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Home My WebLink About1-08-04FUNERAL 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, 1225 Main Street Sebastian, FL 32958 Office (772) 388 -8215 or 388 -8214 Fax: (772) 589 -5570 FUNERAL HOME: 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: FOR DECEASED: Jack Vickers Name Lot 4 Block 8 Unit 1 Lot Block Unit Niche Block Unit N S E W Tuesday, July 8, 2014 - 3:00 PM GRAVESIDE NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) , r Michael Vickers Pz d LJ1' V 7/8/2014 Name Signature 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 Signature 7/8/2014 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: 4d , /" �2_ — q 11 , Cemeterf Sext n Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion Name Unit Block ts 2ly Lot Date of Mark -out Date of Burial 8 Time ✓ '� D Name of Funeral Home J P Authorized by �� JACK KENNETH VICKERS Jack Kenneth Vickers, 86, Johnson City, TN passed away peacefully, Sunday, June 22, 2014 at his home in Johnson City. He was born to the late Everett and Mary Vickers in Sebastian, FL on June 24, 1927. He is survived by his wife Gwen A. Vickers and his son, Michael Vickers. Jack pursued a career in flying and worked for Gulf and Western Company as a corporate pilot after his service in the United States Army. His 20 year career took him many places with many influential and interesting people. He retired and returned to the family groves in Sebastian, until he moved to the mountains of Western, NC. Jack is preceded in death by three sons, Stephen Vickers, Gary Vickers and Kenneth Vickers. He will be laid to rest in his home town of Sebastian, FL, next to his beloved first wife, Ramona Kingsley Vickers of 53 years. No. 001001 208001 001501 322900 001501 341920 001501 341910 001501341930 601010 343800 001501343805 CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT !Flo Lai, 4891 ❑ Cash wdeck# 702;"2- Amount Paid Sales Tax Garage Sales Copies/Bid Specs. LDCICode of Ordinances Election Qualifying Fees Cemetery Lots Lot/Niche , Block , Unit_ Cemetery Fpes /JU � Total Paid Initiate White — apt. of Origin • Yellow — finance + Pink • Applicant • m V W C W a G Z NI j 4 TI ` .-V ^ .,oNj N :,?'Jr5 y� .l . VT ) � iY � � ti �. - ..— a�iLlfAi.��.'4.•aF"JFw •.. - ,i «•�Ar:.. 1. I i. _ • � .. r a: e: .JUL -18 ;2012 WED 11 :15 AM From:The UPS Store 4239 MCB Bristol Highvday 7725899175 FAX No, 423 232 5134 07/17/2012 10 :56 P. 003/005 #500 P.002 /007 v� ado hh�� rl NOME OF MUCM MAND Burlal tights __ in the Sebas}ian Municipal Cemetery lots/niches purchased by mfe_ AA s�,Yt A C V J<6CS (Please print name and address of purchaser) (Lot/niche, block, unit description) are intended for interment of the following individuals: FA Mi Please print name(s): p l (- (12) �_. I�ei� G' f ViC;Ae, -5 (3,�C3U`c1�i1 C �% ,i GiK.e x- (a) i! c e�—S �1 s) i� wiz-i t/r uK:cr 5 (4) (9) (14 ) (10)/.7Y►�D.�1 (is) interment tots /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, t h re d u �ta a e►ms of this agreement. 17 r Z t Date na ure n _any or ZU k?! b subscribed and ew to berets me this ( '---Y o� produced wh is ..anally kmWn W nom, o p Molary Public. slate oi•f�errfda '['y� ` Az STATE :1G. Ir ." OF Nam.. or im.rmo team j TENNESSEE Y NOTARY 1 �'•. PUBLIC JUL-18,2012 WED 11:15 AM From:ihe UPS Store 4239 MCB Bristol Highway 7725899175 �onoo HOME of PEllU1N ISLAND FAX No. 423 232 5134 07/17/2012 10:56 P. 004/005 #500 P.003/007 Burial ri hts in the S bastion Municipat Cemetery lots /niches purchased by me � c �1 �'tcl�ST c b 5" f v c t;►' � 4„ e xl� C, `� TO 3 Whe l (Please print name and address of purchaser) ZC)v 5o d-..') 9 'low- (?� �- (Lot/niche, block, unit description) are intended for interment of the following individuals: Please print name(s): (PT Cl 7l U; (2 c� X11) =,,rp- -.t ��`w�� )Pw Yic.K z�s i- I cY -4,, -S p) o1-- C 81 I(i c .+r°a ,o j a -4- c�'�1�� -} fir V roy-z -s tic_Kers �7_P a' bet -- r� c f P (( ;<.k4r V Il..�`�t'� ` 'S =Y! 1 ♦ 1 r.i ( �v`.i� �7'�.I�1 a4` 7 C • i`.'7...4' J Uf 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. t h d e t a terms of this agreement. 5lgnature- Date ubseribed and sworn b before = •r• i��3 Q - Qrdt/V TO QLo Wary Public, State oLWor a Names of Irdwrea form me INS who N or at;�. V t �' by own qp me, or has pwducsd M' �% r rFH 00 F -n Di 4to iC y:.pV7gRyFF;�= JUL-18 -2012 WED 11:15 AM From:The UPS Store 4239 MCB Bristol Highway 7725899175 cma iioME of PEttCAN $LAND FAX No. 423 232 5134 07117/2012 10:57 Burial rights In the bastion Municipal Cemetery lotsiniches purchased by me Ei E �r 5 (6s -ru &r 1,0f)F 5t7 kayo r�'��t TP (Please print name anti address of purchaser) unit are intended for interment of the following Individuals: Please print narnew: .-f (Y`C3! (1i) (x :5� V i C- V-,e-- p � r; -�- ( tvSUr� 1 i - (12 ) ,. a t (33� V► cy ers a 01- (R�Cag) LprwS��l 1 (13 ) 'a1 � (14 ) F i o � t�'? N- UUVUU� #500 P.0041007 0 interment tots /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 rmad and nd t d the terms of ihIs agreement. Signature Date to bergs Me Ift 0--day of,,% 1 I � ---- -� by Dserit�sd qnd �� who is persalelgl k((ttj ��J�I has ploduead 1,s2��GL& ln(Q(n't pieswel+twmbon .,•��...•...F%�'�i jrF,� prirF'` Notary PuMb. Smte of Flerido Z-,J HpH C Nernst of IrNwnee taw+