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Pre-Arrange Online

Name:

Name at Birth:

Gender:

Date of Birth:

Social Security Number:

Occupation:

Type of Business/Industry:

Residence Address:

City:

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Birthplace:

Marital Status:

Surviving Spouse (Maiden Name):

Ancestry:

Race:

Hispanic Origin:

U.S. Armed Forces Member:

Highest Education:

Father's Name:

Mother's Name

Informant's Name:

Relationship:

Informant Address:

City:

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Home Phone:

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Email

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661-404-5612

Rubio's Funeral Home

1100 Chester Avenue

Bakersfield, CA 93301

Fax: 661-404-5613

Email: ristorubio2@gmail.com

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