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Vital Statistical Information

When a death occurs it is the funeral homes responsibility to complete a death certificate and file that with the county health department prior to any disposition taking place (burial, cremation, out of state transportation). Along with the medical information that the doctor or coroners will complete, the information in this downloadable form is also required. To assist us in completing the death certificate this information can certainly be filled out ahead of time and faxed or mailed back to us.

« Download the Form »


Please fill out the form and then fax or mail it back to us:

Fax: (909) 623-3950

Mailing Address: Todd Memorial Chapel, 570 North Garey Avenue, Pomona, California 91767



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