FOR IMMEDIATE SERVICE

If death has occurred, please accept heartfelt condolences from our family to yours.

 

 

 

Call us right away to assist you and to answer your questions at this very difficult time (209) 400-7625.

Please fill the following form and submit to start the arrangements.

Decedent’s Personal Information:

Name of the Decedent
First
Middle
Last
Aka
Date of Birth
Country or State of Birth
Social Security Number
Does the Decedent have Pacemaker
Any other Radioactive Implant
Approximate Hight
Approximate Weight
Marital Status
Ever in the US Armed Forces?
Highest Education Level
Was Decedent Hispanic/Latino/Spanish ?
Decedent Race (May use up to 3 choices)
Occupation (Do not write Retired, write recent, or usual work)
Kind of Industry (Transport, Medical, Government, Education etc.)
Years in Occupation
Decedent’s Address
Street
City
Zip County
Years lived in that County
Surviving Spouse’s NameFirst
Middle
Maiden (Name before Marriage)
Decedent’s Father’s NameFirst
Middle
Last
Decedent’s Father Birth Country or State:
Decedent’s MotherFirst
Middle
Last
Maiden (Name before Marriage)
Decedent’s Mother Birth Country or State:
Name & Address of the Cemetery for Burial

Primary Care Physician

Where is your loved one now?
Physician Name
Hospital / Hospice
City
Physician's Phone
E-mail
Last time seen by the Physician (Approximate Date)

Informant’s Information:

Informant’s Name
Relationship to the Decedent
Informant’s Address
Street
City
Zip
Informant’s Phone
Informant’s E-mail
Where would you like the Death Certificate to be mailed at

Decedent’s Location

Address
City
County