Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69K - Division of Funeral, Cemetery, and Consumer Services › Chapter 69K-1 - GENERAL APPLICATION AND LICENSURE REQUIREMENTS › Section 69K-1.001 - List of Approved Forms; Incorporation by Reference

Current through Reg. 50, No. 138; July 16, 2024
The following forms are hereby adopted and incorporated by
				  reference and can be obtained from the Department by writing to the Department
				  of Financial Services, Division of Funeral, Cemetery, and Consumer Services,
				  200 East Gaines Street, Tallahassee, Florida 32399-0361, by logging on to the
				  Department's website at
http://www.myfloridacfo.com/Division/funeralcemetery/
,
				  or by telephoning (850)413-3039:
(1)
				DFS-PNL-1, "Application for Preneed License," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09968
.
(2) DFS-HistS, "Historical Sketch," Rev.
				08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09966
.
(3) DFS-PNLB, "Application for Preneed Branch
				Office License," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09967
.
(4) DFS-PNLT1, "Application for Transfer of a
				Preneed License," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09965
.
(5) DFS-PNS-1, "Preneed Sales Agent
				Application for Agent License and Initial Appointment," Rev. 10-06.
(6) DFS-CEMN, "Application to Organize a New
				Cemetery Company," Rev. 10-06.
(7)
				DFS-F-32, "Financial Statement," Rev. 10-06.
(8) DFS-CEM, "Application to Transact
				Cemetery Business," Rev. 10-06.
(9)
				DFS-F-35, "Application for Authority to Acquire Control of an Existing Cemetery
				Company," Rev. 10-06.
(10)
				DFS-F-43, "Performance Bond," Rev. 10-06.
(11) DFS-C-3, "Surety Bond Claim Form," Rev.
				11/18.
http://www.flrules.org/Gateway/reference.asp?No=Ref-11117
(12) DFS-TFD-1, "Preneed Funeral Contract
				Consumer Protection Trust Fund Proof of Claim and Disbursement Request," Rev.
				10-06.
(13) DFS-N1-1702, "Cemetery
				Renewal," Eff. 10-06.
(14)
				DFS-N1-1703, "Exempt Cemetery Renewal," Eff. 10-06.
(15) DFS-N1-1704, "Change of Address or
				Contact Data - Individuals," Eff. 10-06.
(16) DFS-N1-1705, "Change of Address or
				Contact Data - Entities," Eff. 10-06.
(17) DFS-N1-1706, "Application for Embalmer
				License by Internship and Examination," Eff. 10-06.
(18) DFS-N1-1707, "Application for Embalmer
				License by Endorsement," Eff. 10-06.
(19) DFS-N1-1708, "Application for Embalmer
				Intern License," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09960
.
(20) DFS-N1-1709, "Other Licensing
				Examinations," Eff. 10-06.
(21)
				DFS-N1-1710, "Endorsement Licenses - Continued," Eff. 10-06.
(22) DFS-N1-1712, "Application to Re-Take
				Florida Law & Rules Exam," Eff. 10-06.
(23) DFS-N1-1713, "Miscellaneous
				Applications," Eff. 10-06.
(24)
				DFS-N1-1714, "Certification of High School Graduation," Eff. 10-06.
(25) DFS-N1-1715, "Adverse Licensing Action
				History Form," Eff. 10-06.
(26)
				DFS-N1-1716, "Criminal History Form," Eff. 10-06.
(27) DFS-N1-1717, "Other Licenses Form," Eff.
				10-06.
(28) DFS-N1-1718, "Business
				Entity - List of Principals," Eff. 10-06.
(29) DFS-N1-1719, "Mortuary Science Course
				Information Form," Eff. 10-06.
(30)
				DFS-N1-1720, "Application for Funeral Director License by Internship and
				Examination," Eff. 10-06.
(31)
				DFS-N1-1721, "Application for Funeral Director License by Endorsement," Eff.
				10-06.
(32) DFS-N1-1722,
				"Application for Funeral Director Intern License," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09964
.
(33) DFS-N1-1723, "Application for
				Combination Funeral Director & Embalmer License by Endorsement," Eff.
				10-06.
(34) DFS-N1-1724,
				"Application for Combination Funeral Director & Embalmer License by
				Internship & Exam," Eff. 10-06.
(35) DFS-N1-1725, "Application to Reactivate
				Inactive or Delinquent Embalmer License," Eff. 10-06.
(36) DFS-N1-1726, "Application to Reactivate
				an Inactive or Delinquent Funeral Director License," Eff. 10-06.
(37) DFS-N1-1727, "Application to Reactivate
				an Inactive or Delinquent Funeral Director/Embalmer License," Eff.
				10-06.
(38) DFS-N1-1728,
				"Application for Inactive Status," Eff. 10-06.
(39) DFS-N1-1729, "Purchase Order Brochure,"
				Eff. 10-06.
(40) DFS-N1-1730,
				"Trustee's Report, Preconstruction Trust Fund," Eff. 10-06.
(41) DFS-N1-1731, "Trustee's Report, Care
				& Maintenance Trust Fund," Eff. 10-06.
(42) DFS-N1-1732, "Application for Concurrent
				Funeral Director and Embalmer Intern License," Effective 02/23,
https://www.flrules.org/Gateway/reference.asp?No=Ref-15122
.
(43) DFS-N1-1734, "Notice of
				Termination/Change of Supervisor," Eff. 10-06.
(44) DFS-N1-1742, "Certification of Licensure
				in Good Standing," Rev. 10-06.
(45)
				DFS-N1-1743, "Change of Funeral Director/Direct Disposer in Charge," Rev.
				10-06.
(46) DFS-N1-1744,
				"Application for Direct Disposer License," Rev. 10-06.
(47) DFS-N1-1746, "Application for Retired
				Professionals," Eff. 10-06.
(48)
				DFS-N1-1747, "Supervisor's Quarterly Report of Apprentice or Intern Training,"
				Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09982
.
(49) DFS-N1-1748, "Application for Funeral
				Establishment License," Effective 02/23,
https://www.flrules.org/Gateway/reference.asp?No=Ref-15123
.
(50) DFS-N1-1749, "Registration as Training
				Agency," Rev. 08/12
http://www.flrules.org/Gateway/reference.asp?No=Ref-09981
.
(51) DFS-N1-1750, "Application for Cinerator
				Facility License," Rev. 10-06.
(52)
				DFS-N1-1751, "Funeral Establishment/Monthly Report of Cases Embalmed or Bodies
				Handled," Rev. 10-06.
(53)
				DFS-N1-1752, "Direct Disposal Establishment/Monthly Report of Cases Embalmed or
				Bodies Handled," Rev. 10-06.
(54)
				DFS-N1-1753, "Cinerator Facility/Monthly Report of Cases Embalmed or Bodies
				Handled," Rev. 10-06.
(55)
				DFS-N1-1754, "Centralized Embalming Facility/Monthly Report of Cases Embalmed
				or Bodies Handled," Rev. 10-06.
(56) DFS-N1-1756, "Application for
				Centralized Embalming Facility License," Effective 02/23
https://www.flrules.org/Gateway/reference.asp?No=Ref-15124
.
(57) DFS-N1-1757, "Application for Direct
				Disposal Establishment License," Effective 02/23
https://www.flrules.org/Gateway/reference.asp?No=Ref-15125
.
(58) DFS-N1-1758, "Application for
				Refrigeration Facility License," Rev. 10-06.
(59) DFS-N1-1759, "Application for Removal
				Service License," Rev. 10-06.
(60)
				DFS-N1-1760, "Application for Approved Continuing Education Provider Status,"
				Rev. 10-06.
(61) DFS-N1-1761,
				"Application for Continuing Education Course Approval," Rev. 10-06.
(62) DFS-N1-1762, "Monument Establishment
				Sales Agent Application for Agent License," Eff. 10-06.
(63) DFS-N1-1763, "Monument Sales Agent
				Renewal," Eff. 10-06.
(64)
				DFS-N1-1764, "Change of Name & Request for Revised License Certificate -
				Entities," Eff. 10-06.
(65)
				DFS-N1-1765, "Change of Name & Request for Revised License Certificate -
				Individuals," Eff. 10-06.
(66)
				DFS-N1-1766, "Request for Duplicate License," Eff. 10-06.
(67) DFS-N1-1768, "Provisional or Temporary
				License, Application for Initial License," Eff. 10-06.
(68) DFS-N1-1769, "Provisional or Temporary
				License, Application for Renewal," Eff. 10-06.
(69) DFS-N1-1770, "Election of Procedures for
				Removal of Cremated Remains and Postcremation Processing," Eff.
				10-06.
(70) DFS-N1-1771, "Broker of
				Burial Rights Renewal," Eff. 10-06.
(71) DFS-N1-1772, "Monument Establishment
				Renewal," Eff. 10-06.
(72)
				DFS-N1-1774, "Preneed Sales Agent - Application for Appointment," Eff.
				10-06.
(73) DFS-C-MON1,
				"Application for Monument Establishment License," Effective 02/23
https://www.flrules.org/Gateway/reference.asp?No=Ref-15126
.
(74) DFS-EC-1, "Report of Identification for
				an Exempt Cemetery," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09980
.
(75) DFS-PNL-R, "Cover Sheet and General
				Instructions for Preneed License and Branch Annual Renewal Packet," Eff. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09963
.
(76) DFS- PNL-R1, "Invoice - Renewal of
				Preneed License," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09971
.
(77) DFS- PNL-R2, "Financial Statement
				Instructions," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09962
.
(78) DFS-PNL-R2A, "Balance Sheet of Preneed
				Licensee," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09978
.
(79) DFS-PNL-R2B, "Income Statement," Rev.
				08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09977
.
(80) DFS- PNL-R3A, "Statement of Preneed
				Sales Under Each Individual Trust, Surety Bond, or Insurer," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09976
.
(81) DFS-PNL-R3B, "Summary of Preneed
				Activity," Eff. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09975
.
(82) DFS-PNL-R4, "Annual PNL Financial
				Statement and Renewal Statement Certification and Application for Renewal,"
				Eff. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09974
.
(83) DFS-PNL-R5, "Notice of Non-Renewal of
				Preneed License," Eff. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09973
.
(84) DFS-PNL-R6, "Net Worth Alternatives
				Form," Eff. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09972
.
(85) DFS-C-BBRI, "Broker of Burial Rights
				License Application," Rev. 10-06.
(86) DFS-PNLBR "Application for Preneed
				Branch Office Renewal License," Eff.10-06.
(87) DFS-N1-2001, "Notice of Change in
				Location of Funeral Establishment," Eff. 10/09.
(88) DFS-N1-2002, "Notice of Change in
				Location of Cinerator Facility," Eff. 10/09.
(89) DFS-N1-2003, "Notice of Change in
				Location of Direct Disposal Establishment," Eff. 10/09.
(90) DFS-N1-2036, "Application to Renew
				Funeral Director Internship to Continue Course of Study," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09969
.
(91) DFS-N1-2037, "Application to Renew
				Internship Due to Illness, Hardship, or Awaiting Results," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09979
.
(92) DFS-N1-2038, "Application to Take the
				Florida Law & Rules Exam," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09984
.
(93) DFS-N1-2039, "Certification for General
				Supervision of Intern," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09983
.
(94) DFS-N1-2040, "Report of Suspension of
				Intern's Conditions of Internship," Rev. 08/16
http://www.flrules.org/Gateway/reference.asp?No=Ref-09970
.
(95) DFS-N1-2041, "Application for Approval
				of a Course of Study under section 497.373(1)(d)2., F.S.," Eff. 1/12.
(96) DFS-N1-2183, "Preneed Trust Fund, Annual
				Trustee Report," Eff. 03/19
http://www.flrules.org/Gateway/reference.asp?No=Ref-11118
.
Rulemaking Authority
					  497.103,
					 497.141,
					 497.142,
					 497.146,
					 497.147,
					 497.152,
					 497.263,
					 497.264,
					 497.266,
					 497.269,
					 497.270,
					 497.272,
					 497.281,
					 497.283,
					 497.287,
					 497.368,
					 497.369,
					 497.370,
					 497.373,
					 497.374,
					 497.375,
					 497.376,
					 497.380,
					 497.382,
					 497.385,
					 497.453,
					 497.454,
					 497.456,
					 497.458,
					 497.462,
					 497.464,
					 497.466,
					 497.550,
					 497.551,
					 497.553,
					 497.554,
					 497.602,
					 497.603,
					 497.604,
					 497.606,
					 497.608 FS. Law Implemented
					 497.103,
					  497.140,
					  497.141,
					  497.142,
					  497.143,
					  497.146,
					  497.147,
					  497.263,
					  497.264,
					  497.266,
					  497.269,
					  497.270,
					  497.272,
					  497.281,
					  497.283,
					  497.287,
					  497.365,
					  497.368,
					  497.369,
					  497.370,
					  497.373,
					  497.374,
					  497.375,
					  497.376,
					  497.377,
					  497.378,
					  497.379,
					  497.380,
					  497.382,
					  497.385,
					  497.453,
					  497.454,
					  497.456,
					  497.458,
					  497.462,
					  497.464,
					  497.466,
					  497.550,
					  497.551,
					  497.553,
					  497.554,
					  497.602,
					  497.603,
					  497.604,
					  497.606,
					  497.608 FS.
New 9-28-03, Formerly 3F-5.010,
					  69K-5.010, Amended 1-24-08,
					 4-18-10, 6-17-10, 7-22-12, 12-27-18, 10-6-19,
					 2-20-23.