Burial Form - Islamic Cemetery of California (LODI)

Please call Cemetery Manager at +1 209 607 8915 for the Contract Number.

Contract Number:

Deceased Name:

Date of Birth:

City of Birth:

State of Birth:

Country of Birth:

Date of Death:

City of Death:

County of Death:

State of Death:

Next of Kin:

Next of Kin Email:

Next of Kin Phone:

Relationship to Deceased:

Funeral Home Used:

Burial Section: