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Unit I
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Lot
Date of Mark -out
Date of Burial 7/_3 1 / ZY. —
Name of Funeral Home Jr ,('.t y K
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Certificate No. 2073
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Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Russell W. & Patricia Farabaugh Watson 3304 E. Derry Dr., Sebastian, FI 32958
(name) (address)
in and for consideration of the sum of $1,400.00 is entitled to full interment rights in
the Sebastian Municipal Cemetery for the following plot/niche:
Unit-1— Block 29_ Lot(s)Niche(s)_6 & 7_
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 22nd day of March 2006.
OF S BASTIAN, FLORIDA
fu manner
ity Manager
0
Sally Maio, MMC
Gify Clerk
FUNERAL HOME:
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
For information contact:
Kip Kelso Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589 -2545
City Clerk's Office
City Hall, 9225 Main Street
Sebastian, FL 32958
Office (772) 388 -8215 or 388 -8214
Fax: (772) 589 -5570
Strunk Funeral Home and Crematory
ADDRESS: 1623 North Central Avenue, Sebastian, Florida. 32958
PHONE* 772- 589 -1000
(Check One)
X OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TIME:
Lot-7—Block 29 Unit 1
Lot Block Unit
Niche Block Unit
N S E W
THURSDAY, JULY 31, 2014 1:00 PM GRAVESIDE
FOR DECEASED: Russell W. Watson
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Russell S. Watson 7/28/2014
Name tignature Date
I certify that I have determined the ownership of the above described site that all site fees and administrative
fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR:
Tim Marvin
Name
, A L40 7/28/2014
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 hav been paid: Z_�, V. ,J / /
Cem cle ry S ton Date
This form to be provided to C]6/k's Office by Sexton for permanent record upon completion.
Total Paid 150-1)
a
Initials
White - Dept. of Origin . Yellow - Finance • Pink • Applicant
CITY OF SEBASTIAN
CITY CLERK'S OFFICE
RECEIPT
4898
Name Sh-An �Z Wat s on ❑ Cash
Date '
�r l Check # '7 C' -7
No.
Amount Paid
001001 208001
Sales Tax
001501 322900
Garage Sales
001501341920
CopieslBid Specs.
001501 341910
LDClCode of Ordinances
001501 341930
Election Qualifying Fees
601010 343800
Cemetery Lots
LoVNiche— Block Unit
C
✓
001501 343805
Cemetery Fees
Total Paid 150-1)
a
Initials
White - Dept. of Origin . Yellow - Finance • Pink • Applicant
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