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 num- ber of the funeral establishment;

3.        The responsible funeral director’s name and license num- ber;

4.        The name of the funeral establishment’s current and pre- vious 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 misde- meanor;

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 dishon- esty, 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, regis- tration, 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, reg- istration, 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 con- firming 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 num- ber of the funeral establishment;

3.        The name of the funeral establishment’s current and pre- vious owner;

4.        The responsible funeral director’s name and license num- ber;

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 con- firming responsibility for the funeral establishment’s compliance with Arizona state laws and rules; and

11.     The applicant’s signature.

Historical Note

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).