Pre-Need Intake — Direct Cremation LA

Thank you — your intake has been received.

A member of our team will review your file and follow up if anything is unclear.

If you need anything in the meantime, please call (213) 818-7115 or email care@directcremationla.com.

Section 01

Identity

As it appears on a government-issued ID. We use this for the death certificate when the time comes.

First name *

Middle name

Last name *

Suffix

Maiden name / also known as

Sex *

Date of birth *

Social Security Number *

City of birth *

State / country of birth *

Race (California requires this)

Hispanic / Latino origin

Highest level of education completed

Section 02

Marital status

If you have been widowed or divorced, list your most recent spouse's name.

Marital status *

Spouse's full name (if applicable)

Spouse's maiden name (if applicable)

Section 03

Occupation

Your usual occupation over your working life — not your most recent role if you've retired. "Retired" alone is not accepted on the certificate.

Usual occupation

A single occupation. Avoid lists.

Kind of business or industry

Years in this occupation

Section 04

U.S. military service

Veterans may be eligible for a flag, military honors, and VA burial benefits at no charge. We help coordinate these.

Served in the U.S. Armed Forces?

Branch (if yes)

Service start year

Service end year

Section 05

Usual residence

Where you currently live. If you live in a long-term care facility, list that here.

Street address *

City *

County *

ZIP *

State *

Years lived in this county

Living in a long-term care facility?

Facility name (if yes)

Section 06

Parents

Required on the death certificate. If unknown, write "unknown."

Father's first name *

Father's last name *

Father's state / country of birth

Mother's first name *

Mother's maiden name *

Last name at birth.

Mother's state / country of birth

Section 07

Informant and next of kin

The informant is the person we'll work with when the time comes — usually the closest family member.

Informant's full name *

Relationship to you *

Informant's phone *

Informant's email

Informant's mailing address

Backup contact name

Relationship

Phone

Section 08

Plan confirmation

Confirm or update your wishes from your original pre-need agreement.

Disposition

What should happen to the ashes?

Updates or special instructions since your original agreement

Your information is sent securely to our care team. We'll review your file and contact you only if something needs clarification.

Complete your file at your own pace.

Thank you — your intake has been received.

Identity

Marital status

Occupation

U.S. military service

Usual residence

Parents

Informant and next of kin

Plan confirmation