •; My Comm. Expires Feb 27, 2019
Commission # FF 172764
Bonded through National Notary Assn.
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