Ariz. Admin. Code § 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 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;

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.

Notes

Ariz. Admin. Code § R4-12-207

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).