Arranging a Direct Cremation

To begin disposition arrangements please complete and submit the following online form. If a deceased is in the care of a medical examiner, please also fill out the release form at the bottom.

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Education*
Marital Status*
At time of death
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*
Ever in the U.S. Armed Forces?*
- Yes
- No
- Unknown

Decedent's Residence*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
County of Residence
Years in County*

Informant's Name*
First Last
Relationship to Decedent*
Informant's Phone*
Informant's Email*
Informant's Address*
Street Address Address Line 2 City State ZIP Code
Did the decedent have a PreNeed Arrangement with Pacific Interment?*
- Yes
- No
The decedent verbally named me to control the disposition of his/her remains.
- Yes
- No
The decedent named me to control the disposition of his/her body in a will or other document..
- Yes
- No
I am the decedent or decedent's spouse, child, parent or nearest other relative.
- Yes
- No

Primary Care Physician*
Address of Primary Care Physician*
Street Address Address Line 2 City State ZIP Code
Phone of Primary Care Physician*
Fax Number of Primary Care Physician*
Was the place of death a hospital?*
- Yes
- No
Location Other Than Hospital
- Home
- Nursing Home
- Hospice
- Other
County of Death*
Are the remains in the possession of a Coroner/Medical Examiner?*
- Yes
- No
Facility Name
Address of Remains
Street Address Address Line 2 City State ZIP Code
Does the decedent have a surgically implanted device such as a pacemaker, chemo pump, or prosthetic device?
- Yes
- No
Disposition Arrangements
Do you wish for the remains to be embalmed before cremation?*
- No
- Yes
Disposition of Cremated Remains
- Sea Scattering
- Return to Family
Cremains to be received by?
First Last
Address for Cremains
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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City Cremation

License: FD-1824

3101 17th Street
San Francisco
CA 94110

F: (415) 252-1582