HomeMy WebLinkAbout4-02-09Name j6 /• Ao!,* kZ> Oh/AQP
Unit
Block
Lot
Date of Mark -out
Date of Burial /� 1'�^ Time
Name of Funeral Home S f- A (,? /41 5
Authorized by ,
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CITY OF SEBASTIAN
CITY CLERK'S OFFICE 4899
RECEIPT
Al rs Ma I d e) n o-d o
Name
-
❑ Cash
Date
-
)(Check#
( /(?Z
No.
Amount Paid
001001 208001
Sales Tax
001501 322900
Garage Sales
001501 341920
Copies/Bid Specs.
001501 341910
LDC1Code of Ordinances
001501 341930
Election Qualifying Fees
601010 343800
Cemetery Lots
7
% UQ, 6Q
�,
/�
-
LoUNlche t3lock
Unit f
001501 343805
Cemetery Fees
J60j1t&*rvW Total Paid 1-006 00
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
ett or
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y
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, residence of purchaser or person for whom lot is intended for interment must be
provided at time of purchase 40 a5 -f-a S j a
Name(s)
Address _
E� ?
Area Code & Phone Number
Residence Address of Intended Occupant if Other Thara'Purchaser
Office Use Only
Receipt is acknowledged in the sum of:
f���
Dollars ($ /0 0, 00 )
on this 4-k day of uS , 20 Iq for the purchase of the following
described Cemetery Lot(s) and/ Niche(s).
Unit , Block , Lot(s) "I Niche(s)
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) opening & Closing
Vase and Ring for Niches (cost) Interment
tgnature of-Purchaser 50ty of Sebastian
W O H
Circle One
Disinterment
TOTAL $ ) U () (1, 6 C)
Service fees are to be paid at time of need only
1:1W W- DATA\Ms- CemeterylRECE! PT. doc
68!87/2614 15:00 7722287079 COS AIR BLDG
Jun se. Z:012 9:46MM 14F LFISERJET FAX
FUNERAL DIRECTOR'S. REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENI'NO IN SEBASTIAN MUNICIPAL CEMETERY
.nn
59 L—NN
For Informalian cuntam:
Kip Kelso - Camufory Sexton
Spbastlan MunlcipM Camefdry
(772) 609.254,5
Clfy Clerk's Office
CiryHsr7, !223 Main Street
Sebastian, FL 32950
011lce (772) 388-8275 or ,?113 E321A
Fax: (772) 589 -5570
FUNERAL HOME:
PHONE N: T.,3
(Check One)
OPEN BURIAL, LOT
. PEN CREMAINS LOT
PEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TIME:
Lot q Block I Unit
Lot � -01OCk � —u(1;t .
Nlclin Block 'Unit
VV
FOR DECEASED: 4
ivame
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE;
(Mull provide proper documentation of ownership)
PAGE 02102
p.2
Ivarne Bnatufe i7te'�
I certfy that I have detem�ned tMe ownership of the above described g1te thot all site foes and
edmIN91trative fees have been pain and outhwixe opening of some
NAMR AND SIGNATURE OF LICENSED FUNSRAt7ME C70Fi,
Vf0 ('rte _4 1A / /0Ge
l
faBtC
• ..w.......h... ......�.�............�..... . ra ..•a..n.n................... r— ....•. .......•..•..........
Cametery 9aKton Cerlification,
i certify thM I hays ch teCked tha ownership Information by vlawing the owner's deed and confirming
with Clerk's office and t of all fees have been paid
e tmry ex n / Date
This form to be provided to Clerk's Orfice by Sexton for permanent record upDn complallan,
Aleyr,"'
744140
il)vriw s"
City of Sebastian
Sebastian Cemetery
Ph.# 1(772)589- 2545
Fax# 1(772)228-9927
Note : This Is for informational purposes reguarding Monuments at Sebastian Cemetery .
Note : This is for Single Markers under 2 ft.&over 2 ft.(over 2 ft.is a poured foundation)
Please return to City of Sebastian U("y MIX )
Sebastian Cemetery
1921 North Central Ave. Foundation youf
32958 By : f'fi/Jot/Vic S•
Attention Cemetery Sexton date : 1.21/ al iV
stone installed
h. : f. /11.
Size : 1-0 x 2-0 x 0-4 grey granite flat grass vet. marker date : / .//iP/jl,
Name 8 Date : HIS: Eli Maldonado HER :
D.O.B. 1951 D.O.B.
D.O.D. 2014 D.O.D.
Legal Descripition :
Unit . 4
Blk. : 2
Lot : 9
Square Ft. : ,.
Approved By : K. G . K.
Checked By : K. G . K.
DATE 12/10/14
By : funeral home
Example : .
4 " `�
2 '