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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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. 44111P
HOME OF PELICAN ISLAND
Burial rights in the Sebes
! v` tan Municipal Cemetery lots/niches purchased by me
A t1 le t \"6k r5 I (13 -,.t./1c ' 1APE- 3-011,0P(
(Please print name and address of purchaser) -( 0 1 60 1
(Lot/niche,block, unit description)
are intended for interment of the following individuals:
Please print name(s):c q
ia),R, Y i c, ,~S V. �°
.
(2) O. trnenCA, rimers (7) ae Cv .e., -t. . (12) L Vec,e-4-1- kickers
(3)?1 1ono-- v'tc.A.e..r5 (S) Serr .h iii(ic QY5j (13) AkkgrEl VtCAtr5
(4) (9) (14) V - '-' tow_
(S) i;,K-.c.s e 1 c-\-` (10) akrAido VYcik-er5 (15)l/c -4:-65 p j o 4--
interment lots/niches are not to be transferred without written approval of the City of
Sebastian. interment tots/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. - to •e. erms of this agreement.
1— r7 - 1Z
nature Date
n day or ZU 1Z t,
8h scribtnj I. U to biters me this me, or • has produced
who Is personalty known io -me,
• e s Identification. ow%I I 1't t t t�/i copIE 7-
Nolary Public.Slate o "'q'� `As." STATE • C.
O ! OF =.
Names �^^ ' 2 TENNESSEE I "
tr NOTARY 1*z
ik',. PUBLIC , '
rH.►n„o
•
JUL-18;2012 WED 11 : 15 AM MOB 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
CP/
one
HOME Of PEUCAN ISLAND
Burl I rights in the Sebastian Municipal Cemetery lots/niches purchased by me
;Ara it licaRC6 f 6� rtidlier )4,,c C, 'i 7O 3 7M
(Please print name and address of purchaser)
(Lot/niche,block,unit description)
are intended for interment of the following individuals:
Please print name(s): `'/
)46 (40-) if;ciz� �io-t- ( 61) ar&,.'1 �c� 76P Vic.KMzes 004--
(7 16 7) ((5)- o.. sk=n c� 6a77J p)o4--
141) Qe ) Y; -r, G 4- (/)( -) cc 7)(.38') V rc g.c.-s e lo4_
P")69) i)Cn (' � er�S 4) ?ors l x 0n (X Pci)00.80 Ubuti s
(96.2 a) to 4-- VI 44&rs (76(06) eP6 (7 36) 4nh4r V,c4.24.� ve
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 = •• •e t; • a terms of this agreement.
-7 —( • 7 --17—
Signature Date
ubse4bed end sworn b before me !ht�`� e pown ko-ft;;÷-,. _ hempod=
► tit 'a, • to'i t n'>� ore!de teliD (1 .•.... `.1
F Wary Public.State ol�ladda >! A(� •
gF
Op
'o lT S S -C
Norma of Interred form N d Rn
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''///1;° .;.6(3i.ittS4\‘`‘
"illrIttti"\%
JUL-18-2012 WED 11 : 15 AM MCB Bristol Highway FAX No. 423 232 5134 F. UU5/Un
From:The UPS Store 4239 7725899175 07/17/2012 10:57 #500 P.004/007
(.. )
ono
46210°
HOME OF PELICAN ISLAND
Burial rights In the bastion Municipal Cemetery lots/ntches purchased by me
� EI E I (c S (6 s 7 'd 1 AE 506)6,,d C r tt -r,
(Please print name and address of purchaser)
Lod 3 t ir. a Or-A- I
(Lot/niche,block, unit description)
are intended for interment of the foliowtng Individuals:
Please print name(s):
-4' r , I for,. (• 3 e /1143, i (11 )
re-rC.5._
(17f ] . •C. t)-A-- (7 fl stir (12)
y"/ (�S3`h V i Y-ers- _0-I-- (7'( t1°t 5z.in p I n-j-, (13)
() ( 7)‘:1)VIC,V•Lr" plp4--' (PI V plo.k (14)
(I[ V►(.. i5 c10i- 901 (46)L.FrU:s pk,-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 d and nd t d the terms of this agreement.
-7 - i 7 - 1 2--
Signature Date
4 to before me it i' ` ay ef�� I by
bsrnAi St,� , who Is personally kt`pd ..ltj 1.pr has produced
Ty) CU.. Oat t stD t n'lt,g S. as Identification %9?.....-•-• Fj�
Notary Public,Slate of Florid* -r,..) _ y• 4,0?-0;p? ;11 Mamas o(NNanee lane 13494/?).4 4c . �