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Decedent Information

* Decedent's Full Name
First / Middle / Last

Also Known As
First / Middle / Last Name or NA

Date of Birth

Birth State / Country

Date of Death

Time of Death

Years of Age

Sex

Female

Male

Other

Social Security Number

Education
Highest Grade or Degree

Occupation
Type of work for most their life (do not use retired)

Years in Occupation

Business / Industry

Martial Status

Were they ever in the U.S. Armed Forces?

Yes

No

Unknown

Were they spanish/hispanic/latino?

Yes

No

Decedent's Race
Up to 3 races may be listed

Decedent's Residence
Address / City / State / Zip

Country

Years in Country

Final Disposition

Burial at cemetery

Keep at residence

Scatter at sea by mortuary

Notes

Informant Information

*Informant's Name
First / Middle / Last

Relationship to the Decendent

Informant's Mailing Address
Address / City / State / ZIp

*Surviving Spouse's Name
First / Middle / Last (maiden) or NA

Parental Information

*Father's Name
First / Middle / Last or NA

Birth State

*Mother's Name
First / Middle / Last (maiden) or NA

Birth State

Contact Us

Los Angeles
Ashes to Ashes
3371 Glendale Boulevard # 218
Los Angeles, CA 90039
Tel: (323) 804-1944
Fax: (323) 663-3323

Palm Springs
Ashes to Ashes
340 W. San Rafael Dr.
Palm Springs, CA 92262
Tel: (323) 804-1944

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