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HomeMy WebLinkAbout3-COL-40DnBName Unit_ Block Lot �D Date of Mark -out Date of Burial qh�3 1141. Time l0 % ao 14 Name of Funeral Home All, Authorized by z `'' of 1/ �� OVID M. SHIVERS Ovid M. (Buddy) Shivers, Jr., 58, of Vero Beach, died August 18, 2014. He was born on February 7, 1956 in Avon Park to Ovid and Elah Shivers. Ovid was a lifelong resident of Indian River County. He owned and operated B&D Service Center in Wabasso and Raindancer Irrigation in Fellsmere. He is survived by his loving wife of 39 years Deborah; son Jacob Shivers; grandchildren Eden and Jacob Shivers; and sisters Betty Doty of Sebastian and Janet Bobo of Vero Beach. SEAWENDS NDS CidEIMATORY Sebastian, Florida 735 Fleming Street • Sebastian, Florida 32958 www.seawindsfh.com (772) 589-1933 We hereby certify that these are the remains of OVID M SHIVERS JR " ! " . The remains were received from SEAWINDS FUNERAL HOME & CREMATORY Cremation Permit No. 14-73380-5206 Issued at BREVARD COUNTY Date of Death AUGUST 18, 2014 Date of Cremation By Cremator CITYCIF HOME OF PELICAN ISLAND Certificate No. 2431 CITY OF E-1' STIAN Certificate Of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Deborah Shivers P. 0. Box 815 Fellsrnere, FL 32948 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 niche: Unit 3, Columbarium, Niche 40dnb 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 19th day of August, 2014. CITY OF SEBASTIAN, FLORIDA ATTEST: Joseph F. Griffin City Manager Sally A/Maio, MMC City Clerk CITY OF SEBASTIAN CITY CLERK'S OFFICE /, C RECEIPT `+ U Name PM o r� a 1 J / 1 t V rs ❑ Cash I Date q— v - o YCheck # 1 10 1 q No. 001001208001 001501 322900 001501 341920 001501 341910 001501 341930 601010 343800 001501343805 Amount Paid Sales Tax _ Garage Sales _ Copies/Bid Specs. _ LDC/Code of Ordinances _ Election Qualifying Fees Cemetery Lots Co _ LotlNiche odli Block I , Unit J Cemetery Fees \!a -S e- .G r i n 75.70 ✓" Total Paid 32,5:7C) Initials White - Dept. of Origin 9 Yellow - Finance • Pink • Applicant bITATEMENT DArE 1TERNIS TO ADDRESS IN bCCOU,-JT'VVlTI I a, -d— Df -,81 2 FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN FOR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY SEUAST raMf d PRICAN MvNo 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 FUNERAL HOME: ADDRESS: PHONE #: (Check One) PEN BURIAL LOT Lot Block Unit OPEN CREMAINS LOT Lot Block Unit _OPEN COLUMOARIUM NICHE Niche.!V/0 Block Unit BURIAL DATE AND SERVICE TIME: ZV •'oD/y� 7'3 FOR DECEASED: U ;,j S ivdme .`7/ NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) )W,1� SLQ4111,,' Name Signature Date 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. A-1 �A Name Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership inforination by viewing the owner's deed and confirming with Clerk's office and that all fees have been paid . Cem0lery eon Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. + Total Paid TVtJ. Initials White — dept. of Origin a Yellow — Finance • Pink - Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4908 { Deb 4 ret h� A ! 4 e—rS Name ❑ Cash Date ,rJ Check #� No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 CopieslBid Specs. 001501 341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees q006. 601010 343800 Cemetery Lots j Lot/Niche 46dh Block W 1 Unit j 001501 343805 Cemetery Fees + Total Paid TVtJ. Initials White — dept. of Origin a Yellow — Finance • Pink - Applicant CmOf SE]BASTKN x HOME OF 'PELICAN ISLAND �l 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, residence of purchaser or person for whom lot is intended for interment must be provided at time of purchase Name(s) � f 5 CG„ rd �f 1d, o Address Utvo+`"J, FL 1?�'; 7 {(,S Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowledged in the sum of: Lt A'V Dollars ($' UC `' ) on this day of ISG' r, GAS` , 20for the ,purchase of the following described Cemetery Lot(s) and/or Niche(s). Unit , Block , Lot(s) Niche(s) 40 c A 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) Interment Signature of Purchaser Pity of Sebastian W O H Circle One Disinterment TOTAL $ /©()(). 0 Service fees are to be paid at time of need only [:IW W-DATA\Ms-iCemeterylRECEIPT.doc