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Home My WebLink About4-16-20, Name Unit_ Block. Lot _ � • GC'� 4x 8) 3H� Date of Mark-out I � � � � 1 /� Date of Burial �� Time �� G Name of Funeral Home c�� Authorized by�' �-'�-�l/�- ' 7 N � a 1 S m i $ . IG e < � f T � m m • ,q � � s � 9 7 � C'! d Y d 7 � °o 0 A � � o °o °o °o o °o Z 0 ° o 0 0 0 °o 0 w � � A N OOD p W � N O O O O O O O m' o m m v o c�i d c� z � � � �' °� �'° m n � �o N � � � N X � p N G N�p � (�� N � .i G � n �! � � T(p = N � �Q �iF � c � I'1�- � � z d 3 m � � � � � d A N 11 � � � � O C 7 '9 �. A � < � n m m O � � y N W -i0y � � �s �Z m \ � •�' � �� ` �.�,. _ i �t�+',,•� .,�,� ,_ "�� _._. FrON'tE C�F PELtCAN I�LANQ Certificate No. 1967 �� ' �� Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Estelle Chase &/or Jennifer Julian 7475 131 Street Sebastian, FL 32958 In and for consideration of the sum of $700.00 is entitled to full interment rights in the Sebastian Municipal Cemetery for the following lot: Unit 4, Block 16, Lot 20 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. This certificate replaces previously issued Certificate No. 1967 dated June 22, 2004. CONVEYED THIS 14th day of June, 2010. CITY OF SEBASTIAN, FLORIDA � `AI Minner City Manager ATTE ST : (�f �:` �� C r: Sally . Maio, MMC ity Clerk �. �1 { � �� _ �"^'^�v�. .. ....�'fl>��.,�`• i HOME OF PEUCAN ISUNi3 Certificate # 1967 ��1�� ! �� .��:�� Certificate of Interment Rights IN ACCORDANCE with provisions of the Code of Ordinances of the City of Sebastian, it is hereby certified that: Clifford H. Chase, Jr., Estelle Chase and Jennifer Julian (name) 7475 l31 St., Sebastian, FZ 32958 (address) in and for consideration of the sum of 1 400.00 has purchased and is entitled to full interment rights in the Sebastian Municipal Cemetery for the following plots: Unit _ 4_ Block _16_ Lots_ 19 & 20_ of the Sebastian Municipal Cemetery, as maintained on �le 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 22nd day of June, 2004 OF SEBA IAN, FLORIDA A'1"I' • � � .. _ � , , � �er�y��e Moore Sall A. Maio, CMC Itv`'IGTana�er City Clerk � /1 \ ( �� " \� � �O .�_ - `�-' Strunk Funeral Home - Vero Beach CLIFFORD HENRY (MAGOO) CHASE, JR. ( October 22, 1951 - April 17, 2010 ) CLIFFORD HENRY (MAGOO) CHASE, JR. Mr. Clifford Henry (Magoo) Chase, Jr., 58, died April 17, 2010 at his residence in Micco, FL. He was bom in Brockton, MA and lived in Micco for 8 years coming from Coconut Creek, FL. He was the Owner/Operator of Chase Plumbing and Chase Consignment both businesses located in Sebastian, FL. He has been involved with lots of Biker Groups including Wings of Gold Motorcycle club in Broward County and Iron Cross Motorcycle Club, Billerica, MA. He was an avid Beatles and Boxing fan. Survivors include his son, Clifford Taylor of North Miami, FL; daughters, Jennifer Julian of Roseland, FL, Lisa Salem of Tewksbury, MA, Jessica Garrett of Bonneau, SC, Carolina Chase of Seattle, WA; brother, Edward Chase of Lake City; 6 grandchildren. Memorial contributions may be made to the Leukemia Society of America, Inc., 4360 North Lake Boulevard Suite 109, Palm Beach Gardens, FL 33410 in memory of Clifford Chase, Jr. SERVICES: A Funeral Service will be 2:00PM on April 20, 2010 at Strunk Funeral Home, Sebastian, FL. Burial will be at Sebastian Cemetery, Sebastian, FL. A. PLORIDA DEPARTMENT OF �� (TYPE) 1. Name of Deceased 2. Place of Death County Brevard 3. 4 Stafe af F(orida, Department of Flealth, Vital Statistics APPLICATIO(d FOR BUROAL - iRANSIT PERM9T First Cli€ford City, Town or Location �1I�1CC0 Middle HPnry Last Date of Chase, Jr. Death e of (If neither, give street address) >. or Month Day Year 04/17/2010 i„St. 5353 Carey Lane, IUlicco, FL 3Z976 Name of Medical Address Phone Number Certifier Noor M. Merchant 13060 US Highway 1 Suite A Medical Examiner hysician SebaSttar), FL 32958 772/589-0879 Name of Funeral Home/Direct Disposal Address Fla. Lic. No./Reg. No. Phone No. (Area Code) Establishment Strunk Funeral 1623 N. Centrat Avenue Homes � Crematory Sebastian, FL 32958 F041870 772/589-1000 5. Check a. � The medical certification has been completed and signed. A completed certificate of death accompanies this Appropriate application. Box b. �CX $uSar1 was contacted on April 19, 2010 He/she verified that this death was from natural causes, that there was no accident nor other external cause of death, and that Noor M. Merchant, M.D. will complete and sign the medical certification of cause of death within 72 hours. � was contacted on He/she verified that , Medical Examiner, will complete and sign the medical certification of cause of death within 72 hours. o. r=uneral Girector/ Signa �re �.E. Ro.;Reg. No. Da?e Signed �a� �� . �� Fo��o�$ oal�9/20�0 a. c BURIAL - TRANSIT PERMIT Permission is hereby granted to dispose of this body. Permit No. � 228—� 0-0416 � A five (5) day extension of time for filing the death certificate (exclusive of weekends) has been requested and granted since the physician has been contacted by the funeral director and will not be able to complete the medical certification of cause-of-death section of the death certificate within 72 hours. �No extension of time for fi e deaYh certificate has been requested. Re�r or �'°e—" Date Date Certificate Subregistrar Signature � �/N�-v� Issued: 04/17/2010 Dye: 04/21 /2010 Approval Number: AUTHORIZATION for CREMATION, DISSECTION, or BURIAL-AT-SEA Date Medical Examiner, , gave authorization by telephone to Funeral Director/Direct Disposer. Date The Medical Examiner's approval must be obtained before disposal by any of the above methods. A waiting period of 48 hours after death is required for all cremations. �. CEMETERY 012 CREMATORY Methcd of Disposition: Place of Disposition ,/� � 4 �BURIAL �STORAGE Date of Disposition �/��p _ �CREMATION Signature of Sexton 1 or Pers�n-in-Charge � �OTHER (Specify) 0 This permit must be endorsed by the Sexton or person-in-charge (or by the Funeral CirectorlDirect Disposer when there is no Sexton) and returned within 10 days to the local Caunty Health Department in.the county where disposition occurred. DisUibution� White: Cemetery or Crematory DH 326, 8/97 (Obsoletes all previous editions) Yellow: Funeral Director or Direct Disposer (Stock Numbec 5740-000-0326-2) pink: Local Registrar a«ni.a i rooQ � IQG7 «�� 5�s�sT� ��:�'`� HOME OF PEUCAN ISIAND 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 I�p � Mrs �.'� �F�o�� t(..dsc ..��e ��ivN1 F�� JuL�� Name(s) ° ' °Y�� 1 �3� �T �'� �,vs-�i .� �- - �L �a �i s8 Address �ya � � �� - 3f� s Area Code & Phone Number Residence Address of Intended Occupant if Other Than Purchaser Office Use Only Receipt is acknowiedged in the sum of: �Il.e� D�) Dollars ($ f �Q(�_ U6 � on this n� day of �(�Yl P_ , 20 0� for the purchase of the following deseribed Cemetery Lot(s) and/or Niche(s). Unit �, Block _�,, Lot(s) 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: Corner Markers (set of 4-$20) Opening & Closing Vase and Ring for Niches (cost) Interment Disinterment W O H Circle One TOTAL $ DO Dv � D�D.I�D ) ( !/L �� Signature of Purchaser C' of Sebastian Service fees are to be paid at time of need only I:\W W-DATA\Ms-Cemetery\RECEIPT.doc C11Y Of �� _�..� : �:.�..^ .�: � HOME OF P'ELiCAN 1S€�11VD June 29, 2004 Mr. & Mrs. Clifford H. Chase and Jennifer Julian 7475 1315` Street Sebastian, Fl 32958 Dear Mr. & Mrs. Chase and Ms. Julian: Enclosed is City of Sebastian Certificate Number 1967 for the purchase of Cemetery Lots 19 & 20, Block 16, Unit 4. Also enclosed is a copy of your receipt and the Rules and Regulations governing the Sebastian Municipal Cemetery. If you have any questions, please contact our office. Sinc ely, / / j��'/ .! G" ` Sally . aio, CMC City Clerk SAM: ar enclosure �� City oj Seb�rstiQn Sebastian Cemetery Ph. # I (772) 589 - 2545 Fax # 1(772) Notc : This is for ioformational purposes reguarding Monuments at Sebastian Cemctery . Note : P{ease return to : Attention . Sebastian ('emetery 1921 Piorth Central Ave. 32938 Cemetery Sexton Dry Mix Foundati��n poured �,y ; herman date : 6/10/10 stone instailed b� ; herman • 1- 0 x 2- 0 x 0- 4 standard grey granite flat grass marker date : 6/10/10 Size : ' Names & Dates : His : Clifford H. Chase Jr. Her : D.O.B. 1951 D.O.D. 2010 Legal Description : Unit : 4 Blk. : 16 �ot : 20 Approved By : K. G. K. K.G.K. Checked By : Date : Example 6/10/10 By : Eagle D.O.B. ._ �•� 4 " deep -�-�� 12„