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.JUL-18;2012 WED 11 : 15 AM MOB Bristol Highway FAX No, 423 232 5134 P. 003/005
From:The UPS Store 4239 7725899175 07/17/2012 10:56 #500 P.002/007
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SEB4alliolAN
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NOME OF nUCAN MAO
Burial rights in the Sebastian Municipal Cemetery lots/niches purchased by me
! Vt
tc \ t VNGI<frS t h �.�dit r 1 APE 5011401-1 e,r i
(Please print name and address of purchaser) 'j' 60
(Lot/niche,block, unit description)
are intended for interment of the following individuals:
Please print name(s):
(1) L (6) ;GR.2!'5 l04- (11 ) VEC, siarS 041-
(2) ' QC 1-n��d eYS (7) a oe-.9.e, V1t- }' (12) ireY A Vii ei-s
(3) .•` (VI')ono._ V iGK•t r`j (a) B''. (13) VIAATtl terc e: r5
(9) (14) V,c
(5) 11CK•4.c 5 ,tt h (10) 61--(1,142,') V) -4 2r-s (15)1/,-cJ-'- io1-
Interment lots/niches are not to be transferred without written approval of the City of
Sebastian. Interrnentllots/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.
h re d u t71 a arms of this agreement.
nature Date 10 kl< by
Subscribed t V before me this _�-, or ' has produced
who is personally krwWn So me,
•_ •sidentification. `0111��rrrrii
Slate .k.6. T
Nol la SS �'Z,P' STATE
j•' OF ,
Nam.s of Warred form _ 2 TENNESSEE•i
it . NOTARY i
'•' . PUBLI C , '
JUL-18;2012 'QED 11 : 15 AM MOB Bristol Highway FAX Ho, 423 232 5134 P• 004/005
From:The UPS Store 4239 7725899175 07/17/2012 10:56 #500 P.003/007
ona
111=11P
. NOME OF PELICAN ISIAND
Burl l rights in the,Sf bast�en Municipal Cemetery lots/niches purchased by me
;G it Ui j/ie1/5 (67. ro r )4„r- 11..00 C, c1 T13 3 7 i
(Please print name andtaddress of purchaser)
(Lot/niche,block,unit description)
are intended for interment of the following individuals:
Please print name(s):
9 4 G (i) V i R.:-3 pie— (fi§i) T I t L A,„0.4; i i) Vic.K.z.-s (5 14-
W.6 1.) 0 Vie.Kers eki1 vi(��7- r,)..l-F .s =n (� 2 3 ) Yick...e,s p) 1--
/1i C() Ili c .r5 Ft G.4- (l'i .2,3)' r Lf,. cs-A 7)62) Vtc.gtes f'104-
P;')69) --Der- V(IGkerS .4) PWr5 1.4x,0G�n VrPcf) a Ubuq/As ((i<.k.- (
19626Y R-o�c ,e- Vrr rs (76-(0-5) ePrSI\ 0e -errs (t )34nhtr1 c, v;c.;..z.e--s Ue.
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 h. .4„;.d = •. •e t- •, ' e terms of this agreement.
"7 —(s-2 --I2-
Signature Date
ubseribed and sworn b herons me thts day of 4Ot ..___• �i_ by
Whp �,�� rg4�l �i��kvown me, or hee produced
Wary Public,State ol.EJwide , _ o
NF
S
Norms of IMsrree lone S V 7:41/9 4. r'I r•
.. 4/C . ..
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JUL-18;2012 WED 11 : 15 AM MOB Bristol Highway FAX No. 423 232 5134 N. UUS/UUn
From:The UPS Store 4239 7725899175 07117/2012 10:57 #500 P.004/007
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;O ortra
4113111P
HOME OF PELICAN ISLAND
Burial rights in the bastion Municipal Cemetery lots/niches purchased by me
ivy,,A( E (A0/3 165 `,(v�W 1APE 50 6)601.) laic( -,-
(Please print name and address of purchaser)
(Lot/niche,block, unit description)
are intended for interment of the following individuals:
Please print name(s):
•� �
-4' ( ( t-trOt,.1 - ec .e -s (• 3 k,A thw, 4 i 4_. (11 )
( 'C_. • ,- -4- (7( ;1 S n • (12)
PI (33) V►C.i ors nl 0_1_ (l'' ,) tric05v,-1 p i D.3.- (13)
(f) ( ?21`1 1 Vi C-V• reD p i O 4— tyi t Lou_lsan 101.04 (14)
(' () V t 04-er 5 {,b-' ( 646)L.pjws)-p 6 4 (15)
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 i-d and nd= -t d the terms of this agreement.
./Ar -7 - / 7 - iZ-
Signature Date
t bacni�� nd to borers me Ibis p. dayknieof � . `i i,Pr h pws ioduc d
�, who le "' .
T M. (fit (nt.D_c e'Lt.p'S. as Identification. f•""S F);■',
Notary Pubtb,slats of Florid* • 3 :-. 2; N NF c
yI. At°rgRFF .^
Names of Wooed form �'ti; 84C :: of
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