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HomeMy WebLinkAbout3-COL-26QTY OF SEBASTL HOME OF PELICAN ISLAND Certificate No. 2441 MY 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: Joseph L. & Carol A. Victor 13530 Mystic Drive, Apt 103 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 26 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 21St day of November, 2014. CITY OF SEBASTIAN, FLORIDA ATTEST: o Joseph F. Griffin City Manager c�— Sally A. �Wo, MMC City Clerk CITY OF SEBASTIAN CRY CLERK'S OFFICE 4957 PPMPT PT /'Ir `- Mrs V1 Cl Ur Name ❑Cash 9r7 Date Z- 7-1 - 14 )( Check # k I R No. Amount Paid 001001208001 Sales Tax 001501 322900 Garage Sales 001501 341920 Copies/Bid Specs. 001501341910 LDC/Code of Ordinances 001501 341930 Election Qualifying Fees 601010 343800 Cemetery Lots 000 (� jT LoUNiche Z(GdsQ Block `,40I Unit 001501 343805 Cemetery Fees I Total Paid q_60 O Initials White - Dept. of Origin- Yellow - Finance •Pink - Applicant PLEASE PRINT DECEASED \J e NAME: �© -.5 Lv V I C - (First) (Middle) (Last) DATE OF BIRTH: DATE OF DEATH: SIGNATURE: PRINTED NAME OF SIGNATURE: DATE: Unit 3 Columbarium: (Month) -z-6 (Day) FOR OFFICE USE ONLY Niche No.: 2-6 d S a (Year) PLEASE PRINT DECEASED NAME: (First) (Middle) (Last) DATE OF BIRTH: (Year) DATE OF DEATH: (Month) (Day) (Year) SIGNATURE: PRINTED NAME OF SIGNATURE: Cm-ol a -x t \1rI C T-012 DATE: I— � -- 15— FOR OFFICE USE ONLY Unit 3 14no fS ftf v"10 Niche No.: