Form Fe 653 007 PDF Details

In the realm of funeral establishments, navigating the complexities of regulatory requirements is paramount for operating within legal boundaries. The FE 653 007 form serves as a bridge for funeral establishments seeking to apply for or renew their Certificate of Removal Registration, a critical step in ensuring compliance with state laws around the handling and transportation of human remains. This detailed document mandates a $30 fee for initial applicants and a $15 fee for those renewing, payable to the Department of Licensing. It encompasses a comprehensive framework for establishments, from detailing business types to the declaration signed under penalty of perjury, ensuring the veracity of provided information. Applicants must furnish a variety of specifics, including the establishment's name, unified business identifier (UBI) number, and pertinent contact details, alongside information on the establishment’s representative. The form, aimed at streamlining the process for both local and out-of-state establishments with comparable regulations, also outlines the responsibilities of certificate holders and the potential repercussions in the event of statute or rule violations. Crucial for maintaining the integrity of the industry, this form facilitates the seamless operation of funeral establishments while safeguarding public health and trust.

QuestionAnswer
Form NameForm Fe 653 007
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names653007 ihra patna form

Form Preview Example

Funeral Establishments

Certificate of Removal Registration Application

Funeral establishments can use this form to apply for certificate of removal registration. Send this completed form and a check or money order for $30 for an initial application or $15 for an annual renewal, payable to the Department of Licensing, to: Funeral and Cemetery Licensing,

Department of Licensing, PO Box 35001, Seattle, WA 98124-3401

Establishment

For validation only

PRINT or TYPE Establishment name

Unified Business Identifier (UBI) number

Street address

City

State

ZIP code

County

(Area code) Daytime telephone number

Mailing address (if different)

 

 

Location manager or contact person name (Last, First, Middle initial)

Type of business (check one)

Sole proprietor Partnership Corporation

Sole proprietor, partner, corporate officer – Attach additional pages as required

Name

Address

Name

Address

Name

Address

Name

Address

Name

Address

Name

Address

Title (sole proprietor, partner, corporate officer)

City

 

State

 

ZIP code

 

 

 

 

 

 

Title (sole proprietor, partner, corporate officer)

City

 

State

 

ZIP code

 

 

 

 

 

 

 

 

Title (sole proprietor, partner, corporate officer)

City

 

State

 

ZIP code

 

 

 

 

 

 

 

 

Title (sole proprietor, partner, corporate officer)

City

 

State

 

ZIP code

 

 

 

 

 

 

 

 

Title (sole proprietor, partner, corporate officer)

City

 

State

 

ZIP code

 

 

 

 

 

 

 

 

Title (sole proprietor, partner, corporate officer)

City

 

State

 

ZIP code

 

 

 

 

 

 

 

Declaration – Must be signed by owner, partner, or corporate officer

I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

 

 

 

Title

 

 

 

X

Date and place

 

Signature of proprietor or corporate officer

 

 

For office use only

24003

 

Certificate date

 

 

 

 

 

 

 

Certificate number

 

 

 

 

 

 

 

 

 

 

FE-653-007 (R/2/14)WA Page 1 of 2

We are committed to providing equal access to our services. If you need accommodation, please call (360) 664-1555 or TTY (360) 664-0116.

Funeral establishments licensed in states that border Washington State, with similar laws, may apply for this registration for the limited purpose of removing human remains from Washington State prior to submitting a Certificate of Death.

Each branch of a funeral establishment is considered a separate establishment and must be registered as a fixed place of business.

The conduct of funeral directors, embalmers or any other person employed by or acting on behalf of a removal registrant is the direct responsibility of the holder of the Certificate of Removal Registration.

The Funeral and Cemetery Board may impose sanctions on the holder of a Certificate of Removal Registration if the registrant is found to be in violation of any death care statute or rule.

Certificate of Removal Registrations expire on January 31, or as otherwise determined by the Director.

Certificates of Death, Notices of Removal, and Disposition Permits are governed by the Department of Health under RCW 70.58.160 and 70.58.230.

FE-653-007 (R/2/14)WA Page 2 of 2

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Filling out this PDF needs focus on details. Make sure all required blank fields are completed accurately.

1. The Form Fe 653 007 requires specific information to be inserted. Make sure the following blanks are completed:

How you can prepare Form Fe 653 007 portion 1

2. Once your current task is complete, take the next step – fill out all of these fields - Name, Address, Name, Address, Name, Address, Name, Address, City, City, City, City, Title sole proprietor partner, State, and ZIP code with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

The best ways to complete Form Fe 653 007 stage 2

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