Islamic Cemetery of California

14273 Beckman Road, Lodi, CA 95240
Phone: +1 209 607 8915   |   Email: islamicCemetery14273@gmail.com

1. Deceased Information. Please have a Valid ID ready

Contract Number:
Name Of The Deceased:
Deceased Date of Birth:
Deceased Birth City:
Deceased Country of Birth:
Deceased Date of Death:
Deceased City of Death:
County Where Deceased Died:
State Where Deceased Died:
Funeral Home Hnadling the Burial:

2. Next of Kin. Please have a Valid ID ready

Name of Next of Kin:
Relationship to The Deceased:
Next of Kin Phone Number:
Next of Kin Address:
Next of Kin City:
Next of Kin State:
Next of Kin County:
Next of Kin Email:

3. Witnesses. Please have a Valid ID Ready

Witness 1 Name:
Witness 1 Address:
Witness 1 Phone:
Witness 2 Name:
Witness 2 Address:
Witness 2 Phone:

4. Headstone Details

Name As on Headstone:
Deceased Date of Birth:
Deceased City of Birth:
Deceased Country of Birth:
Deceased Date of Death:
Deceased City of Death:
Deceased State of Residence:
Deceased County of Death:
Headstone Contract Number:
Submission Date:
Manager Verification:

5. To be shown to Cememtery Manager Before Burial