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SEBASTIAN
HOME OF PELICAN ISLAND
Certificate No. 2470
CITY 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:
Kathleen S. Poff
6111 River Grove Drive
Sebastian, FL 32976
In and for consideration of the sum of $2,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 3, Lot 10
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 24th day of July, 2015
CITY OF SEBASTIAN, FLORIDA ATTEST:
Joseph F. Griffin
City Manager
Sally A. Maio, MMC
City Clerk
CM or
JJJ_ _ !' f r` ` ( AO
HOME OF PELICAN ISLAND
City of Sebastian Municipal Cemetery Purchase Receipt
To enable the City of Sebastian to determine the correct rate, and in accordance with cemetery rate
regulations, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
Name(s)
Address
eepi S. ioo-F-(
,46 vtr Gro ve br 1 vc
fic,n Ft- 3297!,
Area Code & Phone Number
z a 6 - 9,6
Name & Residence Address of Intended Occupant If Other Than Purchaser
Receipt is acknowledged in the sum of:
OFFICE USE ONLY
e
rs ($_0000. 0 0
on this 241 day of TtLtV 2015 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s).
Unit Ll , Block .3 , Lot(s) /0 Nich
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
1: \ WVV-DATA\ M s-Cemetery\R E C E I P T. d o c
Interment
/W O H
Circle One
Disinterment
TOTAL $
dQ.c."M
OT beoastlan
2000 - 00
The following documents were provided as Proof of
Residency:
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9921
Name Cash
Date -7 - &rCheck #50q '9
❑ 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
(40/010 :?Z/ M60 Z000,00
Total Paid 244mO
Initials
White - Dept. of Origin • Yellow - Finance • Pink - Applicant