HomeMy WebLinkAbout4-03-39 CITY Of
SEBASTIAN
HOME OF PELICAN ISLAND I'
Certificate No. 2493
CITY OF SEBASTIAN
Certificate of Interment Rights
'� II
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
III Patricia S. Cernigliaro I'
101 King Fisher Way
Sebastian, FL 32958
In and for consideration of the sum of $1,000.00 is entitled to full interment
! rights in the Sebastian Municipal Cemetery for the following lot:
Unit 4, Block 3, Lot 39
of the Sebastian Municipal Cemetery,
as maintained on file in the records of the City Clerk
for use in accordance with the conditions,d tions, ordinances, resolutions, rules and
regulations prescribed therefore by the City of Sebastian.
CONVEYED THIS 11th day of March, 2016. !!I
CITY OF SEBASTIAN, FLORIDA ATTEST:
of
/j it
Joseph F. Griffin Sally A. aio, MMC
City Manager a ager City Clerk
03/12/2012 10:30 7722287079 COS AIR BLDG PAGE 01/01
FUNERAL DIRECTOR'S REQUEST TO CITY OF SEBASTIAN
POR BURIAL OPENING IN SEBASTIAN MUNICIPAL CEMETERY
� or.+.�catr isuFro
For information contact:
Kip Kelso - Cemetery Sexton
Sebastian Municipal Cemetery
(772) 589-2545
City Clark's Office
Cify Hall, 1226 Main Street
Sebastian, FL 32958
Office (772) 3884215 or 388-9214
Fax (772) 586-6570
.FUNERAL HOME:
ADDRESS:..Ar �yr� ��E�iyG S'7^2�'E f ��"�Sv���•o�v F�
PHONE f#: 7 2 _---(Y8 - ."
Check One)
t%WW OPEN BURIAL LOT Lot Block Unit
OPEN CREMAINS LOT Lot Block Unit
OPEN COLUMBARIUM NICHE Niche Block Unit
BURIAL DATE AND SERVICE TIME: %%% '� Z S ev 19 E " W
of
FOR DECEASED: S.
Name
NAME AND SIGNATURE OF LOT OWNER OR REPRESENTATIVE:
(Must provide proper documentation of ownership)
Name
Signature
Date
[: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 F DI CTOR:
�4V ^0 �. CV -4 «a c C_
Name
Date
rrr
Cemetery Sexton Certification:
I certify that i have checked the ownership Information by viewing the owner's deed and confirming
with Clerk's office and that all fees have been paid:
Cemetery Sexton
Date
This fortn to be provided to Clerk's Office by Sexton for permanent record upon completion.
CITY OF SEBASTIAN 10087
ADMINISTRATIVE SERVICES RECEIPT
Name C4�^l /G -%AIQ0 ❑ Cash
Date )(Check # 5 x 9 0
0 Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit
001501 362100 Taxable Rent
001501 362150 Non -Taxable Rent
450010 369900 Airport Badge
001001218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 351140 Parking Citation
001501 342100 Police Security Services
001501 329200 Site Plan Review
001501 329300 Subdivision/Plat Review
001501 329100 Zoning Fees
U�-61K3 Lvr37
Total Pail
I
Security Dep Held - Amount $ Check #
White - Dept. of Origin - Yellow - Admin. Svcs. • Pink - Applicant
City of Sebastian
Sebastian Cemetery
Ph. # 1(772) 589 - 2545
Fax 9 1(772) 228 - 9927
Note : This h for informational purposes reguarding Monuments at Sebastian Cemetery .
Note : �Q ✓h 14 // 4 /t c)
7 Foundation noured
y : everlasting / Jamie
dale
Please, eturn to :
Attention
size
Names & Dates : His:
Sebastian Cemetery
1921 North Central Ave.
32958
Cemetery Sexton
g
Legal Description
Unit:
Blk.: J
Lot: 3`t
Approved By: K. G. K.
Checked By:
K.G.K.
Date:
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