Address: P.O. Box 339, Austell, GA, 30168, US
Telephone: (770) 732-6840

West Georgia Crematory
Post Office Box 339
Austell, Georgia 30168
770-732-6840
www.westgeorgiacrematory.com
Information for the Death Certificate
Full Name of the Deceased (w/Maiden)*
Deceased’s Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Live inside the city limits
Yes
No
Veteran
Yes
No
Deceased’s Race:
Father's Full Name
Mother's Full Name w/ Maiden
Place of Birth
Date of Birth
Date Format: DD slash MM slash YYYY
SS#
Occupation
(We cannot file a death certificate that says “Unemployed” or “Retired”)
Nature of Employment
Employer
Marital Status
Married
Widowed
Divorced
Never Married
Spouse's Full Name
How far did the deceased get in school?
Your full name, address, phone number, and relationship
Email to info@westgeorgiacrematory.com or fax to 770-739-1059.
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West Georgia Crematory Post Office Box 339 Austell, Georgia 30168 770-732-6840 www.westgeorgiacrematory.com