Arizona Administrative Code › Title 4 - PROFESSIONS AND OCCUPATIONS › Chapter 12 - Board of Funeral Directors and Embalmers › Article 2 - LICENSING PROVISIONS › Section R4-12-207 - Application for a Crematory License

Current through Register Vol. 30, No. 28, July 12, 2024
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 corporation, a partnership, a limited liability company, or a subsidiary of a
				corporation, a partnership, or a limited 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 director or cremationist and notarized, affirming licensure in Arizona
				and confirming responsibility for the crematory'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
				formation;
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
				felony, 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 applicant'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
				telephone number, if applicable;
v.
				A copy of the notice of expungement; if applicable; 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
				incompetence reasonably related to the applicant's proposed area of
				licensure;
k. 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;
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,
				registration, 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 authority 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;