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Home My WebLink About3-COL-20Name A fL'- Unit Block CO� Lot Date of Mark -out ®— Date of Burial �� / /' Time Name of Funeral Home / Oe �X 1 � (Ij Authorized by / CITY OF SEB Zb- HOME OF PELICAN ISLAND Certificate No. 2440 CITY,F SEBASTIAN Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Henry F. & Patricia M. Albers 13530 Westport Drive, Apt 302 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 niche: Unit 3, Columbarium, Niche 20 d/s/a 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 3rd day of November, 2014. CITY OF SEBASTIAN, FLORIDA -7j Joseph F. Griffin City Manager ATTEST: Sally A,.t4ajo, MMC City Clerk PATRICIA M. ALBERS Age 84, of Sebastian, FL, passed away on October 31, 2014. Vero Beach Crematory, LLC 1830 Wilbur Avenue Vero Beach, Florida 32960 We hereby certfv that these are the cremated human remains of: Patricia M. Albers October 31, 2014 November 6, 2014 (Date of Death) (Date of Cremation) Strunk Funeral Home and Crematory Sebastian, Florida (Funeral Home in Charge) (City and State) 3829 By: I ,, (Cremation ID Number) ( rematorSignat a . Total Paid 50100 Initials White- Dept. of Origin • Yellow - Finance • Pink Applicant CITY OF SEBASTIAN CITY CLERK'S OFFICE RECEIPT 4948 y,, u r A' b �S Name,5l l ❑ Cash ,/I 3- `1 S Date kCheck# No. Amount Paid 001001208001 Sales Tax 001501322900 Garage Sales 001501341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501341930 Election Qualifying Fees 601010 343800 Cemetery Lots C4 I 7 3 LoVINZodsa Block Unit 001501 343805 Cemetery Fees A1C- 5v.00 Total Paid 50100 Initials White- Dept. of Origin • Yellow - Finance • Pink Applicant CITY OF SEBASTIAN FINANCE DEPARTMENT RECEIPT 9947 Name 7ue nk�Albcrs ❑Cash Date �� LO— �5 artheck# 7.315 ❑ 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 00/SDI LI3805 a& /00.00 + /. liisinter RGi/iter ed (N Total Paid /00 .0 O Initials White - Dept. of Origin • Yellow - Finance • Pink - Applicant CITY OF SEBASTIAN - CRY CLERK'S OFFICE RECEIPT 1, t� /, n 4 7 4 7 �f Name ( t M ni ,Q ` ' f erJ ❑ Cash Date C Ki Check# 5 No. Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501 341920 CopieslBid Specs. 001501341910 LDC/Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots �v� W U 00 (� LollNicheW&a Block r �L 7, Unit J 001501 343805 Cemetery Fees Total Paid `C"'00 Initials White- Oept of Origin • Yellow - Finance • Pink - Applicant 11/03/2014 12:42 #3818 P.001/001 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, 9225 Main Street Sebastian, FL 32958 Office (772) 388-8215 or 388-8214 Fax. (772) 589-5570 FUNERAL HOME: Strunk Funeral Home and Crematory ADDRESS: 1623 North Central Avenue, Sebastian. Florida. 32958 PHONE#: (77215$9-1404 (Check One) OPEN BURIAL LOT OPEN CREMAINS LOT x OPEN COLUMBARIUM NICHE BURIAL DATE AND SERVICE Lot`BIoc Unit Lot—Block—Unit Niche 20 DIS/A Block B Col Unit 3 N S E W Placement in Niche ONLY by SFH staff FOR DECEASED: Patricia M. Albers Name NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE: (Must provide proper documentation of ownership) Henry F. Albers _ HeM T. AC6ers 11/3/2014 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: Tim Marvin Timothy W. Marvin 11/312014 Name Signature Date Cemetery Sexton Certification: I certify that I have checked the ownership information by viewing the owner's deed and confirming with Clark's office and that all fees have been paid: Cemet Seilon Date This form to be provided to Clerk's Office by Sexton for permanent record upon completion. CITY OF SEBASTIAN CITY CLERKS OFFICE 4954 RECEIPT Name M P_ ii/ r /T'l' +� as 0 Cash QQ Date r �y — I4 kCheckl J �bQ No. Amount Paid 001001 208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs, 001501 341910 LDC/Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots 1-ot/Niche26S Block Unit 001501 343805 Cemetery Fees UaSe 4 rine Q,DU V p"� Total Paid niti Is White - Dept. of Origin • Yellow - Finance • Pink - Applicant PLEASE PRINT DECEASED NAME: �Prfjl cin M (First) (Middle !TATE OF BIRTH: DATE OF DEATH: SIGNATURE: PRINT SIGNA uc-(4,sT :z5 Month) (Day) o4 ro/3r--;{ 3J Month) (Day) 0 DATE: Ove v /6 -'z Q FOR OFFICE USE ONLY Unit 3 Double / South / A COLUMBERIUM: 0 J.mltin NICH NUMBER: 0 AS )->3 ra (Last) /Y3U (Year) 61 (Year) DECEASED q _ NAME: (First) DATE /(1C Of" it. iia; DATE OF DEATH: SIGNATURE: PRINT SIGNATURE: mm PLEASE PRINT (Month) r e5c 12N!� a o 173 (Day) (Day) (Year) FOR OFFICE USE ONLY Unit 3 Double / South / A COLUMBERPUM: �oAS �• �1uulhl N1CH NUMBER: ZO D /5 /A.