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The answers to these questions are necessary to complete the cremation.

You do not need to provide this information now, or in advance of our immediate assistance. However, should you choose, you can start to answer these questions now, to be prepared later.

PERSON WHO WILL BE CREMATED PERSONAL DATA
NAME OF PERSON WHO WILL BE CREMATED– FIRST (Given)
MIDDLE
LAST (Family)
ALSO KNOWN AS - if applicable (include FIRST, MIDDLE, LAST)
DATE OF BIRTH mm/dd/ccyy
AGE Yrs
GENDER
PLACE OF BIRTH (U.S. State or Foreign Country)
SOCIAL SECURITY NUMBER
SERVED IN U.S. ARMED FORCES?
- YES
- NO
- UNK
Branch of Service*
Hidden
MARITAL STATUS (at Time of Death)
MARITAL STATUS (at Time of Death)
EDUCATION – Highest Level/Degree
WAS PERSON WHO WILL BE CREMATED HISPANIC/LATINO(A)/SPANISH?
- YES
- NO
Country of Origin
PERSON WHO WILL BE CREMATED RACE – Up to 3 races may be listed
USUAL OCCUPATION – Type of work for most of life. DO NOT USE RETIRED
KIND OF BUSINESS OR INDUSTRY (e.g., grocery store, road construction, employment agency, etc.)
YEARS IN OCCUPATION
PERSON WHO WILL BE CREMATED USUAL RESIDENCE
USUAL RESIDENCE (Street and number, or location)
CITY
COUNTY/PROVINCE
ZIP CODE
YEARS IN COUNTY
U.S. STATE OR FOREIGN COUNTRY
YOUR INFORMATION
YOUR NAME, RELATIONSHIP
Your Email*
YOUR MAILING ADDRESS (Street and number, or rural route number, city or town, state and zip)
PERSON WHO WILL BE CREMATED’S SURVIVING SPOUSE AND SURVIVING OR DECEASED PARENT INFORMATION
NAME OF SURVIVING SPOUSE – FIRST (Given)
MIDDLE
LAST (Birth or Maiden Name)
NAME OF FATHER/PARENT–FIRST
MIDDLE
LAST
PLACE OF BIRTH (U.S. State or Foreign Country)
NAME OF MOTHER/PARENT–FIRST
MIDDLE
LAST (Birth or Maiden Name)
PLACE OF BIRTH (U.S. State or Foreign Country)
Does the person who will be cremated have a pacemaker or other electronic imbedded device?
- Yes
- No
Does the person who will be cremated weigh over 250lbs.?
- Yes
- No
Does the person who will be cremated weigh over 400lbs.?
- Yes
- No
LA Cremation does not offer the service of cremating someone 400 pounds or more; for this service please contact our sister company Lighthouse Memorial & Receptions - (310) 792-7575.
Did the person who will be cremated have an Advance Health Care Directive, Five Wishes Document, or a Durable Power of Attorney for Health Care? (POLST and DNR forms do not apply)*
- YES
- NO
First name, last name, email and phone number of each adult, living, primary agent(s)*
If your loved one didn't have an advanced health care directive, did your loved one have a spouse?*
- YES
- NO
First name, last name, email and phone number of spouse*
If your loved one didn’t have a spouse, did they have children over the age of 18 yrs old?*
- YES
- NO
First name, last name, email and phone number of each adult, living child*
If your loved one didn’t have children are their parents living?*
- YES
- NO
First name, last name, email and phone number of each adult, living parent*
If your loved one didn’t have living parents, did they have siblings?*
- YES
- NO
First name, last name, email and phone number of each adult, living other closest relative*
If none of these apply, please describe your relationship*
Send Email To*
- Email to Me
- Email to Me and LA Cremation
Email*
Phone*
Name*
First Last
Name of Loved One*
First Last
Your Relationship to Loved One*
Email*
Phone*
Location of Passing if services are needed
Please select the reason you would like to be contacted:*
- About Someone Who has Died
- Arrangements for Someone That Will be Needed in the Very Near Future
- A Long Term Advance Plan
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Please call us at (310) 792-7585 if you have any questions not answered on this website.
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2701 182nd Street
Redondo Beach, CA 90278

(310) 792-7585
FD 1491

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PERSON WHO WILL BE CREMATED PERSONAL DATA

PERSON WHO WILL BE CREMATED USUAL RESIDENCE

YOUR INFORMATION

PERSON WHO WILL BE CREMATED’S SURVIVING SPOUSE AND SURVIVING OR DECEASED PARENT INFORMATION

Customer Reviews

Jerry H.

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