Forms

As added convenience for our families, we have made the following required forms available to complete online. Once completed, please print and sign them; then either email, fax, or mail them directly to Douglass & Zook. If you would prefer to hand deliver them, you could bring them with you when coming into Douglass & Zook for an appointment with a Counselor.

Please note that the person with the legal authority to complete these forms and control the disposition of the person who has passed away is determined based on the following order of priority:

 

  1. An agent under a Power of Attorney for Healthcare
  2. Surviving spouse
  3. Adult child, if only child; or majority of adult children if more than one
  4. Parent(s)
  5. Adult sibling, if only one sibling; or majority of adult siblings if more than one
  6. Adult person or persons respectively in the next degree of kinship
  7. Conservator of the person appointed under Probate Code
  8. Conservator of the estate appointed under Probate Code
  9. Public Administrator

Authorization for Release of Remains

The person with the right to control disposition must complete this form in order for Douglass & Zook to transfer your loved one into our care.

LA Coroners Release Form

The County of Los Angeles requires that those with the right to control disposition of the remains sign an Order for Release Form. This allows the remains of the decedent to be released from the coroner to the chosen mortuary. To complete the form, the mortuary needs information on the decedent including health diagnosis and history, and details of death.

San Bernardino County Release Forms

The County of San Bernardino requires that those with the right to control disposition of the remains sign an Order for Release Form. This allows the remains of the decedent to be released from the coroner to the chosen mortuary. To complete the form, the mortuary needs information on the decedent including health diagnosis and history, and details of death.

Riverside County Release Form

Riverside County requires that this form is completed and signed in order to release your loved one to Douglass & Zook from the Sheriff-Coroner. Please complete both pages. The first page will permit Douglass & Zook to pick up and transfer your loved one into our care and the second page will release their personal property that will also be brought back to our mortuary.

Declaration of Disposition of Cremated Remains

This form fulfills a legal requirement for Douglass and Zook to state where the cremated remains in their care will go after the process is completed. The name of the decedent and who has the legal right to control disposition must be completed on this form.

CA Req for Death Certificate and Permit for Disposition

Douglass & Zook provides the highest standards of service in the San Gabriel Valley. However, we cannot proceed with an interment or cremation without a death certificate or permit for disposition. This form must be signed to release Douglass & Zook from all liabilities in the event that there is a delay.

Appointment Checklist

This list summarizes items that are needed to move forward with funeral arrangements. Included are the details required by the state in order to complete the Death Certificate.

Veteran Forms

Military Records Request Form

You may request military records from all United States military branches. This is available free of charge if your loved one served after 1957, or for a nominal fee if he or she served prior to 1957. To have the quickest response time, as many fields as possible should be filled out on page two, including all service dates and where to return the documents. Page three lists all address codes and addresses to mail this form once completed.

Application for Burial Benefits

Application for Burial Benefits from the Department of Veterans Affairs contains four sections that need to be completely filled out dependent upon if you will be claiming plot allowance only or burial and/or interment as well. Please be sure to provide all information on cause of death—service related or not—as well as all expenses allowance in order to receive financial reimbursement.

Application for Presidential Memorial Certificate

As a way to honor your Veteran’s memory, the Department of Veterans Affairs recognizes service in the United States military by preparing an engraved paper certificate that is signed by the current President. The next of kin may request this by filling out the request form and providing military documents.

Make an appointment
Give us a call today at (855) 852-9505 or (626) 358-3244