Section R4-12-207. Application for a Crematory License

An applicant for a crematory license shall submit an application packet to the Board that contains the fee required by the Board, information required in A.R.S. § 32-1395, and the following:

1.        An application form that contains:

a.         The name of the crematory;

b.        The address of the physical location and telephone number of the crematory;

c.         Whether the crematory is a proprietorship, a corpo- ration, a partnership, a limited liability company, or a subsidiary of a corporation, a partnership, or a lim- ited liability company;

d.        The name and license number of the responsible funeral director or cremationist;

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

f.         A statement, signed by the responsible funeral direc- tor or cremationist and notarized, affirming licensure in Arizona and confirming responsibility for the cre- matory’s compliance with Arizona state laws and rules;

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

i.         The state and date of incorporation or forma- tion;

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

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

h.        Whether the applicant has ever been convicted of or entered into a plea of no contest to a class 1 or 2 fel- ony, including the information in subsection (1)(i)(i) through (1)(i)(vi);

i.         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 appli- cant’s proposed area of licensure including the:

i.         Charged felony or misdemeanor;

ii.        Date of conviction;

iii.      Court having jurisdiction over the felony or misdemeanor;

iv.       Probation  officer’s  name,  address,  and  tele- phone number, if applicable;

v.        A copy of the notice of expungement; if appli- cable; and

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

j.         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 incom- petence reasonably related to the applicant’s pro- posed area of licensure;

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

l.         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:

i.         Reason for the denial or rejection,

ii.        Date of the denial or rejection, and

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

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

i.         Reason for the suspension or revocation,

ii.        Date of the suspension or revocation, and

iii.      Name and address of the state licensing author- ity that suspended or revoked the license;

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

o.        The applicant’s signature;

2.        A copy of a funeral establishment license or crematory authority certificate issued by the Arizona Department of Real Estate to a cemetery that operates a crematory.

Historical Note

Adopted effective January 2,1985 (Supp. &5-1). Amended by adding subsections (F) and (G) 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).