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.JUL-1B 2012 WED 11 : 15 AM MOB Bristol Highway FAX No. 423 232 5134 P. 003/005
From:The UPS Store 4239 7725699175 07/17/2012 10:56 #500 P.002/007
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ana
. 4iaiiwo
NOME of PEUGAN ISUND
Burial rights in the Sebes}ian Municipal Cemetery lots/niches purchased by me
AA,,WAA t V\GkErS 1 (9h - vLjit r I pp e 3-011°4on'(±
(Please print name and address of purchaser) 1" Ii '1 60 I
(Lot/niche,block, unit description)
are intended for interment of the following individuals:
Please print name(s):
(1) E_ Y (6) k A-e-r'5 p l 4— (11 ) Vi L*,-e )(0--
(2) 0' Ms,r,461/4 l OW,pr-5 (7) ae Cr- .e, -r..... . . (12) 1 lrect4 Vicike—s
(3)cFN V i Gk•�.,`i (8) Jerrak Vic ers (13) wttl Vr C: ;�S
��1141C�- t
'4). C4- V ! VY 5 (9) 1
(8) J/i Ck -1 5 ell (1 b) C y 141.e Pc.4‹. r5 05)34,..p,..5 pl.)-
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 re d u to a erns of this agreement.
i� 17 12--
G%
nature Date
ink Ati.:04____. Zy �1( br
y's t- 1.V W berore' me this _doy o/who 1s psraonely known me, or has produced
is mantiliotltlon. til
r(4+ �.C1'11a. -Q%. U.19.12^—_ .4`ZP�'�TATET�A.
Nolary Public.Slateof.Plerids -r� g '..
4Y d� OF lQrrNS otlnNna4 ion+. w 1 TENNESSEE w
S.A is NOTARY j
*.\. PUBLIC.,' .:
JUL-18;2012 WED 11 : 15 AM MCB Bristol Highway FAX No. 423 232 5134 P. 004/005
From:The UPS Store 4239 7725899175 07/17/2012 10:56 #500 P.003/007
' 111111
ana
S� �AN
NOME OF PELICAN ISIAWD
Burl rights in the,,Se�bastian Municipal Cemetery lots/niches purchased by me
A t
;G 4 E U4kei/5 ((oc ilicite )41pc Es1-1.xri C,I"(1 - 3 7M
(Please print name and add(ess of purchaser)
LA- 60 4-..31 TAoc- - '6 0c;14- 1
(Lot/niche,block,unit description)
are intended for interment of the following individuals:
Please print name(s):
246 Wl it iCyi.- ' & (16 x1) ��t'-•t ,4;&-) P' w7 Yi(. •e...5 pk 4-
(11'6 -)) V i tt e. p k.i- 61,;)-1 r.cio.,.l- :,sc:-n 9,1!(:-.5) 1r I ck.e,--s p)(.4--
I) )$ Ili .r`› .I c4' ( ) j L. a6rrr-L, ) 0 V f c S p 1 04—
(•H• ^ a., 1C-ker-S ' ) PWI On C Pc/9 e Uzwei)AS () it k:k(
(9 ?C))1.t r V;r. .prS (7 )( 1 �(i C-V--e.Y-s c� 1 410ht-1 c, v;c4.24,-,5 71e
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 d u e a terms of this agreement.
ji/ -7 --I —2 --17.—
Signature Date QQ�,,,,
ubseribed end swan b bears me 4b s�`% ,,ykno of CkM.J ha:z._:_a.k.s p ducal
comes Idenliliolkt �r, ....., �0r',
( , ^ D``I,LS UI,p"_- _ `j� CFTF•• T
Nulery Public.Slate olnorids A/
9 HONFss i c
Names of(Mowed form s:.A�44,6 I.i
. 4� 1/ ,
JUL-18;2012 WED 11 : 15 AM MCB Bristol Highway FAX No. 423 232 5134 f. UUS/Un
From:The UPS Store 4239 7725899175 07/17/2012 10:57 #500 P.004/007
(''S7 )
..�
SEBASTIAN Ma
44211P
NOME of MOW ISLAND
Burial rights in the S bastion Municipal Cemetery lots/niches purchased by me
�, F.i E Uc c5 165- T 'd46r 1,0r�F 506600 Cg(( rri
(Please print name and address of purchaser)
loo S t "I1 8' Or,`A- ,
(Lot/niche,block, unit description)
• are intended for interment of the following Individuals:
Please print name(s): /, t
•t ( j 1C r w1 • i[J1. i-s t. 3 C�R+�7' , 4 i 4_ (11 )
(12)
(MM Vi ct Le..-5 0 o-1-- ( (a8) L S4,, ,;,)r,-1-, (13)
V�) (?)q 1 VI C-Vse.Y"7 p j 4 {yf A L on pl 4, i14 j
(, ( y,u)4-e-5 n10 - ( C-./6)Lplws:)plo-1- (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 - .d and nd t d the terms of this agreement.
Signature Date 7,
{� q 1e berors me This ! day et`� 1 ______ by
s lr`.Pr1at fl.� , who is personsity kr`p R(, ',pr has produced
y2 CA. O t S n1D t e [L.3. as identification. .-s�' .-"'"Sir 4��%
:j 4 .tr`
lMn clli-In -a !_-4trt '�-' = �t t 4-ik D,o1F :-n
N Pubtb.stare of t,J =>°• �OHFS3 .'r_=t• ibtf .41 00 Nsmss of lMsned la+� % eerk .r; � �
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