3434 17th Street | San Francisco, CA 94110 | Tel: 1-415-431-4900

DUGGAN'S FUNERAL SERVICE
| The Duggan Welch Family

3434 17th Street
| San Francisco, CA 94110
| Tel: 1-415-431-4900
| Fax:
|

DUGGAN'S FUNERAL SERVICE
| The Duggan Welch Family

3434 17th Street
| San Francisco, CA 94110
| Tel: 1-415-431-4900
| Fax:
|

Funeral Directors License Number FD44

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Arrange a Cremation Now
- Arrange a Cremation Now
- Arrange a Cremation Now Form
Price Lists
Obituaries
Resources
About Us
Contact Us

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Section Title

DUGGAN'S FUNERAL SERVICE
| The Duggan Welch Family

3434 17th Street
| San Francisco, CA 94110
| Tel: 1-415-431-4900
| Fax:
|

Arrange a Cremation Now Form

Please carefully read the instructions before beginning.

You will be asked a series of questions required by the State of California to complete a death certificate. There may be information you do not know. Please try to be as thorough as possible because this information will be printed on the death certificate. Here is some information you will need along the way.

Decedents social security number, place of residence, work history, education, and marital information.
Decedents parents information (name and state of birth).
Physicians information

Important to Note – No form field can be left blank. Use the term "Unknown" for any information you do not have. The word "Unknown" will be printed on the death certificate for these fields.

Once the information has been gathered you will be prompted to print the forms, which will have the information you just entered auto-populated. Please sign and date the necessary areas. These areas will be marked with red symbols, so they are easy to find. Once completed, fax the form to (415) 861-9866. If you have any difficulties feel free to email us at info@duggansfuneralservice.com, or call us at (415) 431-4900.

Arrange a Cremation Form

Informant's Relationships

Select a word from the list that best describes your relationship to the decedent:

I claim the right to control the disposition of the decedent's bodily remains because:

The decedent named me to control the disposition of his/her remains in a will or other documentI am the decedent's childI am the decedent's spouseI am the decedent's parentI am the decedent's nearest other relative

(check all that apply)

Informant's Name & Address:

First Name

Last Name

Street

City

State/Province

ZIP/Postcode

Telephone

Email Address

Decedent's Vital Information

First Name

Middle Name

Last Name

AKA (Also Known As) include full AKA - first, middle and last

Date of Birth

State of Birth

Sex

MaleFemale

Does the decedent have a surgically implanted pacemaker, chemo pump, or prosthetic device?

Option 1Option 2

Foreign Country of Birth If born outside the US

Decedent's Residence Address

Current Location Name of Hospital, Nursing Home, Funeral Home or Country Coroner

Last Residence Address Street & Number

City

State

Country or Province If resided outside the US

Foreign Country If resided outside the US

Number of Years Residing in Country/Province

Zip Code

Decedent's Education/occupation

Education Select the highest degree or level of school completed

Kind of Business or Industry grocery store, insurance, etc.

Number of years in occupation

Usual Occupation (most of life) Do not use "Retired" or "Unemployed"-enter most recent occupation

Social Security Number

Was the decedent ever in the U.S. Armed Forces?

YesNoUnknown

Was the Decedent of Latino Origin?

Is the decedent Spanish/Hispanic/Latino?

YesNoUnknown

8. Decedent's Race

What is the decedent's Race or Ethnicity?

UnknownWhiteCambodianChineseVietnameseKoreanFilipinoHmongAsian IndianJapaneseLaotianOther AsianSamoanGuamanianNative HawaiianOther Pacific IslanderBlack or African AmericanAmerican Indian or Alaska NativeOther

(Select up to 3)

9. Decedent's Marital Information

What is the decedent's Marital Status?

Never MarriedMarriedDivorcedWidowedUnknown

10. Parent's Vital Information

Please enter the name and birth state of the Father of the decedent:

First Name

Middle Name

Last Name

State of Birth

Foreign Country of Birth If born outside the US

11. Disposition Information

Please select a final disposition:

BurialResidenceScatter at sea

Note: those seeking "Scattered at sea" must select "Residence" first and then "Scattered at sea."

Name of person(s) who will keep cremains at their residence

Street

City

State/Province

ZIP/Postcode

12. Physician's Information

First Name

Last Name

Street

City

State/Province

ZIP/Postcode

Telephone

13. Order Death Certificates

Select the number of death certificates you would like City Cremation to order from the San Francisco Country Health Department: Total Country Fees: $12 Each

14. Shipping

Where shall the ashes be shipped?

Recipient's First & Last Name AND/OR Institution Name

Street

City

State/Province