HomeMy WebLinkAbout4-03-08Name :5 4,,A,,.. iola ee
Unit
Block
Lot a �J
Date of Mark -out
Date of Burial S^ Time l/ oO/i'
Name of Funeral Home
Authorized by
M or
SEE
HOME OF PELICAN ISLAND
Certificate No. 2464
QTY OF SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Bernard Small
3875 10th Street
Micco, 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 8
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 1st day of July, 2015.
CITY OF SEBASTIAN, FLORIDA
Joseph F. Griffin
City Manager
ATTEST:
Sally A.. aio, MMC
City Clerk
FUNERAL HOME:
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
For information contact:
Kip Kelso Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clerk's Office
City Hall, 1225 Main Street
Sebastian, FL 32958
Office (772) 388-8215 or 388-8214
Fax. (772) 589-5570
Strunk Funeral Home
ADDRESS: 1623 North Central Avenue, Sebastian, Florida, 32958
PHONE#: 772-589-1000
(Check One)
X OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE TI
FOR DECEASED:
Julia Monti
Name
Lot-8—Block 3 Unit 4
Lot—Block—Unit
Niche Block Unit
N S E W
, July 22, 2015 11:00 AM St. Sebastian Catholic Church
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Tim Marvin `/ u✓�u–� �� �S'
Name Signature D to
I certify that I have determined the ownership of the above described site that all site fees and administrative
fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR:
Tim Marvin
Name
Signature ate
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clerk's
office and that all fees have been paid:
Z-Z)S-
Cemet ry Se cn Date
This form to be provided to Clerk's Office by Sexton for permanent record upon completion.
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 991 7
Names-trunk/MOn-6 Ll Cash �7 -7
Date � -/6-(,5 YCheck # 2 7 1
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501362100 Taxable Rent -
001501362150 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
W 5W 343 -5 ()/C /650-U0
Total Paid/50.00
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9907
Name i3eV'P► e ✓m0--1 ` ❑ Cash
Data 7 —1 15 Check #
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
Col. I- ZOOU.00
Total Paid 2-000.00
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant
cm• or
HOME OF PELICAN ISLP,ND
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.
��e-�-n cid -51V'11
Names
2875 4 SiI'e'-t, M; Cco, Ft 3L97(o
Address
C -77z) (Gq-3,f17
Area Code & Pho e Number
Name & Residence Address of Intended Occupant if Other Than Purchaser
OFFICE USE ONLY
Receipt is acknowledged in the sum of:
Ao A,e-tcgQ,vt-d cwt %v
Dollars ($2=0,00)
on this I_day of �— jAjq —1 20 15 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit q , Block 3 , Lot(s) D Q
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:1W W-DATA\Ms-Cemetery\RE C E I PT. d oc
Interment
/W O H
Circle One
Disinterment
TOTAL $ 2000. UO
Ity of Sebastian
The following documents were provided as Proof of
Residency:
�► j ••
City of Sebastian
Sebastian Cemetery
Ph.* 1(772)589-2545
Fax# 1(772)22R-9927
Nutc : This Is for Informational purposes reguarding Monuments at Sebastian('emelers .
Note ' This is fur Single Markers under 2 ft.&over 2 ft.(user 2 ft.is a poured foundation )
Dry Mix
Please return to ! City Of Sebastian
Sebastian ('entrter�
1921 North Central Ave. Foundation poured
32958 by : j ami e/
•
Attention : Cemetery Sexton dile 9/10/15
stone installed
b : j ami e
Base: 3-1 x 1-1 x 0-6 Die : 1-6 x 0-6 x 2-0 date
Size .
9/22/15
Name & Dates : If'. • Her : Julia Monti
D.O.B. D.O.B. 1917
D.O.D. D.O.D. 2015
_egal Descripition :
Unit: 4
BR. : 3
8
Lot:
Square Ft. :
Approved By : K.G.K.
Checked By : K.G.K.
Date: 9/10/15
By : EverLasting Monument Co.
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