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HOME OF PELICAN ISLAND
Certificate No. 2641
CITY QE SEBASTIAN
Certificate of Interment Rights
IN ACCORDANCE with provisions of the Code of Ordinances of the City of
Sebastian, it is hereby certified that:
Edna Douglas
7935 129th Place
Roseland, FL 32957
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 3, Block 67, Lots 15 & 16
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 5th day of July, 2019.
CITY OF SEBASTIAN, FLORIDA ATTEST:
maul E. Carlisle
City Manager
�Ax&te Gvja.
Janette Williams, MMC
City Clerk
CRY (A
SEW'kSrIAN�i��i
"s'".� `
HOME OF PELICAN UAM
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, proof of City residency of purchaser or person for whom lot is intended for interment must
be provided at time of purchase.
EDMA 1ot,talas
Name(s) --7g35 laqA YIA.CE
ts>rLvnrD.Ft. �a9,5'1
Address
Area Code & Phone Nu er
�s*6c- E . Jbou1aS
Name & Residence Address of Intended Occupant' they Than Purchaser
OFFICE USE ONLY
Rece'�iipt is acknowledged in the sum of:
((FOLLC fnovSA fh find Dollars ($45boo.cc' )
on this 5 day of -Tk l y 2020 for the purchase of the following described
Cemetery Lot(s) and/or Niche(s). /J
Unit -3, Block (ci , Lot(s) 1,5+1(o Niche(s)
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:
Comer Markers (set of 4 -$20) Opening & Closing I�� •/ W O H
Circle One
Vase and Ring for Niches (cost) Interment Disinterment
Temporary Marker Preparation & Installation
��4-Lmx(c-
Signature of Purchaser
TOTAL $ 4, 15-0 • 00
,
City oiSebastl
The following documents were provided as Proof of
Residency:
I:NWW.DATA\Ms-CemelerARECEIPT.doc
and
'SIAW, Ic. CITY OF SEBASTIAN 11710
ADMINISTRATIVE SERVICES RECEIPT
Name�gU Cash
Date �L�19 KCheck# �w 1
U Credit
Amount Paid
001001
208001
Sales Tau
001001
220000
Security Deposit
001501
362100
Taxable Rent
001501
362150
Non-Texable 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
I—
(cototo 3438CC WIS
4 coo.c0
r?clScl :f°i3Sos OIC
�� lSC.°i
()n1iT 3 Blv b -i L -CTS tS+Ib
,Qe, Total Pei ,4 S6.
Indials
White - Dept. of Origin • Yellow -Admin. Svcs. • Pink -Applicant
L'Mot
SE�T�N
HOME OF PELICAN ISLAND
1225 Main Street
Sebastian, FL 32958
(772)589-5330 Phone
July 9, 2019
Mrs. Edna Douglas
7935 129' Place
Roseland, FL 32957
RE Interment Rights to Unit 3, Block 67, Lots 15 & 16, in the Sebastian Municipal
Cemetery.
Dear Mrs. Douglas:
Enclosed is City of Sebastian Certificate 2641 entitling you to full interment rights in
Unit 3, Block 67, Lots 15 & 16 in the name of Edna Douglas.
If you have any questions, please contact our office at 388-8209.
Sincerely
Cathy Tgsta
Records Clerk
Enclosure