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Name of Funeral Home
Authorized by
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SE4N I
HOME OF PELICAN ISLAND
Certificate No. 2462
CIT - 01F SEBA STIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Carolyn L. Sipel
6215 109th Place
Sebastian, FL 32958
In and for consideration of the sum of $4,000.00 is entitled to full interment
rights in the Sebastian Municipal Cemetery for the following lots:
Unit 4, Block 2, Lots 33 & 34
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 June, 2015.
CITY OF SEBASTIAN, FLORIDA
7
Joseph F. Griffin
City Manager
ATTEST:
Sally A. aio, MMC
City CI rk
06/23/2015 16:16
FUNERAL DIRECTOR'S REQUEST TO
FOR BURIAL OPENING IN SEBASTIAN I
For information contact:
Kip Kelso.Cemetery Seal
Sebastian Municipal CemE
(772) 589-2545
City Clerk's Office
City Mall, 1225 Main Stn
Sebastian, FL 32958
Office (772) 388-8215 or 38
Fax. (772) 589-5570
FUNERAL HOME: Strunk Funeral Home and Crematory
ADDRESS: 1623 North Central Avenue, Sebastian, Florida 3295E
PHONE* A777-589-11300
(Check One)
xx OPEN BURIAL LOT
OPEN CREMAINS LOT
OPEN COLUMBARIUM NICHE
BURIAL DATE AND SERVICE
FOR DECEASED: Paul Wil
Name
N
, 10:00 AM, Friday, June
NAME AND SIGNATURE OF LOT OWNER OR REPRESENT
(Must provide proper documentation of ownership)
OF SEBASTIAN
:IPAL CEMETERY
Unit
2015 - church
#4556 P.001/001
Carclvn Sipel CS'Aoe 1 6/24/2015
Name Signature Date
I certify that I have determined the ownership of the above descrI4 site that all site fees and administrative
fees have been paid and authorize opening of same.
NAME AND SIGNATURE OF LICENSED FUNERAL DIRECTOR:
Louis W. Beard
Name
Signature
Cemetery Sexton Certification:
I certify that I have checked the ownership information by viewing t
office and that all feces have been paid:
C61711teryext n Date
This form to be provided to Clerk's Office by Sexton for permanent
6/24/2015
Date
owner's deed and confirming with Clerk's
upon completion.
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9902
Name Carolyn Sipel 17 Cash
Date June 24, 2015 Check# 747
❑ 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
001001218010 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
601010 343800
U4—B2—L33 & 34
4,000.00
� Total Paid 4,000-00
Initials
White - Dept. of Origin • Yellow - Finance - Pink - Applicant
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 0003
Name Strunk/Sipel Li Cash
Date June 24, 2015 LkCheck# 7270
❑ 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
001501 343805 o/c
150.00
Total Paid 150 - 0 0
Initials
White - Dept. of Origin - Yellow - Finance • Pink - Applicant