Fla. Admin. Code Ann. R. 69K-1.001 - List of Approved Forms; Incorporation by Reference
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
(2) DFS-HistS, "Historical Sketch," Rev.
08/16
(3) DFS-PNLB, "Application for Preneed Branch
Office License," Rev. 08/16
(4) DFS-PNLT1, "Application for Transfer of a
Preneed License," Rev. 08/16
(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.
(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
(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
(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
(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
(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
(57) DFS-N1-1757, "Application for Direct
Disposal Establishment License," Effective 02/23
(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
(74) DFS-EC-1, "Report of Identification for
an Exempt Cemetery," Rev. 08/16
(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
(77) DFS- PNL-R2, "Financial Statement
Instructions," Rev. 08/16
(78) DFS-PNL-R2A, "Balance Sheet of Preneed
Licensee," Rev. 08/16
(79) DFS-PNL-R2B, "Income Statement," Rev.
08/16
(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
(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
(84) DFS-PNL-R6, "Net Worth Alternatives
Form," Eff. 08/16
(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
(93) DFS-N1-2039, "Certification for General
Supervision of Intern," Rev. 08/16
(94) DFS-N1-2040, "Report of Suspension of
Intern's Conditions of Internship," Rev. 08/16
(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
Notes
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.
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