DECEDENT'S FIRST NAME MIDDLE LAST

AKA: FIRST, MIDDLE, LAST DATE OF BIRTH AGE SEX

BIRTH STATE (COUNTRY, IF NOT US) SOCIAL SECURITY NUMBER VETERAN? Y/N MARITAL STATUS (C rrent)

DATE OF DEATH HIGHEST LEVEL OF EDUCATION HISPANIC DESCENT? Y/N DECEDENT'S RACE

USUAL OCCUPATION KIND OF BUSINESS/INDUSTRY YRS IN OCCUPATION

DECEDENT’S ADDRESS, CITY, STATE, ZIP CODE

NEXT OF KIN/ INFORMANT'S FULL NAME NEXT OF KIN RELATIONSHIP

NEXT OF KIN'S ADDRESS

SURVIVING SPOUSE'S FULL NAME (FIRST, MIDDLE, LAST (BIRTH/MAIDEN LAST NAME, IF FEMALE)

FATHER'S FIRST NAME FATHER'S MIDDLE NAME FATHER'S LAST NAME BIRTHPLACE (State Only, Co ntry i Not US)

MOTHER'S FIRST NAME MOTHER'S MOTHER'S MAIDEN NAME (AT BIRTH) State Only, Co ntry i Not US)

PLACE OF DISPOSITION: NAME, ADDRESS, CITY, STATE, ZIP ( FINAL RESTING PLACE, EXAMPLE: RESIDENCE, NAME OF CEMETERY, OR COUNTY OF SEA SCATTERING)

I HEREBY ALLOW THE OMEGA SOCIETY TO PLACE THE ABOVE INFORMATION ON THE DEATH CERTIFICATE

DATE

PRIMARY TELEPHONE ALTERNATE PHONE EMAIL ADDRESS

COUNTY YRS IN COUNTY

OF LIVING CHILDREN

S

S

THE OMEGA SOCIETY

** for whom arrangements are being madeS

SS S S S S

PRIMARY TELEPHONE ALTERNATE PHONE EMAIL ADDRESS

S S

1

AUTHORIZATION TO CREMATE

AUTHORIZATION TO RELEASE This is my authorization to release the remains of:

SIGNATURE Date(To be signed by authorized next of kin, or self signed)

RelationshipPrint Name

SIGNATURE Date(To be signed by authorized next of kin, or self signed)

RelationshipPrint Name

The undersigned hereby requests and authorizes THE OMEGA SOCIETY® or it’s assigns, in accordance with and subject to it’s rules and regulations, to cremate the remains of:

(Please print the full name of the person for whom arrangements are being made.)

and certifies and represents that he or she has the right to make such authorization and agrees to hold THE OMEGA

SOCIETY® and it’s assigns, harmless from any liability on account of said authorization and cremation. THE OMEGA SOCIETY® disclaims all responsibility for rings, jewelry, gold or other valuables left on or with the deceased.

Disposition Permit To Read As Follows

SCATTER AT SEA:

RETURN TO FAMILY: (for Special Disposition as provided in Health and Safety Code)

CEMETERY INURNMENT: Complete Cemetery Name:

If at Sea, By Family: To be scattered off the coast of

Return to whom:

Cemetery Address (Street):City

County

Unwitnessed Sea(by Omega, no family present)

Private Sea Charter(by Omega, family to witness)

At Sea, by Family(Family to scatter themselves)

To be picked up Omega to ship (additional charge) Phone:

State County ZipPhone:

To be picked up Omega to ship (additional charge)

I certify the deceased does does not have a pacemaker or other battery operated implant.

CHARGES: I understand that I am to pay THE OMEGA SOCIETY® all current charges in full at time services are contracted, unless account is prepaid.

(Please print the full name of the person for whom arrangements are being made.)

to THE OMEGA SOCIETY®1577 North Main St., Orange, CA 92867

Phone: 714-754-7781 FAX: 714-754-7103

2

WORKSHEET FOR EDUCATION AND RACE/ETHNICITY

DECEDENTS EDUCATION-Check the box that best describes the highest degree or level of school completed at the time of death.

Enter appropriate information in box No. 13

0-11th grade. Enter highestyear completed:

12th grade, but no diploma.Enter 12 ND

High school graduate or GED completed. Enter HS GRADUATE

Some college credit, but no degree. Enter SOME COLLEGE

Associate degree (e.g., AA, AS). Enter ASSOCIATE

Bachelor’s degree (e.g., BA, AB, BS). Enter BACHELOR’S

Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA). Enter MASTER’S

Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD) Enter either DOCTORATE orPROFESSIONAL:

WAS DECEDENT HISPANIC/ LATINO(A)/SPANISH/?

If not Hispanic/Latino(a)/Spanish, check “No” in box No. 14/15.

If Hispanic/Latino(a)/Spanish, check “Yes” in box No. 14/15 and enter specific origin.

No

Yes, Mexican, Mexican American, or Chicano

Yes, Central American

Yes, South American

Yes, Cuban

Yes, Puerto Rican

Yes, other Hispanic/Latino(a)/Spanish

Specify:

WHAT WAS DECEDENT’S RACE OR ETHNICITY? (Check one or more races to indicate what the decedent considered himself or herself to be)

Enter text for up to 3 races in box No. 16

White

Black or African American

American Indian or Alaska Native (North, South, and Central American Indian) Specify Tribe(s):

Native Hawaiian

Guamanian

Samoan

Other Pacific IslanderSpecify:

Asian Indian

Cambodian

Chinese

Filipino

Hmong

Japanese

Korean

Laotian

Thai

Vietnamese

Other AsianSpecify:

OtherSpecify:

PRIVACY NOTIFICATION

Civil Code Section 1798.9 et seq. requires each state agency to provide notice to Individuals completing this form. The information is being requested by: DEPARTMENT OF HEALTH SERVICES, OFFICE OF VITAL RECORDS, MS 5103, P.O. Box 997410, Sacramento, CA 95899-7410. The information requested on this certificate is authorized and required by Divisions 7 and 102 of the Health and Safety Code, and related provisions within the Civil Code, Code of Civil Procedure, and Government Code.

The principal purpose for this record is:

1. To establish a permanent record that is legally recognized as prima facie evidence of the facts therein for each death occurring in the State ofCalifornia.

2. To provide information, to health authorities and other qualified persons with a valid education or scientific interest, for demographic and epidemiologicalstudies for health and social purposes.

3. To provide information to the National Center for Health Statistics for compiling national statistical reports, and to state and federal agencies for fileclearance purposes.

4. To provide individuals with certified copies from the records to serve their personal needs, such as applying for social security or death benefits.

The record shall be open for examination during regularly scheduled office hours, except when access is specifically prohibited by statute or regulations.

LEGAL REQUIREMENTS FOR FILING CERTIFICATE OF DEATH

Each death shall be registered with the local registrar of births and deaths within eight calender days after death and prior to any disposition of the human remains.

The medical and health section data and the time of death shall be completed and attested to by the physician last in attendance, or his/her designee, provided such physician is legally authorized to certify and attest to these facts, or by the coroner in those cases in which he is required to complete the medical and health section data and certify and attest to these facts.

The medical and health section data and the physician or coroner’s certification shall be completed by the physician within 15 hours after the death, or by the coroner within three days after examination of the body.

3

Disclosure of Preneed Funeral Agreement

The funeral establishment, ____________________________________________________________, (funeral establishment name)

license number FD________, DOES ____, DOES NOT ____ (check one) have a preneed arrangement, as

defined below, made by or on behalf of ____________________________________________________. ( ame of ecedent)

If the funeral establishment does have a preneed agreement, complete the following:

In compliance with Business and Professions Code Section 7745, the funeral establishment has presented to the person named below a copy of any preneed agreement which has been signed and paid for in full, or in part by, or on behalf of the deceased and is in the possession of the funeral establishment.

____________________________________________ ______________________________ Signature of funeral establishment representative Date

“Preneed arrangement,” "preneed agreement” or “preneed” is written instruction regarding goods or services or both goods and services for final disposition of human remains when the goods or services are not provided until the time of death, and may be either unfunded or paid for in advance of need.

Funeral Establishment’s Responsibility – Business and Professions Code Section 7745 requires a funeral establishment to present to the survivor of the decedent or the responsible party a copy of any preneed agreement in its possession which has been signed and paid for in full, or in part by, or on behalf of the deceased. Business and Professions Code Section 7685.6 requires a copy of any preneed arrangements to be disclosed prior to drafting any contract for funeral goods or services. The funeral establishment may present the copy in person, by certified mail, or by facsimile transmission, as agreed upon by the person with the right to control disposition. A funeral establishment that knowingly fails to present a preneed agreement as required is liable for a civil fine equal to three times the cost of the preneed agreement, or one thousand dollars ($1,000), whichever is greater.

You may contact the Cemetery and Funeral Bureau for more information on funeral, cemetery or cremation matters or to file a complaint against a licensee:

Cemetery and Funeral Bureau 1625 North Market Blvd., Suite S-208 Sacramento, CA 95834 916-574-7870

____________________________________________ ______________________________Signature of the survivor or responsible party Date

____________________________________________ Print name of the survivor or responsible party

____________________________________________ ______________________________Signature of funeral establishment representative Date

____________________________________________ ______________________________Print name of funeral establishment representative Title The funeral establishment must:

• Give a copy of the completed statement to the survivor or responsible party.• Retain the original or a copy of the completed disclosure statement on file for not less than one (1) year

after the preneed account has been audited by the Bureau or seven (7) years from the date thedisclosure statement was made, whichever comes first.

21F1 (10/03)

3

AUTHORIZATION TO ACCEPT O DECLINE EMBALMING

TO: THE OMEGA SOCIETY®

RE:

I,

I understand that for storage or embalming purposes the decedent may be transported to the following location:

Signed:

Executed this day of ,

, Relationship to Decedent:

.

, Relationship to decedent: , who did did not (check one) authorize embalming at the above named funeral establishment. Phone ( ) Date and time authorization granted:

i ection i to e co eted t e ne a e ta i ent e e entati e o i e ec tin t i a t o i ation to acce t o dec ine e a in dec a e nde ena t o e t at t e o e oin i t e and co ect

Executed this day of , , at .

ne a ta i ent e e entati e int na e

(Authorized Next of Kin)

OMEGA SOCIETY®

1577 NORTH MAIN STREET

ORANGE, CA 92867

do do not c ec one e e t e a in

(Decedent’s Name)

a in i t e addition to o t e e ace ent o od id c e ica e e ati e o t e a ication o c e ica e e ati e o t e te o a e e ation o t e odI

( nt ) ( ea )at

( t and tate)

ne a ta i ent e e entati e i nat e

( nt ) ( ea ) ( t and tate)

Janet de Michaelis

The undersigned hereby represents that he/she has the legal right to control disposition of the remains of the decedent.

S Si ection i to e co eted t e ne a e ta i ent i a t o i ation to acce t o dec ine e a in i

o tained o a

The above statement was read and o o ided to:

4

DECLARATION FOR DISPOSITION OF CREMATED REMAINS

for whom arrangements are being made

(Final Destination of Cremated Remains)

Signed Date

Signed Date

Signed Date

Signed Date

Signed Date

Signed Date

IMPORTANT: Business and Professions Code § 7685.2(b) requires Funeral Establishments to complete this form, provided by the Cemetery and Funeral Bureau, when making arrangements for cremation. Failure to complete this form may result in disciplinary action by the Bureau. This declaration does not replace the written authorization to cremate required by Health and Safety Code Sections 7110 and 7111.

NOTICE REGARDING CREMATED REMAINS

in

5

user20Typewriter

http:www.cfb.ca.gov

THE OMEGA SOCIETY®1577 North Main St., Orange, CA 92867

(714) 754-7781

Authorization for Cremation and Disposition of Human Remains

[Note This is an important legal document which you should read carefully before signing.]If you have any questions please ask your Funeral Counselor and or,“For more information on Funeral, Cemetery, and Cremation matters, contact:

Department of Consumer Affairs Cemetery and Funeral Bureau 1625 North Market Blvd. Suite S-208 Sacramento, CA 95834(916) 574-7870”

The Cremation Process is performed according to California Law. There can be no Allowance for ethnic or religious variation. Subject to the rules and regulations of the Crematory and any applicable Federal, State, Local Laws, or Ordinances the undersigned hereby certifies, warrants and represents that I/We have the full legal right and authority to authorize and do hereby authorize the Crematory (hereafter the “Crematory”) to perform the cremation of the remains of;

Casket/Containers: The Crematory requires either a casket or alternative cremation container. All caskets and alternative containers must meet the following standards: 1) be composed of combustible materials suitable for cremation; 2) be able to be closed to provide a complete covering for human remains; 3) be resistant to leakage or spillage; 4) be sufficient for handling with ease; and 5) be able to provide protection for health and Safety of Crematory personal. The Crematory is authorized to inspect the casket or alternative container, including opening it if necessary. In the event there is leakage or damage, the Crematory may contact the Funeral Home directly for instructions. Metal, Plastic, Fiberglass Caskets or Cremation Containers will not be allowed to be cremated. The Crematory is authorized to remove and dispose of handles, ornaments and any other non-combustible items attached to the cremation container prior to cremation. I/We further authorize the Crematory to make disposition of any non-combustible items in any lawful manner it deems appropriate. These may include, but not limited to hinge, handles, latches, etc. In the event the urn or other container is insufficient to accommodate all of the cremated remains, the excess will be placed in a separate receptacle (plastic urn)at no charge. The receptacle (plastic urn) will be kept with the primary receptacle and handled according to the disposition instructions on this form.

Pacemakers, Prostheses, and Radioactive Devices: Pacemakers and prostheses, as well as any mechanical or radioactive devices or implants in the decedent, may create a hazardous condition when placed in the cremation chamber. It is imperative that such items be removed prior to cremation. If the Crematory is not notified of these devices and implants, and not instructed to remove them, then the person(s) authorizing the cremation will be held responsible for any damages caused to the Crematory personnel or equipment by such devices or implants. By initialing this paragraph, I/We give permission to the, Crematory, Funeral Home, or staff to remove the surgical hardware as referenced above prior to cremation. The Funeral Home and or the Crematory are authorized to dispose of the devise(s) as deem appropriate.

Approximate Weight

(Hereafter The “deceased/Decedent”), and to arrange final disposition of the cremated remains as follows;[Decedent s Usual Address]

[FIRST NAME] [MIDDLE NAME] [LAST NAME]

Place of Final Disposition (Final Destination of the Cremains)

I REQUEST C (I ITIA ne nl )YES O

Funeral Home handling the arrangements:(Hereafter the Funeral Home)

THE OMEGA SOCIETY®

Casket or Cremation Container Selected /Urn SelectedALTERNATIVE CONTAINER PLASTIC UTILITY

(check one) INITIAL

If YES ele t whi h O E o refer(ADDITIONAL CHARGE F R AC )

OTH ID iewing A itnessing

ID Viewing O

O

6

Initial _______itnessed Cremation (insertion into the cremation chamber)

PACEMAKER: YES NO

The Cremation Process:

Authorizing Agent: An Authorizing Agent is the person(s) having the right to control the disposition of the Decedent pursuant to Health and Safety Code Sec.7100.1.)Decedent, 2) An agent under power of attorney for Health care, 3) Spouse or Registered Domestic Partner. 4)Adult Children, 5) Parents, 6) Other surviving competent adult Kin. By signing this Authorization for Cremation and Disposition, I/Weacknowledge and agree that I/We have read and understood every part of this authorization, including the fact that the process of cremationis irreversible, and I/We nevertheless desire that the Deceased’s remains be cremated in accordance with this authorization. I/We agree toindemnity, release and hold the Crematory, The Funeral Home, Their affiliates, Employees and assigns, harmless from any and all losses,damages, cost or expense, resulting from the Funeral Home’s and Crematory’s reliance on or performance consistent with directions,declaration, representation, authorization and agreements herein, including, but not limited to, any delay in, or damage arising from thetransportation of the human remains or cremated remains of the Decedent, and liability or causes of action in connection with the cremationand disposition of the cremated remains as authorized herein. I/We warrant that all representations and statements made herein are true andcorrect. I/We have either identified or waived my/our rights of identification of the Decedent that were delivered to the Funeral Home as theDecedent and I/We have authorized the Funeral Home to deliver the Decedent to the Crematory.

The Human body burns with the casket, container, or other materials in the cremation chamber. Some bone fragments are not combustible at the incineration temperature and, as a result, remain in the cremation chamber. During the cremation, the contents of the chamber may be moved to facilitate incineration. The chamber is composed of ceramic or other material which disintegrates slightly during each cremation and the product of that disintegration is commingled with the cremated remains. Nearly all of the contents of the cremation chamber, consisting of the cremated remains disintegrated chamber material, and small amounts of residue from previous cremations, are removed together and crushed, pulverized, or ground to facilitate inurnment. Some residue remains in the cracks in uneven places of the chamber. Periodically, the accumulation of this residue is removed and inturred in a dedicated cemetery property or scattered at sea in accordance with State Laws. The acknowledgment shall be filed and retained, for at least five years, by the person who disposes of the remains. Due to the nature of the cremation process, any personal possessions or valuable materials such as dental gold and silver, or jewelry (as well as any body prostheses or dental bridgework) that are left with the Decedent and are not removed from the casket or cremation container prior to cremation may be destroyed and become non-recoverable, or if not destroyed, they will be handled by the Crematory in accordance with the instructions on the instructions on the authorization. If you desire to save such items, the Authorizing Agent must make arrangements to remove any such possessions or valuables prior to cremation. After the cremated remains are removed from the cremation chamber, all non-combustible materials (insofar as possible), such as dental bridgework, body prosthesis, and materials from the casket or containers such as hinges, latches, etc., will be separated and removed from the human bone fragments by visible or magnetic selection. Unless specifically requested to return such items in writing, the Crematory is authorized to dispose of these materials with similar materials from other cremations in a non-recoverable manner, so that only the human bone fragments will remain. There may be small non-combustible material the operator may not visibly see and be placed into the urn with the human bone fragments. When the cremated remains are removed from the cremation chamber, the skeletal remains often contain recognizable bone fragment. After the bone fragments have been separated from the other material, they will be mechanically processed (pulverized), which includes crushing particles unrecognizable as human remains, prior to placement into the designated container.INITIAL

DISPOSITION OF CREMATED REMAINSI/We authorize the Crematory to release the cremated remains of the Decedent to the possession and custody of the Funeral Home. I/We understand that the services and obligation of the Crematory shall be fulfilled when the cremated remains of the Decedent are released to the possession and custody of the Funeral Home. I understand that in the event the cremated remains have not been permanently interred or picked up by me or my designated representative within 20 days from the date of cremation, The Funeral Home is authorized to lawfully dispose of the unclaimed cremated remains pursuant to statutes. I/We hereby authorize the Funeral Home to arrange for the disposition of the cremated remains of the Decedent.

INITIAL RELEASE TO: THE OMEGA SOCIETY®

Printed Name:

Relationship:

Phone #:

Executed at on the day of, ,City and State Day Month Year

SIGNATURE(To be signed by authorized next of kin, or self signed)

7

Do the cremains need to be back OR at a location by a certain date?If so, by what date:

Are the cremains to be picked up?By whom:

Are the remains to be shipped?Ship to:

Does the decedent weigh 250 lbs. or more?

A certified copy of a death certificate is needed for any type of transfer of an asset where asurvivor is receiving title or money. For example: bank accounts, brokerage accounts, stocks, bonds, CD’s,Life Insurance policies, pension funds, IRAs, real estate, DMV and Social Security (for spouse and minor children only).

Death Certificates arrive by mail in 2-3 weeks (OC), up to 4 weeks (other counties), mailed directly from the County Health Department (not from the Omega Society office) How many Certified Death Certificates would you like us to order?

Mail DC’s to:

NOTE: Once death certificates have been ordered, additional certified copies should be ordered directly from the Health Department in the County where the death occurred. To prevent identity theft, death certiifcates may onlybe ordered by certain authorized persons. They include parent or legal guardian, child, grandparent, grandchild, sibling, spouse, domestic partner, or Durable Power of Attorney for Financial (without limitations). Orders may be made in person at the County Health Department upon presentation of a valid ID and Signature of a sworn statement attesting to your re-lationship. Or, orders may be made by mail by completing the appropriate Health Department’s specific form and having it notarized by signing it before a sworn notary. Contact the local Health Department where the death occurred for further

YES NO

YES NO

YES NO

Phone:

(photo ID required. Put N/A if not applicable)

(Address)

(Add $95 shipping

(Name)

Phone:

YES NO(Additional charges for weight of 250 lbs. or more. Weight will be verified.)

(Name)(Address)

(Add $21 for each certified copy)

(day of week) (month) (day) (year), , ,

OMEGA SOCIETY® ADDITIONAL INFORMATION

instructions . italc e .co /deat certi icatesI have read & understand the above: Date:

YES NO

YES NO

YES NO

SSS S

S

YES NO

1. OBITUARIESThe OC Register no longer provides free obituaries. If you would like to place a paid obituary in The Register, please call them directly at 714-796-4973. You will be billed directly by the Register on a per line basis. Omega Society families receive preferred pricing.

5. DEATH CERTIFICATES

within CA be ond CA mega o iet ass mes no res onsibilit on e in ossession of )

8

4 PACEMAKERDoes the decedent have a pacemaker? YES NO ($75 addtional to remove)

Registration Application2017 FULL BODY BURIAL 5UntitledUntitled

DECEDENT LEGAL NAME FIRST NAME: MIDDLE: LAST: AKA FIRST MIDDLE LAST: DATE OF BIRTH: AGE: SEX: BIRTH STATE COUNTRY IF NOT US: SOCIAL SECURITY NUMBER: VETERAN: [ ]MARITAL STATUS: [ ]DATEOF DEATH: HIGHEST LEVEL OF EDUCATION: HISPANIC DESCENT: [ ]DECEDENTS RACE: USUAL OCCUPATION One Only RetiredDisabled not accepted: KIND OF BUSINESSINDUSTRY: YRS IN OCCUPATION: OF LIVING CHILDREN: DECEDENTS ADDRESS CITY STATE ZIP CODE: COUNTY: YRS IN COUNTY: NEXT OF KIN INFORMANTS FULL NAME: NEXT OF KIN RELATIONSHIP: NEXT OF KINS ADDRESS CITY ZIP CODE: FULL NAME OF SURVIVING SPOUSE FIRST MIDDLE LAST BIRTHMAIDEN LAST NAME IF FEMALE: FATHERS FIRST NAME: FATHERS MIDDLE NAME: FATHERS LAST NAME: BIRTHPLACE State Only Country if Not US: MOTHERSFIRSTNAME: MOTHERS MIDDLE NAME: MOTHERS MAIDEN NAME AT BIRTH: BIRTHPLACE StateOnly Country if Not US: PLACEOFDISPOSITIONNAME ADDRESSCITY STATE ZIP FINAL RESTING PLACE EXAMPLE RESIDENCE NAME OF CEMETERY OR COUNTY OF SEA SCATTERING: DATE: PRINT NAME: RELATIONSHIP: PRIMARY TELEPHONE: ALTERNATE PHONE: EMAIL ADDRESS: SECOND NEXT OF KIN: SECOND NEXT OF KIN RELATIONSHIP: SEOND NEXT OF KIN PHONE: SECOND NEXT OF KIN ALT: PHONE:

SECOND NEXT OF KIN EMAIL ADDRESS: Date of Death: Location of Decedent: Dec_Full: Sea_Type: Scatter_County: Dispo: Return_who: PU_Ship: Return_Phone: Cem_Name: Cem_Street: Cem_Phone: Cem_City: Cem_State: Cem_County: Cem_Zip: Pacemaker: Signature_Date: Signer_Name: Signer_Relation: Fun_Home: The Omega Society ®FD_Num: 1280Astric: Preneed: Text89: Janet de MichaelisFun_Rep_Title: PresidentDOES = Pre-Registered or Pre-Paid: DOES NOT = NOT Pre-Registered nor Pre-Paid: Embalm: Name of Funeral Establishment and Telephone Number: The Omega Society ® (714) 754-7781Name of Crematory and Telephone Number: The Omega Society ® (714) 754-7781Manner, Location and Other Details of Disposition: Manner, Location and Other Details of Disposition line 2 of 4: Manner, Location and other details of Disposition line 3 of 4: Manner, Location and other details of Disposition line 4 of 4: Name of persons with the legal right to control disposition line 1 of 3: Name of persons with the legal right to control disposition line 2 of 3: Name of persons with the legal right to control disposition line 3 of 3: Date of First Signature of Person(s) with legal right to control disposition: Date of Second Signature of Person(s) with legal right to control disposition: Date of Third Signature of Person(s) with legal right to control disposition: Name of persons contracting for cremation services line 1 of 2: Name of persons contracting for cremation services line 2 of 2: Janet_Sig: License number if a Funeral Director: 486Dec_First: Dec_Middle: Dec_Last: Decedents_addy: Final_Dispo: Viewing_y_n: View_Type: Executed_City: Executed_State: Executed_Day: Executed_Month: Executed_Year: Signer_Phone: Return_Date: Need_Back_Day_Week: Need_Back_Month: Need_Back_Day: Need_Back_Year: Pickup: PU_Phone: PU_By: Ship: Ship_Name: Ship_Addy1: Ship_Addy2: Ship_Phone: View or Witness: Weight: Approx_Weight: Num_Certified_A: DC_Name: DC_Addy1: DC_Addy2: Private Charter: Sea Unwitnessed: Full Service: Race_white: OffRace_black: Off0-11th_Choices: [0]Race_indian: OffEducation: OffBox14/15: OffIndian_Specify: Race_hawaiian: OffRace_Guamanian: OffRace_Samoan: OffRace_PI: OffPI_Specify: Race_Asian_Indian: OffRace_Cambodian: OffRace_Chinese: Off14/15_Specify: Race_Filipino: OffRace: OffRace_Japanese: OffRace_Korean: OffRace_Laotian: OffRace_Thai: OffRace_Vietnamese: OffDoc/Prof: [Doctorate]Race_Other_Asian: OffAsian_Specify: Race_Other: OffOther_Specify: Pacemaker Additonal Info: Choice4