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Certificate No. 2468
CITY OF SEB ST_ SAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Patrick or Susan Killimett
519 Egret Circle
Barefoot Bay, FL 32976
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 3, Lot 20
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 14th day of July, 2015.
CITY OF SEBASTIAN, FLORIDA
Joseph F. Griffin
City Manager
ATTEST:
Sally A. M'o, MMC
City Clerk
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9913
Name/r7 ?-/q-
r.Kt l // me� ❑Cash
/
Date - /IY - ISUKheck#
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501 362100 Taxable Rent -
001501 362150 Non -Taxable Rent -
450010 369900 Airport Badge
001501 329500 Alarm Permits
001001 218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 369900 Miscellaneous Revenue
001501 359000 Other Fines/Forfeitures
001501 351140 Parking Citation
001501 342100 Police Security Services
60/010 343800 2000.00
Total Paid z O().00
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
rm or
HOME OF PELICAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
rg-
tr ick. #
qSusan Kilt) mein
Names
5ig rsirei Circle', Boxe-hoof acv FC 32y76
Address
MIDS) -705 - (6-34 or 000370- 8z04
Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
Dollars ($ ZOOO,0
on this _qday of u 20 15 for the purchase of the following described
Cemetery(( Lot(s) and/or Niche(s).
Unit `T Block 3 , Lot(s) 2-0 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)
Temporary Marker Preparation & Installation
Signature of Purchaser
I:\\AW-DATA\Ms-Cemetery\R EC EIPT.d oc
Interment
/W O H
Circle One
Disinterment
TOTAL $, IZG00. C0
bij
qty of Sebastian
The following documents were provided as Proof of
Residency:
01/25/2016 17:47
FUNERAL DIRECTOR'S REQUEST TO 41TY OFEBAgIAN
FOR BURIAL OPENING IN SEBASTIAN M NICIPA CEM TEF
For information cont
Kip Kelso. Cemetery I
Sebastian Municipal C,
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Sth at
Sebastian, ISL 32958
Office (772) 3$$-8215 or 2$ -8214
Fax: (772) 589-5570
FUNERAL HOME: Strunk Funeral Horne and Crematory
ADDRESS: 1.623 North Central Avenue Sebastian. Florida 3295
PHONE* -
(Check One)
XXX OPEN BURIAL LOT Lot_20_slock 3 U
OPEN CREMAINS LOT, Lot— Block U
OPEN COLUMBARIUM NICHE Niche lock
BURIAL DATE AND SERVICE TIME: 1/2812016, Thursday BEM EFN 11:
FOR DECEASED: Helen KI1111mett
Name ,
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTA
(Must provide proper documentation of ownership)
Patrick Killimett
Name Signature
Un
AM to
I certify that I have determined the ownership of the above describe site that li site 1
fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR:
Tim Marvin V. �
Name Signature
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing th 3 owner's
office and that all fees have been paid:
Cem ery S xtonDate
This form to be provided t Clerk's Office by Sexton for permanent r cord upo
#5274 P.001/001
12:00 PM Immediate Burial
1/25/2016
Date
and administrative
1/25/2016
Date
confirming with Clerk's
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