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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