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MAKE ARRANGEMENTS
FULL BODY BURIAL AT SEA
GENERAL PRICE LIST
DISPLAY MERCHANDISE
OUR FACILITY
ONLINE SERVICES
AWARDS
OUR CHARITIES
HELPFUL READING
WHAT OUR FAMILIES SAY
CURRENT OBITUARIES
LIFE TRIBUTES
OUR HISTORY
CONTACT US
HOME

MAKE ARRANGEMENTS

If a death has just occurred, after submitting this form, please call us right away at 213.747.9121 so that we can assist you immediately. If a death has not just occurred, please allow us some time to get back to you. However, you’re welcome to call us anytime for assistance.

Making Arrangements

On-Line Form Information To be able to receive a decedent’s death certificate, please fill out this form and submit it automatically to us. You will receive a copy of your submission in an email. In filling out this form, please note that you are creating a historical document. The fields with red asterisks (*) are required fields.
Today’s Date (MM/DD/YY) *

Contact Information

For all additional authorizations needed to complete these arrangements, my email address is *
I am making final arrangements for my *
Self Father Mother Grandfather Grandmother Spouse SisterBrotherAuntUncleSonDaughterFriendOther†
†Other (E.g. neighbor, friend, business associate, etc.)
This person *
has passed on has not passed on
Name of person for whom you are making arrangements (first, middle and last) *
Sex
Male Female

Residence

The address of whom these arrangements are being made
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Date of Birth
Number of years in county
Phone (with area code)

Veteran
Yes No
If “yes,” which branch?
Dates served (began)
Date served (ended)

City and State of Birth
Social Security Number, if known (please include hyphens)
Marital Status
Married Widowed Divorced Never Married

Education

Highest Level of Education Completed
UnknownNo Formal EducationElementary SchoolIntermediate or Junior High SchoolSome High School no DiplomaGEDHigh School with DiplomaSome CollegeAssociate’s DegreeBachelor’s DegreeMaster’s DegreeDoctorate’s DegreeProfessional Degree

Race

WhiteCaucasianBlackAfrican-AmericanMexicanMexican American
Other Hispanic

ChineseJapaneseFilipinoKoreanVietnameseAsian IndianCambodianThaiLaotianHmong
Other Asian

Native HawaiianGuamanianSamoanOther Pacific IslanderAlaska NativeEskimoAleutNative AmericanAmerican Indian
Unknown or Other

Employment (do not put “retired” in any fields)

Usual Employer
Type of Business
Occupation
Years in Occupation

Spouse/Parent Information

Spouse’s Name (first, middle, last)
Spouse’s Maiden Name
Father’s Name (first, middle, last)
Father’s Birth State
Mother’s Name (first, middle and last)
Mother’s Maiden Name
Mother’s Birth State

Informant - Person Making These Arrangements

Informant (if self, please state) *
Phone (with area code) *
Residence
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Interment Options

Cremation options (please check all that apply)
Direct CremationWitnessed CremationPriority CremationCremation with Memorial ServiceCremation with Witnessed Placement at SeaFull Traditional Service Followed by CremationNone/Other†
†Other

Burial Options (please check all that apply)
Immediate BurialGraveside WITH VisitationGraveside WITHOUT VisitationFull Traditional ServiceFull Body Burial at SeaNone/Other†
†Other

Immediate Family and Closest Friends

Name (1)
Relationship
Residence
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Name (2)
Relationship
Residence
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Name (3)
Relationship
Residence
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Name (4)
Relationship
Residence
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Additional Information

Please enter any additional information here.
If a death has just occurred, after submitting this form, please call us right away at 213.747.9121 so that we can assist you immediately. If a death has not just occurred, please allow us some time to get back to you. However, you’re welcome to call us anytime for assistance.

Verification

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If you need to update a previously submitted form, please click here.

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