Immediate Need

Name: Angeleno Mortuary
Address: 5948 Van Nuys Blvd, Van Nuys, CA, 91401
Telephone: 818-778-1788

You can get a head start on the process by completing as much of this online form as possible. We recognize you may not know everything right at this moment, but what you do know will be invaluable to your Funeral Director. Submitting this form will surely expedite the funeral arrangement process.

Should you have any questions, please contact us at the funeral home.

Deceased Name:

Maiden Name:

Known As Name:

Date of Birth:

Age:

Gender:

Birth State/Foreign Country:

Social Security Number:

Ever in U.S. Armed Forces?

Marital Status:

Date of Death:

Place of Death:

Place of Death Address:

City:

State:

ZipCode:

Phone:

Highest Level of Education Completed:

Race:

Hispanic Origin:

Occupation:

Type of Business/Industry:

Years in Occupation

Residence Address:

City:

State:

ZipCode:

County:

Years in County:

Foreign Country

Informant's Name:

Informant Address:

City:

State:

ZipCode:

Informant Relationship:

Informant Phone:

Informant Email:

Surviving Spouse Name:

Father's Name:

Father's Birth State:

Mother's Name

Mother's Birth State:

Call Now

Angeleno Mortuary

818-778-1788

5948 Van Nuys Blvd.

Van Nuys, CA 91401

Fax: 818-786-4552

r.medina@angelenomortuary.com

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Immediate Need

Angeleno Mortuary

818-778-1788

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