In the state of Georgia, the care and preparation for future events, specifically preneed funeral services, are meticulously regulated to ensure transparency and financial security for all parties involved. The Georgia C 15 form stands as a cornerstone document in this regulation process, overseen by the Securities and Business Regulation Division under the Secretary of State. Directed by Brian P. Kemp and the Division Director, Robert D. Terry, this form serves a crucial function. It is an annual requirement for funeral homes to report and list all unserviced preneed funeral contracts as of December 31 of each year, detailing the financial status and contractual obligations outstanding. The form is structured in multiple parts, starting with general information about the registrant or funeral home, moving through detailed disclosures of each unserviced contract, and culminating in a certification that validates the accuracy of the information provided and confirms compliance with the mandated preneed escrow account deposits according to the specified Georgia statute, O.C.G.A. 10-14-12(g). This process not only ensures that families are protected and that their prearrangements are secure, but it also establishes a system of accountability and integrity within the funeral service industry in Georgia.
| Question | Answer |
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| Form Name | Georgia Form C 15 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | C15 report list of unserviced preneed funeal contracts georgia form |
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STATE OF GEORGIA |
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Brian P. Kemp |
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SECURITIES AND BUSINESS REGULATION |
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Robert D. Terry |
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Secretary of State |
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2 Martin Luther King Jr. Drive, S.E. |
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Division Director |
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Suite 802 West Tower |
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Atlanta, Georgia 30334 |
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(404) |
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REPORT AND ITEMIZED LIST OF ALL UNSERVICED PRENEED FUNERAL CONTRACTS |
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AS OF 12/31/200__ |
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This report is mandated by O.C.G.A. |
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Please read instructions accompanying this form. |
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PART 1 - GENERAL |
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Registration Number |
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Total number of unserviced |
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Phone Number |
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contracts as of |
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Name of Registrant/Funeral Home |
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Mailing Address |
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City |
State |
Zip Code |
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Location of Records |
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City |
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Zip Code |
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Name and phone number of contact person regarding this report: |
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PART II - UNSERVICED PRENEED FUNERAL CONTRACTS |
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Contract Holder Name and |
Depository |
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Date of |
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Contract |
Total Amount |
Amount |
Total Amount |
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Bank Account Number |
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Contract |
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Number |
of Contract |
Paid to Date |
on Deposit |
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TOTAL (Page 1) |
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TOTAL (Page 2) |
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TOTAL OF ALL PAGES |
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Attach additional pages, as necessary, with complete information as above on every contract holder.
Form |
page 1 |
PART II - UNSERVICED PRENEED FUNERAL CONTRACTS
Contract Holder Name and |
Depository |
Date of |
Contract |
Total Amount |
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Amount |
Total Amount |
Bank Account Number |
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Contract |
Number |
of Contract |
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Paid to Date |
on Deposit |
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TOTAL (Page 2) |
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Attach additional pages, as necessary, with complete information as above on every contract holder. |
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PART III - CERTIFICATION |
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I hereby certify, under penalties of perjury, that the information contained in this Annual Report and the supporting documents attached hereto are true and correct to the best of my knowledge and belief. I further certify that all required deposits have been made
to the preneed escrow account. I am authorized to sign this document on behalf of the individual or corporate owner.
Signature: |
Print Name: |
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Title |
Date |
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Form |
page 2 |