Ariz. Admin. Code § 4-12-204

Current through Register Vol. 30, No. 45, November 8, 2024

Section R4-12-204 - Application for a Funeral Establishment License or Interim Funeral Establishment Permit

A. An applicant for a funeral establishment license shall submit an application packet to the Board that contains the fee required by the Board, information required in A.R.S. § 32-1383, and an application form that contains:

1. The funeral establishment's current and previous name, if any;

2. The address of the physical location and telephone number of the funeral establishment;

3. The responsible funeral director's name and license number;

4. The name of the funeral establishment's current and previous owner;

5. Whether the funeral establishment is a proprietorship, a corporation, a partnership, a limited liability company, or a subsidiary of a corporation, a partnership, or a limited liability company;

6. If the previous owner was a corporation, the name of the corporation;

7. The name and address of each person owning 10 percent or more of the establishment or corporation common stock;

8. If a corporation, partnership, or limited liability company:

a. The state and date of incorporation or formation;

b. The name and address of the Arizona statutory agent or agent appointed to receive process; and

c. The name, address, and title of each officer, director, general partner, or member;

9. Whether the applicant has ever been convicted of or entered into a plea of no contest to a class 1 or 2 felony, including the information in subsections (A)(10)(a) through (A)(10)(f);

10. Whether the applicant, within five years from the date of the application, has been convicted of or entered into a plea of no contest to a felony or to a misdemeanor that is reasonably related to the applicant's proposed area of licensure including the:

a. Charged felony or misdemeanor;

b. Date of conviction;

c. Court having jurisdiction over the felony or misdemeanor;

d. Probation officer's name, address, and telephone number, if applicable;

e. A copy of the notice of expungement, if applicable; and

f. A copy of the notice of restoration of civil rights, if applicable;

11. Whether the applicant, within five years from the date of the application, has committed any act involving dishonesty, fraud, misrepresentation, breach of fiduciary duty, gross negligence, or incompetence reasonably related to the applicant's proposed area of licensure;

12. Whether the applicant is currently incarcerated or on community supervision after a period of imprisonment in a local, state, or federal penal institution or on criminal probation;

13. Whether the applicant, within five years from the date of the application, has had an application for a license, registration, certificate, or endorsement denied or rejected by any state funeral licensing authority including the:

a. Reason for the denial or rejection,

b. Date of the denial or rejection, and

c. Name and address of the agency that denied or rejected the application;

14. Whether the applicant has, within five years from the date of the application, had a license, registration, certificate, or endorsement suspended or revoked by any state funeral licensing authority including the:

a. Reason for the suspension or revocation,

b. Date of the suspension or revocation, and

c. Name and address of the state licensing authority that suspended or revoked the license;

15. Whether the applicant has ever surrendered a license, registration, certificate, or endorsement to the Board or any state funeral licensing authority;

16. A statement, signed by the responsible funeral director and notarized, affirming licensure in Arizona and confirming responsibility for the funeral establishment's compliance with Arizona state laws and rules; and

17. The applicant's signature.

B. An applicant for an interim funeral establishment permit shall submit an application packet to the Board that contains the information required in A.R.S. § 32-1388 and an application form that contains:

1. The funeral establishment's current and previous name, if any;

2. The address of the physical location and telephone number of the funeral establishment;

3. The name of the funeral establishment's current and previous owner;

4. The responsible funeral director's name and license number;

5. Whether the funeral establishment is a proprietorship, a corporation, a partnership, a limited liability company, or a subsidiary of a corporation, a partnership, or a limited liability company;

6. If the previous owner was a corporation, the name of the corporation;

7. The name and address of each person owning 10 percent or more of the establishment or corporation common stock;

8. If a corporation, partnership, or limited liability company:

a. The state and date of incorporation or formation;

b. The name and address of the Arizona statutory agent or agent appointed to receive process; and

c. The name, address, and title of each officer, director, general partner, or member;

9. The name of the previous licensed owner;

10. A statement, signed by the responsible funeral director and notarized, affirming licensure in Arizona and confirming responsibility for the funeral establishment's compliance with Arizona state laws and rules; and

11. The applicant's signature.

Ariz. Admin. Code § R4-12-204

Former Rule, Section 5, Article III; Former Section R4-12-28 amended and renumbered as Section R4-12-204 effective June 16, 1981 (Supp. 81-3). Former Section R4-12-204 repealed, new Section R4-12-204 adopted effective September 18, 1987 (Supp. 87-3). Section repealed; new Section adopted by final rulemaking at 7 A.A.R. 1441, effective March 14, 2001 (Supp. 01-1).