HomeMy WebLinkAbout3-COL-16Name
Unit_
Block
Lot JSY• L�L1 'S
Date of Mark -out
Date of Burial 0� 0A0 J e /" Timed
Name of Funeral Home
A
Authorized by
Certificate No. 2403
CITY OF SEB-I)SSTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Leslie Robinson
661 Stevenson Avenue
Sebastian, FL 32958
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following niche:
Unit 3, Columbarium, Niche 16dsa
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 8t" day of January, 2014.
CITY OF SEBASTIAN, FLORIDA
i
Joseph F. Griffin
Interim City Manager
ATTEST:
';7
Sally A. M, MMC
City derk
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4850
, p n
RECEIPT 4 U 0
Name /\,o b 0nj o n ❑ Cash
Date 02- 2 l e / 41
'I 1 Check #52-71
No.
001001 208001
001501322900
001501341920
001501341910
001501341930
601010 343800
001501343805
Amount Paid
Sales Tax _
Garage Sales _
Copies/Bid Specs. _
LDC/Code of Ordinances
Election Qualifying Fees
Cemetery Loots p _
Lot/Niche f LISA, Block CQ I , Unit
Cemetery Fees
(A)��� Total Paid o • v
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant
My of
HOME OF PELICAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
Name(s)
CaCC 1 SfeV�-n'sD n Ave- , SebQSfr'c� �� rL 32-95,?
Address
C-7 ?J ) 39-E- q30
Area Code & Phone Kumber
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
J� blb-MO-Ld 041,0- "r�o-fl Dollars ($,2000. Dy )
on this �f� day of J-rl tka-rte 20for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit 3 , Block (�o l , Lot(s)
Niche(s) %6 dSa
for use in accordance with the conditions, ordinances, resolutions, rules and regulations prescribed
therefore by the City of Sebastian.
Additional Fees paid at time of purchase:
Corner Markers (set of 4 - $20)
Vase and Ring for Niches (cost)
Temporary Marker Preparation & Installati
Signature of Purchaser
I:\wVV-DATA\Ms-Cemetery\RECEI PT. doc
Opening & Closing 50 - () 0 / w O H
Circle One
Interment
Disinterme
TOTAL $
C�
Coof Sebastian
The following documents were provided as Proof of
Residency:
and
CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4833
RECEIPT
Name p b t /t�j p ❑ Cash
Date 'Check# o2l!O
No. Amount Paid
001001
208001
Sales Tax
001501
322900
Garage Sales
001501
341920
Copies/Bid Specs.
001501
341910
LDC/Code of Ordinances
001501
341930
Election Qualifying Fees
601010
343800
Cemetery Lots 2-000,®�
Lot/Niche- $A Block 4 Unit
001501
343805
Cemetery Fees
0 %� ®,®�
b.xl� Total Paid 2 t,5(), OU
Initials
White - Dept. of Origin • Yellow - Finance • Pink • Applicant