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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.
LW5 R �fJYGi c�
Name s)
Z7�- S l)-21YEL E 4-/-
Address
fiAddress
772 - 171�o Z511
Area Code & Phone Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
s5 0 -tko W a lid C( ^�0 O
($ 2C-00-c'c
on this J7 day of TL, [ y , 20 05 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit '4 , Block 3 ,
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:\W W-DATA\Ms-Cemetery\RECEIPT.doc
Interment
/W O H
Circle One
Disinterment
TOTAL $ 2000- OO
ai°' l/� t -i t f
Vy of Sebastian
The following documents were provided as Proof of
Residency:
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 992%
Name [—.GC i s G a re i k ❑ Cash
Date 7-- 2 7 ` it -e;O ❑ Check #
Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501362100 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
CV o1olo - 3, sUoq ;,- �0, 0 O
Total Paid 000 UO
I Mals
White - Dept. of Origin - Yellow - Finance • Pink - Applicant